ABSTRACT
Wolfram disease is a rare genetic disease which mainly presents as diabetes mellitus and optic atrophy. Presence of maculopathy in a case of wolfram disease is rarely reported in literature. We present here two cases/siblings with age of 12 and 14 years. They had diabetes mellitus, deafness and disc palor. Ocular examination also revealed atrophic maculopathy in both siblings, supported by depressed response on ERG. Assosiation of maculopathy with wolfram syndrome is rare and worth reporting
ABSTRACT
Objective: To study Agreement between Keratometric readings by VERION image guided System, Galilei G4 and Pentacam
Methods: The quasi experimental study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from August 2016 to December 2016. Twenty five patients fulfilling the inclusion criteria participated in the study. All Patients were subjected to Keratometric assessment using Galilei G4 Dual Scheimpflug analyzer [Ziemer, Switzerland], Wavelight Oculyzer II [Pentacam, Germany] and Verion image guided system [Alcon]. Steep and flat meridian and diopter of astigmatism by three systems were recorded and endorsed. All readings were taken by the same observer. Statistical Program for Social Sciences [SPSS] version 22.0 was used for statistical analysis. Results analyzed for significance by t-tests and Interclass correlation analysis. In t tests, P values of <0.05 was considered statistically significant while interclass coefficient of >0.7 was considered acceptable
Results: Fifty eyes of twenty-five patients [22 male, 28 female] with mean age of 29.50 +/- 3.46 years were studied. Flat K, steep K and dioptric power of astigmatism were measured with verion, pentacam and Galilei G4. Interclass correlation analysis showed agreement between individual variables measured by the three devices, while one sample t test showed no significant difference between dioptric power of astigmatism between Verion-Pentacam and Verion- Galilei group. [p 0.178 for former and 0.622 for later group]
Conclusion: Verion image guided system is comparable to other instruments used currently for keratometry. Verion can be interchangeably used with Pentacam and Galilee G4 in assessing corneal astigmatism
ABSTRACT
Objective: To compare the change in endothelial cell count after femtosecond laser-assisted cataract surgery [FLACS] versus conventional phacoemulsification
Study Design: Randomized controlled clinical trial
Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from January 2016 to August 2017
Methodology: Patients with senile cataract and age ranging from 40 to 80 years were included in the study. Patients with any other cause of endothelial cell loss, history of trauma, documented diabetes millitis, hypertention and glaucoma were excluded. Preoperative detailed ocular examination, including both anterior and posterior examination, was carried out. Patients were distributed into two groups. Group GP were planned for conventional phacoemulsification, while group GF underwent FLACS. All the surgeries were performed under local anesthesia by same ophthalmic surgeon. Specular microscope [Topcon specular microscope sp-3000p] was utilized to measure the endothelial cell count [ECC] before and 4 weeks after the surgery
Results: Fifty eyes [25 in each group] of 48 patients underwent cataract surgery by phacoemulsification or FLACS. Twenty-five [52.08%] out of the total were females while 23 [47.91%] were males. Median age of the participants in phacoemulsification group was 55 years [IQR 20.50], while in FLACS group it was 54 years [IQR 8]. The median change in endothelial cell count was 228 [IQR 532] in Phaco group, while 23 [IQR 35] in FLACS group. [p<0.05 Mann Whitney U-test]
Conclusion: FLACS is a safe and effective modality for cataract treatment and it induces significantly less endothelial cell loss than conventional phacoemulsification
ABSTRACT
Objective: To determine the correlation between mean central corneal thickness taken with Galilei dual Scheimpflug Analyzer and Applanation Ultrasound Pachymetry
Study Design: Descriptive cross sectional study
Place and Duration of Study: Armed Forces Institute of Ophthalmology Rawalpindi, from Jul 2013 to Jan 2014
Material and Methods: Central corneal thickness was measured in 100 eyes of 50 patients. First three readings were taken with Galilei dual Scheimpflug analyzer, with a gap of 1 minute. Then three readings were taken with ultrasound pachymetry after applying topical 0.5% proparacaine [Alcain]. The mean of the three readings was used for the analysis
Results: For right eye the mean central corneal thickness measured by the Galilei dual Scheimpflug analyzer and Ultrasound pachymetry was 544.06?m +/- 27.36 and 546.88?m +/- 27.71 respectively, and for left eye it was 544.72?m +/- 25.47 and 546.52?m +/- 26.15 respectively. There was a strong and positive correlation between the two instruments [r=0.969, p=0.000 for right eye and r=0.956, p=0.000 for left eye]
Conclusions: The pachymetry readings with GSA showed strong and positive correlation with those of US pachymetry. So GSA may be considered as an alternative to US Pachymetry, thus avoiding operator-dependent errors, patient discomfort and other disadvantages
ABSTRACT
Opioids such as morphine and fentanyl have been used in neuraxial anesthesia to prolong the analgesic effects since long, but these have frequently been associated with few adverse effects e.g. nausea, vomiting, pruritus and rarely respiratory depression. Tramadol has also been used in epidural as well as spinal anesthesia, and respiratory depression has not been reported with its intrathecal use. We present a case in which 20 mg of intrathecal tramadol produced signs of opioid overdose including respiratory depression. The side effects were reversed with naloxone confirming our suspicion that these were caused by tramadol. We recommend adequate monitoring and vigilance for tramadol as is used for other intrathecal opioids
