Effectiveness of preoperative subconjunctival injection of mitomycin-C in primary pterygium surgery

Objective: To compare the effectiveness of preoperative subconjunctival injection of Mitomycin-C at 24-hour and at one month before primary pterygium excision

Study Design: Randomised controlled trial

Place and Duration of Study: Eye Department, Combined Military Hospital, Sargodha, from January to December 2014

Methodology: Eyes of 60 patients were randomly allocated into two equal groups [A and B] of 30 each. In group A Mitomycin-C was injected into the pterygium one month before, and in group B Mitomycin-C was injected 24 hours before excision. All pterygia received 0.1 ml of Mitomycin-C in a concentration of 0.15 mg/ml. Primary pterygia greater or equal to 2.5 mm were selected and excised as a bare sclera technique. Postoperatively, all patients were followed-up for 06 months. The recurrence and corneoscleral complications were recorded. Pearson chi-square test was used to compare the recurrence between group A and group B

Results: The recurrence of pterygium in group A was 3.3%; and in group B, it was 6.7%. Comparison of the recurrences between both the groups was statistically insignificant, [p=0.554].Postoperatively, no serious corneoscleral complications occurred in either group

Conclusion: The preoperative subconjunctival injection of Mitomycin-C in a dose of 0.15 mg/ml given 24 hours prior to excision is as effective as 01 month preoperative injection for primary pterygium surgery with bare sclera technique

Comparison of the long-term and short-term fluctuations of frequency-doubling technology perimetry between peripheral and paracentral zones of visual field

Objective: To compare the long- and short-term fluctuations of frequency doubling technology perimetry between peripheral and paracentral zone and determine the relationship between threshold sensitivity and long- and short-term fluctuation within peripheral and paracentral zone of visual field

Study Design: Descriptive study

Place and Duration of Study: Eye Department, United Nations, Pakistan Field Hospital Level-3 Darfur, Sudan, from February to July 2015

Methodology: Normal eyes of 30 volunteers were recruited. Frequency doubling technology perimetry, program N-30, full threshold was employed. Each subject was tested at weekly intervals, once in the 1st, 3rd and 4th sessions and three times in the 2nd session. Visual field was divided into paracentral, superior, and inferior zones. Short-term and long-term fluctuation as well as threshold sensitivity were calculated for each patient as the mean fluctuation and mean sensitivity value. Mann-Whitney U-test was used to compare each zone in terms of their short- and long-term fluctuations and Spearman's rho correlation test for determining the relationship of threshold sensitivity with short- and long-term fluctuations

Results: Long-term fluctuation values differences were insignificant between superior and paracentral zones. Short-term fluctuation values were statistically insignificant between all three zones. Short-term fluctuation and threshold sensitivity in each zone did not correlate. Long-term fluctuation and threshold sensitivity had a very weak negative, statistically insignificant correlation in superior and paracentral zones

Conclusion: Frequency doubling perimetry exhibits uniform short- and long-term fluctuations in peripheral and paracentral zones of visual field in normal subjects. Threshold sensitivity and long- and short-term fluctuations are independent of each other in peripheral and paracentral zones of visual field

Sociodemographic study of ocular morbidity in school children of aligarh

Ocular Morbidities with its economic and social consequences represents an important Public Health Problem in various part of the world. This was a cross sectional study. The present study was planned to know the prevalence of ocular morbidity in school Children and their correlation with socio demographic profile if any. School children of age 5-12 years of selected AMU schools in the field practice area were the study population. The sample size calculated was 1050 but 1129 were covered in this study. In present study prevalence of ocular morbidity in students were found 32.3%. The prevalence was more among female candidates. So to conclude present study highlights important problem of ocular morbidity in school children. Refractory error was commonest form of ocular morbidity amongst them. Significant association was found between ocular morbidity and socio economic status and diet?

Cytotoxic activities of Rosa brunonii, Calligonum polygonoides Pegnum harmala and Sueda fruticosa extract using brine shrimp

The present study was carried out to record and evaluate the effect of Rosa brunonii, Calligonum polygonoides, Sueda fruticosa and Pegnum harmala L., extracts on brine shrimp collected during March-June 2013 from different regions of District Bannu. These four plants were medicinal xerophytes and widely distributed throughout Pakistan. Rosa brunonii is commonly used as a hedge plant for gardening. Calligonum polygonoides and Sueda fruticosa are locally used as a fuel, while Pegnum harmala [L.] is the most important multipurpose medicinal xeric plant, which is used for various purposes. All these selected medicinal xerophytes have inhibitory effect on bacterial growth. In this study the effect of different concentration [10-70 microg/ml] were tested on brine shrimp. The results showed that maximum cytotoxic activities were observed in Rosa brunonii [100.0+/-0.4], Calligonum polygonoides [100.0+/-0.2] and Pegnum harmala [L.] [90.0+/-5.2] while Sueda fruticosa [50.0+/-7.1] has less cytotoxic property. These activities are may be due to the presence of bioactive constituents

