Stent thrombosis is a major concern in clinical practice: a single Saudi center experience

Drug-eluting stents [DES] are used in the majority of patients who undergo percutaneous coronary intervention [PCI], and have reduced the rate of in-stent restenosis and repeated revascularization in comparison to bare metal stents. However, stent thrombosis [ST] is an uncommon but serious complication of coronary artery stents that is mostly fatal or presents as a large non-fatal myocardial infarction [MI], usually with ST elevation. To study the incidence of stent thrombosis in Middle Eastern Saudi patients who underwent PCI using both drug-eluting stents [DES] and bare metal stents [BMS]. ST can occur acutely [within 24 h], sub acutely [within 30 days], or as late as one year [late] or even more than one year [very late]. In an observational, single center study in catheterization [cath] lab a total of 1386 patients underwent PCI between January 2008 and September 2010. The study included all patients in that period who had acute coronary syndrome and stable coronary artery disease [CAD]. A total of 1386 patients had PCI and stent deployments; 19 [1.3%] patients had stent thrombosis, four patients [21%] received BMS and 15 patients [79%] received DES. Four patients had acute ST; five had subacute ST; eight patients had late ST; while two patients had very late ST. Nine patients [47%] had DM and eight patients [42%] had hypertension. The incidence of ST in Saudi patients who received DES at our center is similar to internationally reported numbers. Almost half of ST patients are diabetics and there is increasing concern that the risk for late stent thrombosis is slightly higher with DES than BMS.

Comparison between the panoptic opthalmoscape and the conventional direct opthalmoscape in the detection of sight threatening diabetic retinopathy: the Kuching diabetic eye study

Objective: To determine the sensitivity and specificity of the conventional direct ophthalmoscope and the PanOptic ophthalmoscope in the detection of sight threatening retinopathy, as well as the “Ease of Use” of these equipments. Methods: 200 diabetics, newly referred from primary health physicians were examined. Fundus examinations were performed with pupil dilatation in a dark room. The examinations were performed by a single investigator using the PanOptic ophthalmoscope, the conventional direct ophthalmoscope and slit lamp biomicroscopy. Results: The overall sensitivity in detecting sight threatening retinopathy using the conventional direct ophthalmoscope was 73.2% (95% CI: 57.1-85.8%), specificity 93.7% (95% CI: 88.7-96.9%). For PanOptic ophthalmoscope, the overall sensitivity in detecting sight threatening retinopathy was 58.5% (95% CI: 42.1-73.7%), specificity 93.7% (95% CI: 88.7-96.9%). The conventional direct ophthalmoscope was 1.38 times (95% CI: 1.17-1.61 times) as easy to use compared to the PanOptic ophthalmoscope. Conclusion: The PanOptic ophthalmoscope is not superior to the conventional direct ophthalmoscope for the screening of Sight Threatening Retinopathy.

Diabetic Retinopathy and the effect of pregnancy

Pregnancy is associated with increased risk of development and progression of diabetic retinopathy (DR). Although pregnancy does not have any long term effect on DR, progression of retinopathy changes occur in 50%-70% of cases. The greatest risk of worsening occurs during the second trimester and persists as long as 12 months postpartum. The other factors found to be associated with its progression include duration of the diabetes, severity of retinopathy at conception, hyperglycaemic control, anaemia and progression of coexisting hypertension. Because of the increased risk of progression of the disease in pregnancy, conception should be delayed till the ocular disease is treated and stabilized and laser photocoagulation should be promptly instituted in all cases of severe non-proliferative retinopathy and should not be delayed till the patient develops early proliferative changes. Good diabetic control before and during pregnancy can help prevent this increase in the progression and serious vision loss.

The importance of ophthalmic signs in the diagnosis of suprasellar meningioma- a case report

A forty-two year old lady presented with gradual, painless, progressive blurring of vision of her left eye for four months. There were no other associated ocular or systemic complaints. Examination showed decreased visual acuity in both eyes and a pale optic disc on the left side. Visual field examination revealed a temporal field defect of the right eye which aroused the suspicion of an intracranial mass lesion. MRI of her brain revealed a suprasellar meningioma. We would like to emphasize the importance of visual field examination of both eyes in patients presenting with unilateral loss of vision.