Subject(s)
Adult , Humans , Male , Anesthesia, Spinal/methods , Injections, Spinal , Anesthesia, Spinal/adverse effects , Drug Overdose , Analgesics, Opioid , Narcotic Antagonists/therapeutic use , Respiratory InsufficiencyABSTRACT
Objective: To compare post-operative pain relieving effect of topical diclofenac 0.1 0,5% in Corneal Collagen Cross Linking [CXL] for patients diagnosed with keratoconus
Methods: This randomized controlled trial was carried out for six months from October 2016 to March 2017. We included young patients having keratoconus with k-readings greater than 47D and central corneal thickness more than 400 microns. All the patients received single dose one drop of topical diclofenac 0.1% to [Group-A] and ketorolac 0.5% to [Group-B] 30 minutes in advance of the corneal collagen cross linking [CXL] procedure. The CXL was performed with topical 0.1% riboflavin eye drops in 20% dextran as a photo sensitizer. After 36 hours of the CXL procedure, the postoperative intensity of pain was assessed verbally by patients with the help of visual analog scale [VAS] numbers from zero to five where 0 designated no pain 6 5 symbolized worst pain
Results: The study comprised sixty eyes of forty one patients. Out of total 16 were male while 25 female patients. The mean age of the patients was 24.27 +/- 2.93 years [range 20 to 29 years]. In the conclusive analysis, diclofenac 0.1% was used on 30 patients in Group-A and ketorolac 0.5% on 30 subjects in Group-B. Pain relieving scores in Group-A [diclofenac 0.1%] was 2.57 +/- 0.67 while in Group-B [ketorolac 0.4% treated arm] was 3.20 +/-0.61
Conclusion: Topical diclofenac 0.1% is statistically comparable to topical ketorolac 0.5% in precluding severity of pain after corneal collagen cross linkage operation
Subject(s)
Humans , Male , Female , Adult , Keratoconus/diagnosis , Narcotics , Diclofenac , Pain, Postoperative , KetorolacABSTRACT
To determine the outcome of the babies in terms of mortality with the diagnosis of Meconium Aspiration Syndrome [MAS]. An observational study. The Neonatal Unit of Services Institute of Medical Sciences and Services Hospital, Lahore, Pakistan, from February 2008 to January 2009. All the babies admitted to the neonatal unit during the period of study with the diagnosis of MAS were included. At admission, demographic, maternal, antenatal and natal data were recorded on a specific form. The progress of the baby, including need for ventilation, medications, complications and outcome were also followed and documented. One hundred and nine babies admitted with MAS, 32% died. Most of the babies [n=73] were admitted from our obstetrical unit and the rest through the emergency department. Majority [60 of 109] were admitted within the 1st hour of life. Most [14 of 15] of the newborns requiring intubation within 1st hour of life, died. Forty four babies were ventilated and 35 of these babies succumbed. Of ventilated babies, 11 developed pneumothoraces. Seventy two percent [13 out of 18] of expired babies stayed for less than 24 hours. Mortality rate for MAS was higher in the study group as compared to international figures. It was especially high in babies requiring mechanical ventilation in 1st hour of life or with co-existing severe hypoxic ischemic encephalopathy
ABSTRACT
Aplastic anaemia is a hematological disorder characterized by pancytopenia resulting from early stem cell deficiency. Chemical exposure, medicines, viral infections and immunodeficiency are the aetiological factors responsible. This study was conducted in the Department of Pediatrics, Mayo Hospital, Lahore from January 1994 to December 1995. Out of 40 children 26 were boys and 14 were girls with median age of 8 years. An association with history of drug intake was present in 32/40 patients The most common relationship was seen with chloramphenicol [40%]. Pallor [47%], bleeding tendency [62%] and prolonged fever [42%] were the most common symptoms and anemia [100%], mucosal bleed [50%] and ecchymoses [37%] commonest signs. All patients had pancytopenia, reduced reticulocyte count and prolonged bleeding time. In this study secondary aplastic anemia was seen more commonly than idiopathic variety and the most common agent responsible was chloramphenicol
Subject(s)
Humans , Male , Female , Anemia, Aplastic/epidemiology , Risk Factors , ChildABSTRACT
Blood glucose, cholesterol and triglycerides levels of the normal and alloxan diabetic male rabbits of local strain were determined after oral administration of ground herbal drugs, Gossypium herbacium [cotton seed], Grewia asiatica [Phalsa] and Gymnema sylvestre [gur-mar]. From the data obtained it is concluded that the G. herbacium and G. asiatica produce considerable and significant hypoglycaemic effects in both, normal and diabetic rabbits, but G. sylvestre shows less hypoglycaemic activity in only normal rabbits. Three different doses [20, 10, 5 g/kg] of two G. herbacium and G. asiatica produced almost same reductions in blood glucose. The maximum reductions were at 3, 6 and 12 hours. It means even minimum dose i.e. 5 g/kg was sufficient to bring about normoglycaemic state in experimental rabbits. In case of blood cholesterol and triglycrides, the uniform dose [10 g/kg] of all three medicinal herbs was administered daily orally for a period of 10 days to normal as well as diabetic groups. The maximum lowering in blood cholesterol and triglycerides of normal and diabetic rabbits was caused by G. asiatica, where the reductions were statistically significant. C. herbacium was second and C. sylvestre was third in order of hypocholesterolaemic and hypotriglyceridemic in activity