comparison of early post operative visual rehabilitations in extracapsular cataract extraction and phacoemulsification

Objective: To compare mean post operative visual acuity of cataractous patients after extracapsular cataract extraction and phacoemulsification with posterior chamber intraocular lens implantation

Methods: 100 patients of more than 50 years of age attending the OPD of Department of ophthalmology, Fatima Jinnah Medical College, Sir Gangs Ram Hospital, Lahore from 1-12-2011 to 30-05-2012, were divided into two equal groups for the study. Group A was operated by phacoemulsification and group B was operated by extracapsular cataract extraction

Results: The visual acuity of operated eye was recorded on first postoperative day which showed improvement in both groups. Mean value of post operative visual acuity was 0.344+0.223 in group A and 0.510+0.287 in group B on log mar scale which is equivalent to 6/12 and 6/18 respectively on snellen chart

Conclusions: it was concluded that there is early post operative visual rehabilitation with phacoemulsification than extra capsular cataract extraction

To determine the frequency of acceptable postoperative astigmatism following phacoemulsification with unsutured 6mm limbal lncision

Objectives: To determine the frequency of acceptable postoperative astigmatism following phacoemulsification with unsutured 6mm limbal lncision

Methods: 65 cataractous eyes of patients attending the outpatient department and admitted in . . were studied from 7 January 2010 to 16 June 2010 at Department of Ophthalmology, Fatima Jinnah Medical College/ Sir Ganga Ram Hospital Lahore. it was a descriptive case study. All patients under went phacoemulsification with sutureless 6 mm limbal incision and rigid PMMA intra ocular lens implantation. Preoperative and postoperative keratometry reading were taken and difference was presented as acceptable astigmatism if less than +/- 1 D. Acceptable astigmatism [Yes, No] presented as percentages and frequencies

Results: The mean postoperative astigmatism was 0.31D with SD of +/- 0.58 D. it was found to be acceptable astigmatism' In 57 patients [87. 7%] while 8 of patients [12.3%] were out of the range of acceptable astigmatism

Conclusion. Postoperative astigmatism after phacoemulsification with 6 mm sutureless limbal incision is within acceptable range and eliminates significant postoperative refractive error

Fractures; causes of low vitamin D and effects of 25 [oh] supplementation in patients above 50 years

To find out the effect in increase in serum 25 [OH] vitamin D levels after supplementation with 1000 lU/day of vitamin D in patients with low vitamin D levels and other factors which may affect the increase in vitamin D levels. Retrospective study. January 2013 and June 2014. Ch. Rehmat Ali Trust Teaching Hospital in the Lahore. The study included patients > 50 years with a low-energy fracture and a vitamin D level < 25 nmol/l. 85 patients were included, mean basal 25 [OH] vitamin D level was 22 nmol/l. After a mean of 10 weeks, the mean increase in vitamin D was 49.5 nmol/l. Only 45.1% reached the target level of > 50 nmol/l. The increase was correlated with the basal level of vitamin D [p < 0.05], and the time interval between the two vitamin D measurements [p < 0.05] and was inversely related to body weight [p < 0.05], but was not related to age, gender or renal function. We found that the generally recommended dosage of 1000 IU of vitamin D per day resulted in suboptimal serum levels after ten weeks of treatment in more than half of the patients. The increase in vitamin D levels was higher in patients with low body weight and in patients with very low basal vitamin D levels. These data suggest that these patients should initially be treated with higher dosages of vitamin D. If not possible, vitamin D measurements should be performed after at least six months of supplementation with dosage adjustment

Correlation of MCQ and SEQ scores in written undergraduate ophthalmology assessment