Thyroid associated ophthalmopathy- a review

Thyroid associated ophthalmopathy is an autoimmune disorder affecting the orbital and periorbital tissues. Hyperthyroidism is commonly associated with thyroid associated ophthalmopathy, however in 5% to 10% of cases it is euthyroid. Genetic, environmental and endogenous factors play a role in the initiation of the thyroid ophthalmopathy. Smoking has been identified as the strongest risk factor for the development of the disorder. The pathogenesis involves activation of both humoral and cell mediated immunity with subsequent production of gycoaminoglycans, hyaluronic acid resulting in oedema formation, increase extraocular mass and adipogenesis in the orbit. The natural history of the disease progresses from active to inactive fibrotic stage over a period of years. Diagnosis is mainly clinical and almost all patients with ophthalmopathy exhibit some form of thyroid abnormality on further testing. Treatment is based on the clinical severity of the disease. Non-severe cases are managed by supportive measures to reduce the symptomatology and severe cases are treated by either medical or surgical decompression. Rehabilitative surgery is done for quiescent disease to reduce diplopia and improve cosmesis.

Pattern of ocular trauma in Kuching, Malaysia

Objectives: To analyze the causes and characteristics of ocular injuries presenting to Sarawak General Hospital (SGH), Kuching. Design: It is a prospective hospital-based study done for a period of 1 year. Setting: Department of Ophthalmology, Sarawak General Hospital, Malaysia. Participants: All ocular injury patients seen for the first time in the Eye Department during the period January 2006 to December 2006 were included in the study. Eye injury patients on follow-up and treated elsewhere were excluded. Results: A total of 233 patients, and 257 eyes, were studied. Men had six-fold higher rates of injury than women. The average age of presentation was 30 years. The predominant age group was between 21-30 years, 26.2 % (n=61). Eye injuries related to work were seen in 36.9% of patients. There was a gross negligence in the use of personal protective devices in the work-related group. The common settings in which the injuries occurred included home 34.3% (n=80) and industrial premises 31.8% (n=74). Assault-related injuries 7.7% (n=18) were seen mostly among young men in the age between 20-30 years. The initial presenting visual acuity of the patients with blunt ocular trauma was better than penetrating injury. Conclusion: Ocular injuries were common in young males. Work related eye injuries were noted in a significant number of cases. Health education and preventive strategies both in the working place and at home will help to decrease the occurrence of ocular injuries.

Ethambutol ocular toxicity in a patient with pulmonary tuberculosis - A case report

Purpose. To highlight the importance of using the Farnsworth Panel D-15 Hue test in colour vision testing in patients on ethambutol treatment. Case Report. A 70 year-old lady received ethambutol as part of her anti-tuberculous regime. She developed blue-yellow colour defect detectable with the Farnsworth Panel D-15 Hue test, but not with the Isihara Pseudoisochromatic Plates. Ethambutol was immediately discontinued from her anti-tuberculous regime. Two months later, her colour vision returned to normal. Conclusion. This case report illustrates the importance of regular monitoring of patients receiving ethambutol for blue-yellow colour defect using the Farnsworth Panel D-15 Hue Test.

Neonatal conjunctivitis - A review

Ophthalmia neonatorum remains a significant cause of ocular morbidity, blindness and even death in underdeveloped countries. The organisms causing ophthalmia neonatorum are acquired mainly from the mother’s birth canal during delivery and a small percentage of cases are acquired by other ways. Chlamydia and Neisseria are the most common pathogens responsible for the perinatal infection. Fortunately in most cases, laboratory studies can identify the causative organism and unlike other form of conjunctivitis, this perinatal ocular infection has to be treated with systemic antibiotics to prevent systemic colonization of the organism. Routine prophylaxis with 1% silver nitrate solution (crédés method) has been discontinued in many developed nations for the fear of development of chemical conjunctivitis