Association of body mass index with risk factors of coronary artery disease

Objective: To evaluate the association of BMI and risk factors of coronary artery disease in patients presenting with chest pain in outdoor cardiology department

Study Design: Descriptive / comparative study

Place and Duration of Study: This study was conducted at the Outdoor Cardiology Department of Nishter Hospital Multan from May 2016 to August 2016

Materials and Methods: All patients who presented with complain of chest pain in outdoor cardiology department were included. Patients were divided into three groups on the basis of BMI

Results: There were 42.0% females patients in obese group as compared to only 12.0% and 20.0% in normal weight and overweight groups [p-value 0.002 Mean age of patients at the time of presentation was significantly less in obese group 49.38 +/- 6.56 years, whereas in normal and overweight patients mean age was 56.60 +/- 9.29 years and 54.84 +/- 9.94 years respectively [p-value <0.001]. There was no patient with age more than 60 years in obese group, 47.5% in overweight group and 52.5% in normal weight group [p-value <0.001]

Conclusion: Obesity is an independent risk factor for the early development of coronary artery disease [CAD] and increased risk of hypertension in early age

Level of depression in patients admitted with chronic heart failure

Objective: Heart failure [HF] is a chronic disease usually associated with psychological issues especially anxiety/depression despite of medical treatments. Aim of our research data study was the estimation of level of depression among admitted CHF patients in Nishtar Hospital and to find an association of various clinical parameters with depression

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at the Cardiology Department of Nishtar Medical College and Hospital Multan from March 2016 to August 2016

Materials and Methods: 400 patients with systolic HF were divide according to the NYHA heart failure classification system. The level of depression was assessed by using Beck's Depression Inventory questionnaire. The patients with a previous history of major depressive disease, psychological diseases, or chronic other severe ailments were excluded. To assess the relationship between variables the chi square test was applied to data

Results: 76 patients in group B of depression were hypertensive and in group A of depression 85 were hypertensive with p=0.04 that is significant i.e. p<0.05. The high depression of group B was much more common in heart failure group B with 53 people having severe depression and 96 group A CHF patients had mild depression with p=0.05 that is statistically significant. Similarly, 94 mildly depressed people were in joint family system of group J and 56 severely depressed patients were in group S with p=0.03 that is highly significant

Conclusion: Depression is very common among CHF patients who are living alone or with spouse only. And severe depression level is more common than mild/moderate depression at higher NYHA classes of CHF

Efficacy of 2.5% and 1.25% povidone-iodine solution for prophylaxis of ophthalmia neonatorum

Objective: To determine the efficacy of 2.5% and 1.25% Povidone-Iodine solution for Ophthalmia neonatorum prophylaxis

Study Design: Interventional study

Place and Duration of Study: Eye Department, Combined Military Hospital, Sargodha, from May to November 2014

Methodology: A total of 200 eyes of 100 newborn babies were enrolled and divided into two groups of 100 right eyes and 100 left eyes. A conjunctival swab for bacterial culture was taken within 30 minutes after delivery. A single drop of 2.5% Povidone-Iodine was then placed in the right eye while in the left eye a single drop of 1.25% Povidone-Iodine was placed. Thirty minutes after placing Povidone-Iodine, a conjunctival swab was again taken. A bacterial suspension was prepared from each swab in determining bacterial counts. The bacterial suspension was inoculated on yeast extract agar and the number of colony forming units were counted. At each culture, the number of colony forming units before and after instillation of 2.5% Povidone-Iodine and 1.25% Povidone-Iodine were compared. Wilcoxon's signed rank test was used for statistical analysis

Results: The 2.5% Povidone-Iodine solution caused a statistically significant decrease in the number of colony forming units [p=0.001]. Similarly, the 1.25% Povidone-Iodine solution also reduced the number of colony forming units to a statistically significant level [p=0.001]

Conclusion: The 1.25% concentration of Povidone-Iodine is as effective as the 2.5% concentration of Povidone-Iodine in reducing the number of colony forming units in healthy conjunctivae of newborns

Efficacy of port-site and intraperitoneal application of bupivacaine in reducing early post-laparoscopic cholecystectomy pain