To determine the psychometric worth of Multiple-Choice Questions [MCQs] and Short-Essay Questions [SEQs] used in internal summative assessment of undergraduate ophthalmology annual send-up examination and to ascertain the quality of items using subjective measures. Correlational analytical study. Fatima Jinnah Medical College, Lahore, from January to March 2012. Fourth year MBBS students appearing in their written send-up annual examination in ophthalmology. The MCQ and SEQ scores were correlated for validity and reliability. Construct validity was estimated [Pearson correlation coefficient]. MCQ's split-half reliability [Spearman correlation coefficient] and SEQ's inter-rater reliability [Pearson correlation coefficient] were also estimated. Moderate correlation was seen between MCQ and SEQ scores [r=0.5, p < 0.01]. Split-half reliability of MCQs had moderate correlation [r=0.4, p < 0.01] while inter-rater reliability of SEQs scores showed high correlation [r=0.9, p < 0.01]. Most of the MCQs [55%] and SEQ's [90%] were at recall level of Bloom's taxonomy. MCQs [30%] attained a higher level [interpretation] as compared to SEQ's [10%]. None of the MCQ and SEQ attained problem solving level. Using variety of tools for assessment improves both the validity and reliability enabling examiners to draw fair conclusions about a student's ability. Validity and reliability can be further improved by arranging training opportunities for item writers to achieve accurate transfer of hypothetical construct in the form of an item. This is crucial since essential and important learning outcomes can only be assessed with valid and reliable tools

Coping strategies of mothers with ASD children

Introduction: Autism spectrum disorder [ASD] is a group of developmental disabilities that can cause significant social, communication and behavioral challenges". American Psychiatric Association's defined ASD as "a single disorder that includes disorders that were previously considered separate - autism, Asperger's syndrome, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified"

Objectives: To exploration of the coping strategies of mother who are the primary care giver of the family and children with ASD. This study correspondingly emphasized on the policy makers to bring this subject to the agenda for the training [Coping] and support [Insurance] of mothers and ASD children for special education needs [SEN] by the government

Study Design: Qualitative study

Methods: This research explored mothers coping practices with ASD children in Rawalpindi by means of qualitative study design phenomenology. Theoretical framework used were, life course perspective and social constructivism which will facilitate the complete process. Interview guide is made on the format suggested by Steinar Kvale. Data analysis will be done by two analytical techniques, grounded theory analysis

Results: The results of this study were categories which were generated were divided into two main parts positive/ healthy and negative/impaired coping strategies they are as follow:- Positive coping strategies. a] Integration b] Networking c] Religion. And the Negative coping strategies a] Avoidance b] Ignorance c] Isolation

Conclusion: Overall, findings indicated that mothers sorrow and grief associated with ASD is common in every mother. Mothers coped by educating themselves. Findings indicated feelings of shock, grief and acceptance were the part of mother's responses, on the discovery of their child's autism diagnosis. Findings indicated daily routines were not affected but the ASD child

Snake venom: their purification and isolation and analysis of their anti-venom anticoagulant properties

Viperidae venoms contain toxins that are direct or indirect anticoagulants that inhibit the clotting pathway, therefore increasing the risk of bleeding. Several venoms from the families Viperidae contain proteolytic enzymes that exercise some effect on the blood coagulation process. Snake venom toxins which delay blood coagulation are proteins or glycoprotein with molecular weights ranging from 6 kDa to 350 kDa. These factors inhibit blood coagulation by different mechanisms.Some snake venoms contain toxins that are direct or indirect anticoagulants, which inhibit the clotting process, thus increasing the risk of bleeding. Snake venom toxins that prolong blood coagulation are proteins or glycoproteins with molecular masses ranging from 6 to 350 kDa. The crude venom of E. carinatuswas obtained from the Venomous Animals from department of microbiology Hazara University, Mansehra [Pakistan]. Sephadex G-75 and DEAE-Sepharose columns were purchased from Pharmacia [Sweden]. CaCl2 and PT kit was purchased from Fisher Diagnostics [USA]. Protein markers were obtained from BioRad [Hercules, USA]. Other reagents and chemicals were of analytical grade from Fluka and Merck. The anticoagulant fractions [F2C and F2D] isolated in the present work were characterized as proteases, since a photolytic effect was observed on casein, BAPNA or human plasma. Our results showed that the PT value significantly increased in the F2C and F2D fractions as compared with PT value of the crude venom. Inthe present study, the venom of Echiscarinatuswas fractionated by chromatography and each fraction evaluated by PT test. These fractions showed enzymatic activity. Their main components were proteins of molecular weights of about 42, 50 and 79 kDa.. Further studies are needed to verify this hypothesis