Single instillation of mitomycin C reduces 1st year recurrence following transurethral resection of non-muscle invasive bladder cancer

To study the impact of single instillation of 40 mg Mitomycin C [MMC-40] within first hour of transurethral resection [TUR], on first year recurrence of non-muscle invasive bladder cancer. In this study of two groups of patients with similar demographics and tumour profile were compared to assess first year tumour recurrence pattern. Group A received MMC-40 within 30 minutes of TUR. Group B patients only had TUR of bladder tumour. Patients' charts were reviewed for demographic profile, preoperative diagnosis and imaging used, cytological work up, tumour profile both during cystoscopy and imaging used, patients records were also reviewed for all subsequent check cystoscopies for recurrence. Any adjuvant treatments like intravesical chemo/immunotherapy etc. were also noted. The results were analysed using a commercially available statistical package, SPSS[TM]. The level of significance was

Coronary heart disease risk-factor profile in a lower middles class urban community in Pakistan

We determined the risk-factor profile and prevalence of coronary heart disease in Metroville, a lower middle class urban community in Karachi, and compared them to the Pakistan health survey PNHS 1990-94, and the US health and nutrition survey 1988-94 NHANES111. Subjects < 18 years and pregnant women were excluded as were people with extreme ranges BMI [corrected] heart rate, height and waist. The prevalence of hypertension was 23% in men and women, hypercholesterolaemia was 17% in men and 22% in women [P < 0.001]. Hyperglycaemia was present in 5% of men and women and obesity in 33% of men and 47% of women [P < 0.001]. Compared to PNHS, the prevalences of obesity, hypertension, hypercholesterolaemia and WHR were higher in our population. Mean values of BMI [corrected] cholesterol, WHR were higher in the US population while mean values were lower for diastolic blood pressure and blood glucose

Evaluation and comparison of coronary heart disease risk factor profiles of children in a country with developing economy

To define the risk factors [RF] profile and prevalence rates of high risk factors in an urban Pakistani community and compare it to the RF profile and prevalence rates of Pakistan National Health Survey. The present study included RF relevant data of 400 house hold children selected by open invitation as a part of Metroville Health Study [MHS], a risk factor modification study which was a cooperation between National Heart Lung Blood institute [NHLBI] USA and National Institute of Cardiovascular Diseases Pakistan. The base line data of 389 girls and 417 boys age 5-17 was included. PMRC data of 5067 and NHANES III survey data of 10,252 US children was used for comparison with MHS. RF analyzed were height weight, SBP, DBP, BMI and serum cholesterol. Comparisons between MHS and PMRC and US were made by using two tailed student t test and of high RF were defined as those exceeding US standards and expressed as percentages. The RF factor profile of urban Metroville children was worse than the national average of PMRC children. Except for diastolic blood pressure in both boys and girls and SBP in PMRC boys, all other RF were less than US children. Prevalence rates were higher in urban Metroville community, i.e., MHS compared to the PMRC which represents national average data. RF profile of Pakistani children has been presented and effect of urbanization demonstrated by comparing the PMRC and MHS RF profile. Hypertension in Pakistani children has emerged as a single most important RF requiring urgent prevention