The aim of this study was to assess the analgesic efficacy of Bupivacaine application at port-site and intraperitoneal infiltration in patients with laparoscopic cholecystectomy. Randomized Controlled Clinical Trial. The study was conducted at Rehman Medical Institute [RMI] Peshawar, Pakistan from June 2009 to June 2012. Patients who underwent elective laparoscopic cholecystectomy during the study period were included in the study. Eighty patients were randomized into two groups, study group and control group. The study group received 40 ml of 0.25% bupivacaine intraoperatively as intraperitoneal infiltration and local infiltration at the port sites. Pain assessment was done using visual analogue pain score [VAS] of 0-10 at fixed intervals during .the first 24 hours post surgery. The mean VAS score in the study group was less as compared to the control group throughout the 24 hours assessment period, however this difference was statistically significant [p<0.001] only during the first three assessments at 1 hour, 4 hours and 8 hours post surgery. The analgesia requirement was also significantly [p<0.001] decreased in the study group. Port site and intraperitoneal application of local anesthetic bupivacaine significantly reduced pain during the first 8 hours post surgery and total analgesia requirement was also significantly reduced. It is a simple and easily applicable technique which increases patient comfort and can be safely used to decrease post operative pain in patients undergoing laparoscopic cholecystectomy

Management of oesophageal foreign bodies

The aim of the study was to evaluate the management of foreign bodies in the oesophagus and to determine the association with socioeconomic status. This cross-sectional analytical study was carried out in the Department of Ear, Nose and Throat and head and neck surgery of Bahawal Victoria Hospital affiliated with Quaid-i-Azam Medical College, Bahawalpur, Pakistan, between December 2012 and May 2013. The medical records of 34 consecutive cases of foreign body ingestion were searched, and the data were recorded on a questionnaire prepared for this purpose. The average age of the patients was 10.38 years; 29 cases [85.2%] were in children under 12 years. There were 18 females [52.9%] and 16 males [47.1%]. Thirty patients [88%] presented with a history of dysphagia, and 25 [73.6%] had vomiting. The site of impaction was the post-cricoid region in 22 patients [66%], the lower oesophagus in 5 [15%], the mid-oesophagus in 4 [13%], the posterior pharyngeal wall in 1 [3%] and the pyriform fossa in 1 patient [3%]. Coins were the most common foreign body [61.8%]. Socioeconomic analysis showed that 18 patients [52.9%] were in the low socioeconomic class, 12 [35.3%] in the middle class and 4 [11.8%] in the upper class. The presence of a foreign body in the oesophagus is a serious condition, and early removal is recommended. Foreign body lodgement is commoner among poor families

Diagnosis and treatment of Hodgkin's lymphoma: at times a challenge

Hodgkin's lymphoma has been traditionally defined as a hematopoietic neoplasm composed of diagnostic Reed-Sternberg cells. More than 70% of the cases involve cervical or supraclavicular lymph nodes. Isolated sub-diaphragmatic lymphadenopathy or organ involvement is rare. We present the case of Hodgkin's lymphoma in a 51 years old female, who presented with obstructive jaundice and lymphadenopathy, empirically treated previously as a case of tuberculosis. Chemotherapy with modified ABVD protocol was given with dose modification according to LFT's. Her liver functions returned to normal levels after the first cycle. The main purpose of reporting the case is to stress definitive diagnosis of the disease before initiating treatment and the modified chemotherapy regimen used in this infrequent presentation of the disease

Comparison of frequencies of peri-procedural non-q-wave myocardial infarction between patients who received and not received high dose atorvastatin before percutaneous coronary intervention

Background: Periprocedural myocardial infarction has been a matter of concern for cardiac interventionists and role of high dose statins is being widely studied now a days

Objective: To compare the frequency of peri-procedural non-Q-wave myocardial infarction between patients who received and not received high dose atorvastatin before percutaneous coronary intervention [PCI]

Material and methods:- This randomized controlled study was carried out from 1[st] February, to 31[st] August, 2010 at Ch. Pervaiz Elahi Institute of Cardiology, Multan. A total of 222 patients with unstable angina on chronic statin therapy undergoing PCI were randomized to atorvastatin high dose bolus group I [80 mg,12 hours before intervention, n=l 11] or group II no atorvastatin [n=l 11]

Results: Mean age in group I, was 53 years and in group II, was 55 years. It was noted that majority were female [88%] in group I, whereas Male [92%] in group II. 33% in group I and 37% in group II were diabetics. Similarly hypertension, smoking prevalence was comparable in both groups. Periprocedural MI occurred in 6 [5.4%] patients in group-I and 17 [15.3%] patients in group-II