Elderly in Abbottabad; health problems and loneliness

What are the health-related problems of the aged and why do they feel lonely? To study the health-related problems and loneliness among the elderly in different micro-environment groups. Participants: Aged persons of age 65 years and above. Cross-sectional. Urban and rural area of Abbottabad. 1st Jan, 2012 to 31st Dec, 2012. T-test and Z-test. During the study, it was found that out of the total 361 aged persons of Abbott bad, 311 [86.1%] persons reported one or more health-related complaints, with an average of two illnesses. The illness was higher among the females [59.5%] as compared to males [40.5%]. The main health-related problems were disorders of the circulatory system [51.2%], musculoskeletal system and connective tissue [45.7%]. It was also found that loneliness was prevalent more in females [72.8%] as compared to males [65.6%]. Loneliness was more prevalent among persons who lived alone [92.2%] as compared to those who lived with their spouse [58.9%] or when husband and wife lived with the family [61.4%]. It was higher among the widows [85.2%] and widowers [75.8%] who lived with the family as compared to the aged who lived with the spouse [58.9%] and the aged husband and wife who lived with the family [61.4%]. Special geriatric services should be started in the hospitals as the majority of the aged have one or more health-related problems. The aged persons should be involved in social activities to avoid loneliness among them

retrospective study of medically compromised patients referred to the Department of Oral and Maxillofacial Surgery, School of Dentistry of Tehran University of Medical Sciences, Iran

Introduction: Due to the increased prevalence of medically compromised patients who require dental treatments, it is a crucial task for dentists and dental specialists to prepare themselves for emergent professional situations. This study was performed to determine the prevalence of different medical problems among a population of patients admitted to a dental educational center. Materials and Methods: In this prospective study, the prevalence of medical problems in patients [n = 968] referred to the Department of Oral and Maxillofacial Surgery of the School of Dentistry of Tehran University of Medical Sciences, Iran, was investigated for 3 consecutive months. Result: Among all patients, 397 were medically compromised patients. The mean age of the patients was 48 +/- 0.15 and 51.4% were men. The results showed that 41% of the patients had at least one medical problem. The two most common diseases were hypertension [13.9%] and diabetes mellitus [6.3%], respectively. The majority of patients with medical problems were referred from private dental offices. The majority of patients [97%] had well-controlled systemic diseases that could be treated in a private office. Conclusion: This investigation showed the necessity of teaching the management of medically compromised patients in dental school curriculum and in continuous dental education programs

Nasal speculum for submental intubation

In 1986 Altemir, for the first time, described submental intubation for maxillofacial cases. A problem with the technique is that the edges of the tube may damage the anatomic tissues of the mouth floor. To avoid such damages, a modification of this technique using nasal speculum is presented here. Moreover, with this technique blood and detached tissues cannot enter into the endotracheal tube while passing through submental tissues

estimation of nd: YAG laser capsulotomy energy level for treating the posterior capsule opacification

Objective: the objective of this study is to estimate the Nd: YAG laser capsulotomy energy level in milli joules [mJ] required to produce a clear visual axis in patients with posterior capsule opacification [PCO] in the Pakistani population

Material and Methods: 138 eyes of the patients who were operated for cataract by routine extracapsular cataract extraction ECCE or Phaco emulsification with intraocular lens implant were included in the study. All had posterior capsule opacification and were treated with Nd; YAG capsulotomy in the Department of Ophthalmology, Sir Ganga Ram Hospital, Lahore from 1st January to 31st December 2011