Impact of socioeconomic conditions on perinatal mortality in Karachi

OBJECTIVE: To study and compare the perinatal mortality [PNM] in hospitals located in various socio-economic areas of Karachi. DESIGN: A prospective review of all births was done from May 1996 to April 1997. Precoded proformas were provided to each hospital and the birth and details of each mother and baby delivered recorded. SETTING: All mothers and their newborn delivered during the time period mentioned. OUTCOME MEASURES: Comparison of PNM in hospitals located in various socio-economic areas of Karachi. A total of 4957 proformas were filled, 63.5% by doctors, 32% by LHVs, 2.9% by administrator and 2.3% by paramedics. Overall 92.3% mothers were housewives, less than 45% of the mothers received primary/secondary education; 42% mothers were of the age 21 to 25 years. More than 52.3% fathers were unskilled labourers. Only 27% mothers were booked while the rest were unbooked or came to deliver on walk in basis. Majority [62%] of the mothers had a > 37 week duration of pregnancy and 51% newborns were male and 49% female. Twenty three% of the newborns weighed < 2500 grams, remaining weighed > 2500 grams but less than 4500 grams; 24.5% newborns died on day one of birth. The PNM per 1000 births in the high, middle and low socioeconomic hospital was 16.4 +/- 23.6, 24.9 +/- 51.20 and 80.4 +/- 177.78 respectively. A statistical significance [p < 0.0000] by the Chi-square for several proportions was seen between the high middle and low socioeconomic hospitals of Karachi. The present socioeconomic conditions will take some time to change. However, this study indicates that perinatal mortality rate may be changed by an improvement in antenatal care of the mother, hence the fetus

Changes in serum lipid profile and malondialdehyde following consumption of fresh or heated red palm oil

The effect of chronic consumption of fresh and heated red palm oil [RO] on lipid profile and lipid peroxidation was investigated. Thirty male rats were divided into 3 groups, each treated with the following prescribed food: [i] basal diet fortified with 15% weight/weight [w/w] fresh red palm oil [FRO], or [ii] heated once red palm oil [1H-RO] or [iii] heated 5 times red palm oil [5H-RO] for 20 weeks. There was a significant increase [p<0.05] in MDA concentration in all 3 groups compared to their respective baseline concentrations and a significant decrease [p<0.05] in total cholesterol [TC] concentration. However, the transient changes observed in serum triglyceride and HDL-cholesterol concentration did not attain significant values. The LDL-cholesterol concentration in 5H-RO group increased significantly [p<0.05] compared to pretreatment value, FRO and 1H-RO groups. Ratio of TC/HDL in 5H-RO group initially increased, but dropped to baseline level at the end of the study. There was no significant difference in the ratio of TC/HDL between the groups. In conclusion, both fresh and heated RO appeared comparable in their effect on serum cholesterol and lipid peroxidation. It appears that long term feeding with fresh and heated RO did not have an adverse effect on serum TG, HDL and TC/HDL ratio. However, it appears that prolonged heating increases LDL-cholesterol level. Further studies are required to ascertain whether the increase in LDLcholesterol and MDA with heated oil would render it more atherogenic

Patterns of referral from health centres to hospitals in Riyadh region

Patterns of attendance and referrals in hospitals and health centres in Riyadh region, Saudi Arabia, studied before and after implementing a referral system showed a 40.6% total decrease in patients attending hospital outpatient clinics; an 11.9% increase in patients attending primary health centres; a 19.2% increase in referrals; a 33.2% increase in patients attending emergency departments; and a 17.3% increase in inpatients. It is clear that the referral system has, and will have, an impact on primary and secondary health care services. In order to optimize positive and minimize negative aspects of this impact, communication between primary health centres and hospitals should be of high standard. Regular reviews and studies of referral systems are recommended

role of the anaesthetic assessment clinic in morbidity of surgical patients

Fifty patients were referred to the anesthetic assessment clinic to evaluate the benefit of these clinics. 36% of the patients approved its benefits and 60% thought they did not find it beneficial. However, these clinics certainly helped to spot patients with multisystem diseases and they would have been liable to have their surgery postponed if they were seen at the night or the operation. It was concluded that anesthetic assessment clinics are valuable and should be encouraged

effect of muscular exercise on blood sugar in bilharzial liver cirrhosis

The present study was performed on 25 patients with bilharzial. Liver cirrhosis, 15 non ascitic and 10 ascitic cases and 15 control subjects, to study the effect of muscular exercise on blood glucose. The blood glucose was estimated in all cases in the fasting state and 30 min after moderate standard exercise on a bicycle ergometer. We found a drop in the blood sugar content in all cases but the drop was significant only in ascitic cases because the liver functions are markedly impaired and so can not compensate for the reduction of the blood sugar after exercise because processes of glycogenolysis and gluconeogenesis are inquired