Conclusion: It is concluded from the study that preloading with high dose [80 mg] atorvastatin bolus before PCI reduces peri-procedural MI in patients on chronic statin therapy undergoing PCI

Serum electrolyte derangements in patients with traumatic brain injury

Electrolyte derangements are common sequel of traumatic brain injury. Use of intravenous fluids, diuretics, syndrome of inappropriate ADH secretion and cerebral salt washing are some of the factors responsible for this. Proper in time detection followed by appropriate treatment not only improves neurological status but also decrease morbidity and mortality. This study was conducted to know serum derangements of different electrolytes in patients with traumatic brain injury. This cross-sectional study was conducted in Pakistan Institute of Medical Sciences, Islamabad, Pakistan from Feb 2009 to Feb 2010. All adult patients with traumatic brain injury who presented to Neurosurgical department with severe head injury [GCS <8] and who need monitoring in high dependency unit, were included in this study. Initially twice daily serum electrolyte monitoring for one week then once daily for remaining period of hospital stay was carried out. All samples were sent to Pathology department of Pakistan Institute of Medical Sciences, Islamabad. Patients who need corrective measures for imbalance had repetition of sampling after giving appropriate therapy. Statistical analysis was performed on SPSS-16. Total 215 patients presented with severe head injury that were managed in high dependency unit. Out of which 127 [59.1%] were male and 88 [40.9%] were females. Most of them were adults between 21-40 years of age [21.4%; 24.7%]. Sodium was the main electrolyte that underwent change and out of which hyper-natremia was major abnormality that occurred in 140 [65.1%] of patients. This is followed by hypo-kalemia that occurred in 79 [36.7%] of patients. Serum calcium and magnesium levels show little derangements. Electrolyte imbalance following traumatic head injury is an important cause to look for in patient monitoring. Sodium is the chief electrolytes of concern. Serum potassium and calcium levels also under goes notable changes

Omphalomesenteric duct cyst in an omphalocele: a rare association

Omphalomesenteric duct [OMD] remnants and omphalocele are not infrequently seen in paediatric patients. In most of the cases, OMD remnant in an omphalocele is a Meckel's diverticulum; however rarely there may be other lesions. A one-day old male baby underwent surgery for omphalocele. At exploration a 10 x 12 cm cyst containing gut contents was found as the content of the omphalocele, with proximal and distal ileal loops running in continuity with it. Resection of the cyst with end to end primary gut anastomosis was done. Baby also had complex associated cardiac anomalies and died few days after surgery due to sepsis

Solid neuroendocrine carcinoma of the breast

Primary neuroendocrine carcinoma of the breast is a rare disease that accounts for less than 5% of all cancers arising from the breast. The tumour cells stain positively for chromogranin and synaptophysin. This report describes the occurrence of infiltrating ductal carcinoma of breast with neuroendocrine differentiated tumour in 37 year old female. Early small cell neuroendocrine cancer of the breast that is treated with surgery and adjuvant chemotherapy shows an increased disease-free survival. She is planned for anthracycline/cyclophosphamide based chemotherapy followed by etoposide/platinum based chemotherapy. As her tumour showed ER/PR positivity, she will be given hormonal therapy subsequently, however, more extensive review is required to define a standard treatment protocol for this rare neoplasm.

prospective randomized trial comparing the spinal and general anesthesia in lumbar disc surgery: a study of 44 cases

General anesthesia is most frequently used for lumbar disc surgery despite the evidence that spinal anesthesia is as safe and may offer some additional advantages. The purpose of this study was to compare the intraoperative parameters and postoperative outcome after spinal and general anesthesia in demographically well matched patients undergoing elective lumbar Decompressive surgery. Prospective randomized controlled study. This study was carried out DHQ Hospital Mirpur AJK from January 2007 and May 2010. In this randomized controlled study we analyzed the outcome obtained in 44 patients in whom either spinal or general anesthesia was induced for lumber disc surgery. The variables recorded were anesthesia related class, surgical diagnosis, disc levels operated and pre, peri and postoperative measurements of variables like BP, and heart rate. All aspects of surgery, recovery, post anesthesia care and pain management were same irrespective of anesthetic type The narcotic and antiemetic requirement and length of stay in the hospital and incidence of urinary retention were also recorded in the post operative course. Demographically both groups were well matched. Anesthesia time was longer in patients receiving GA with increased heart rate and MABP perioperatively. There was more nausea and greater requirements for antiemetic and analgesics in patients receiving. GA [p value<0.05]. Perioperative heart rate and MABP was on normal side and there was no urinary retention in patients who received spinal anesthesia. Spinal anesthesia was a safe and effective as GA for patients undergoing lumbar Decompressive surgery. Spinal anesthesia had added advantages of short anesthesia duration, decreased antiemetic and analgesic requirements. GA general anesthesia, HR heart rate, I/V intravenous, MAP mean arterial pressure, PACU post anesthesia care unit, RCT randomized controlled trial, SA spinal anesthesia

clinical significance of perilimbal conjunctival pigmentation in vernal conjunctivitis