Results: out of 138 eyes who were treated for PCO with Nd: yag laser the maximum energy required was in the range of 1.2 4.0 mJ in 92.1 % of the eyes and the no of shots were< 40 in 88.5 % of the patients eye which is considered to be a safe range thereby minimizing the complications rate

Conclusion: the Nd: YAG laser treatment is an effective technique to improve the hindered vision by PCO. It is not free from complications, so it is advised to be conscious of the extra damage to ocular tissues following Nd: YAG laser capsulotomy. It is also suggested that energy level should be kept to a minimum level to avoid severe complications

functional E1-E2 heterodimer HCV glycoproteins

The two HCV envelope glycoproteins E1 and E2 are released from HCV polyprotein by signal peptidase cleavages. These glycoproteins are type I transmembrane proteins with a highly glycosylated N-terminal ectodomain and a C-terminal hydrophobic anchor. Methods and pathways: After their synthesis, HCV glycoproteins E1 and E2 associate as a non covalent heterodimer. The transmembrane domains of HCV envelope glycoproteins play a major role in E1-E2 heterodimer assembly and subcellular localization. The envelope glycoprotein complex E1-E2 has been proposed to be essential for HCV entry. Results and However, for a long time, HCV entry studies have been limited by the lack of a robust cell culture system for HCV replication and viral particle production. Recently, a model mimicking the entry process of HCV lifecycle has been developed by pseudo typing retroviral particles with native HCV envelope glycoproteins, allowing the characterization of functional E1-E2 envelope glycoproteins., we review our understanding to date on the assembly of the functional HCV glycoprotein heterodimer

Tuberculous patients; cross sectional study of BCG vaccination and antibody TITRE in house hold contacts of tuberculous patients

This study was designed to analyze the BCG vaccination status and compare the immune globulins levels in the household contacts of tuberculous patients with non contacts of unexposed healthy peoples. Lahore. Cross sectional study. Investigations like ESR were done and the sera of 200 persons included in the study were tested for anti tuberculous antibodies by ELISA. BCG vaccination present or absent and scars were positive or negative in both groups were included. The combined serological positivity of the household contacts was 65.8% and for non-contacts was 34.1%. BCG scars were mostly absent in the household contacts as well as in non-contacts; But statistically IgG and IgA were present significantly by higher number in the household contacts as compared to non-contacts, where as no significant difference in the IgM levels. These immunoglobulins status were compared with BCG scars in both study and control groups. The results were analyzed by SPSS version 14. Household contacts of tuberculosis patients are more susceptible to tuberculosis as compared to the non-contacts, as shown by positive and negative status of cglitjirculous antibodies in the house hold contacts. More over BCG vaccination has no significant role in humoral evaluation

Haplotypes and genotypes; the frequency of rhesus alleles, haplotypes and genotypes in major Sakak city population, Aljouf region, Saudi Arabia

Rh-D distribution varies worldwide. The aim of.this study was to document the frequency of Rhesus alleles, haplotypes and genotypes in Aljouf region, Sakaka. The EE genotype is not generally represented in the Aljouf province, and DcE/Ce genotypes are the shared [30.8%], while Dce/Dce and Dce/ce genotypes are less familiar [1.4%]. The frequency distribution of Rh haplotypes among Aljouf population in the present study CDE [0.701] has the highest observed frequency followed by Cde [0.250], cDe [0.116] and CDe [0.040], cDE [0.028], cde[0.021] and cdE[0.008]. The data generated during this study would be important, a base line for advance to be catalogued by molecular rather than serological criteria, and of polymorphisms between RHD and RHCE, which will be a useful for DNA typing and to provide the development of suitable DNA techniques

Mandible prognathism saved a life: a case report / 中华创伤杂志(英文版)

An unusual case of a suicidal firearm injury is presented, in which the victim placed the gun under his chin and fired. However, none of the vital structures of the head and face were injured because the victim's chin was considerably anterior to other facial structures as a result of a class III facial deformity. This resulted in the trajectory of the bullet being anterior to vital facial structures and not causing injury to those structures.

Comparative study of Ecchymosis due to nasal bone Osteotomy in internal continuos and external perforated techniques

The lateral nasal osteotomy is an integral part of cosmetic surgery [rhinoplasty]. A reproducible and predictable technique with the least complication is a significant contributor to operation success. Regarding the different techniques and instrumentation for osteotomy, this study was carried out with the aim of comparison of ecchymosis severity due to lateral osteotomy in internal continuous and external perforated techniques in Tehran from 2004 to 2005. This clinical trial was conducted on 30 patients [15 males and 15 females]. The entire patients had the same situation pre and post operation. In each patient both internal and external osteotomy were performed, and ecchymosis severity due to operation was measured using a ruler on the 1st, 2nd, 3rd, 5th and 7th day following the operation. The data were analysed through SPSS [Smirnov and kolmograph, repeated measure and Wilks tests]. The study results indicated that the ecchymosis severity was far lower in external method than internal method [P=0.01] and it was higher in lower eyelids than in upper eyelids [P=0.01]. Ecchymosis severity was higher on the 3rd day than the other days and it gradually declined from 3rd to 7th days. Age had no significant association with ecchymosis severity while its rate was higher in men than in women [P=0.01]. External osteotomy causes less ecchymosis severity compared to internal technique and has other advantages confirmed by other researchers. Thus, it can be introduced as a preferable educational technique

review of 1000 cases of intraocular lens implantation

One thousand cases of cataract extraction with Intraocular lens implantation done at Shaikh Zayed Postgraduate Medical Institute, Lahore are reviewed. Pre and post-operative visual status is compared. The power of IOL to be implanted was determined by "Estimation" method in 34% and by Biometric computation in 66% of patients. IOLs were implanted under a cushion of air in 48% of cases and with the help of a viscoelastic substance in 52%. Final best corrected visual acuity of 6/12 or better was achieved in 88.6% of the patients who completed the follow up study period. Post-operative complications are discussed. A comparison of results with two international studies is presented

Combined approach in management of ptosis

Thirteen patients with congenital ptosis underwent combined transconjunctival isolation and transcutaneous resection of levator palpebrae superioris muscle. Of these, 10 [77%] had good [within 1mm of normal] and 3 [23%] had fair [within 2mm of normal] postoperative lid level with a minimum three months follow-up; there was no lid malposition and all had good lid crease and fold formation. Lagophthalmos was frequently encountered hut eventually resolved causing no long term exposure problems. Levator function had variable relation to the needed resection. Combined approach enables us to have safe and easy dissection together with the advantages of antero-posterior exposure

review of 1000 cases of intraocular lens implantation

One thousand cases of cataract extraction with Intraocular lens implantation done at Shaikh Zayed Postgraduate Medical Institute, Lahore are reviewed. Pre and post-operative visual status is compared. The power of IOL to be implanted was determined by Estimation method in 34% and by Biometric computation in 66% of patients. lOLs were implanted under a cushion of air in 48% of cases and with the help of a viscoelastic substance in 52%. Final best corrected visual acuity of 6/12 or better was achieved in 88.6% of the patients who completed the follow up study period. Post-operative complications are discussed. A comparison of results with two international studies is presented

Management of congenital ptosis

Out of a total of 12 patients with congenital ptosis, 7 were treated by trans-conjunctival [Iliff's] isolation and resection of Levator palpebrae superioris muscle and 5 underwent a combined approach of transconjuctival isolation and trans-cutaneous resection of Lavator palpebrae superioris muscle. In the former, 5 patients had good post-operative lid level [considered to be within 2 mm of normal], 1 was over corrected, 1 undercorrected and 2 had poor lid skin crease and fold. In the latter, there were no under or over-correction, 3 had good [within 1 mm of normal] and 2 had fair [within 2 mm of normal post-operative lid levels and all 5 had good lid crease and fold formation