To compare the extent of perilimbal conjunctival pigmentation and limbal palisadal pigmentation in patients with vernal conjunctivitis and controls and correlate it with the duration of disease. Case control study. Eye Department, Combined Military Hospital, Abbottabad, from May 2009 to March 2010. One hundred subjects including 50 patients with vernal conjunctivitis and 50 controls were studied. Demographic data, family and personal history, disease duration, symptoms, signs, complications and extent of perilimbal and palisadal conjunctival pigmentation were recorded among patients and controls. Mann Whitney-U test and Spearman's rho test were used for statistical analysis. The extent of perilimbal conjunctival pigmentation in patients with vernal conjunctivitis was more than controls [p < 0.0001]. Similarly, limbal palisadal pigmentation was also more extensive than controls [p = 0.004]. There was no correlation between the duration of disease and severity of conjunctival pigmentation [r = 0.24] [p = 0.086]. The presence of increased perilimbal and limbal palisadal conjunctival pigmentation among patients with vernal conjunctivitis is a specific sign of vernal conjunctivitis

Grading complication following radical cystectomy and ileal conduit for bladder cancer using clavien grading system

To determine the 30-day complication rate of radical cystectomy and urinary diversion using a validated system. An analytical descriptive study. The Aga Khan University Hospital, Karachi, from 1990 to 2010. Patients who had undergone ileal conduit [IC] formation, following radical cystectomy [RC] for muscle invasive transitional cell carcinoma, were studied, using a prospectively maintained data base. Basic details were determined, complications were noted and graded according to the modified Clavien grading system [CG]. Results were presented using descriptive statistics. Of all the RC performed at this hospital 89 patients received IC. Of them 75 were male and 14 female. Mean age was 60 years. Mean duration of hospital stay was 14 days. Ten patients each received pre-operative chemotherapy and radiotherapy, respectively. Mean duration of surgery was 8.2 hours, with mean estimated blood loss of 1334 ml. Preoperative radiotherapy was associated with more complications. No other factor like ASA, co-morbidities, blood loss or duration of stay influenced the complications. Fifty patients [56.2%] did not have any complications. Most common complication of wound infection was seen in 7 patients [CG-2], followed by uretero-ileal leakage in 5, requiring percutaneous intervention under local anaesthesia [GC-3a]. Mortality rate was 4.5%, classified as CG-V. Radical cystectomy with Ileal conduit is a major procedure with a good safety profile at this institute. Longterm follow up is still needed to evaluate delayed complications and quality of life

Myocardial infarction

To assess the frequency of hyperhomocysteinemia in patients of first attack of ST-segment elevated myocardial infarction under age of 40 years. Cross sectional study. December 2009 to June 2010. Ch. Pervaiz Elahi Institute of Cardiology, Multan. A total of 65 patients of acute myocardial infarction were included in the study on the basis of chest pain, ECG changes and increased cardiac enzyme. A total of 65 patients fulfilled the inclusion criteria were included the study. Mean age was 35.68 years. Out of the 65 patients, 87.7% were male and 12.3% were female, 41.5% patients has increased homocysteine level while 68.5% had normal homocysteine level. Plasma Hcy is an important risk factor for the development of the acute myocardial infarction

Cornelia de Lange syndrome - a cause of hypertrichosis in children: case report and review of literature

Cornelia de Lange syndrome is a rare developmental disorder characterized by hypertrichosis, low intelligence, delayed milestones and skeletal and dental abnormalities. Gastroesophageal dysfunction, ophthalmologic, cardiac and genitourinary anomalies, learning difficulties, and mental retardation may be present in severe cases. We report a case of this syndrome who presented for laser treatment for the problem of hypertrichosis, and on examination other features of the syndrome were noted

Werner syndrome: a case report and review of literature

Werner's syndrome is a rare inherited disorder characterized by short stature, sclerosed skin, cataract and premature aging of the face. The disease involves multiple systems of the body and some of the abnormalities may cause life threatening complications such as myocardial infarction and malignancy. We report a case of this rare disorder