Refractive accommodative esotropia; management and results

To determine the efficacy of all time wear of full cycloplegic correction in the management of refractive accommodative esotropia. Descriptive study using non-probability purposive sampling technique. Ophthalmology OPD and Department of Nishtar Hospital, Multan. Oct 2009 to Sep 2010. All children with accommodative esotropia associated with hyperopia were included in the study. The features studied were ocular alignment, association of anisometropia with strabismus and amblyopia, improvement in deviation of squint after amblyopia therapy and full cycloplegic hyperopic correction and regain of binocular single vision and requirement for surgery in patients with accommodative esotropia with hyperopia. Forty four children with refractive accommodative esotropia were identified. Cycloplegic refraction was done for all patients and full cycloplegic correction was given. At presentation 36.4% of children were amblyopic in either eye and most of them had anisometropic hypermetropia. The esotropia was present in more hypermetropic eye. 63.6% of the patients became straight with glasses only and another 25% became straight after amblyopia therapy. Fusion with gross stereopsis was demonstrated in 75% of patients. Cycloplegic refraction remained stable throughout the follow up period. None of these patients was able to discontinue glasses and maintain alignment. Surgery was required in only 11.4% of total patients. Most children with refractive accommodative esotropia have an excellent outcome in term of visual acuity, ocular alignment and binocular single vision with the glasses. Full cycloplegic correction and amblyopia therapy resulted in marked reduction in the deviation of squint and improvement in visual acuity of the amblyopic eye as compared with the prevalence at presentation. The degree of hyperopia remains unchanged with poor prospect for discontinuing glasses wear

Comparison of the effect of ringer's lactate and balanced salt solution on postoperative endothelial cell count after phacoemulcification?

Objective of this study is to compare the effect of ringer lactate and balanced salt solution on endothelial cell count after Phacoemulcification on larger sample size. Randomized Control Trial Study. This study was conducted at the Department of Ophthalmology, Nishtar Medical College and Hospital Multan from December 2009 to May 2011. In this study, total 2902 eyes were included. 1453 were included in group A [where RL was used as irrigating fluid] and 1449 were included in group B [where BSS was used as irrigating fluid]. The patients were examined on Day 1, and at one and three months. At each follow-up visit, corneal clarity was noted as the presence or absence of Descement's folds and intra-stromal or epithelial edema. Anterior chamber was examined for the signs of inflammation as flare and cells. At three months follow-up, specular microscopy was performed. These examinations were done by the same observer who performs the tests preoperatively. It was found that mean endothelial loss in total population was 310.471 +/- 163.055 with SE 3.036 while in group A it was 321.592 +/- 171.620 with SE 4.523. Endothelial cell loss in group B was found to be 299.380 +/- 153.292 with standard error 4.034. Percentage decrease in endothelial cell count in group A was 13.40% while in group B it was 12.54%. Difference in percentage loss of endothelial cell count between two groups was 0.86%. It is found that BSS is better solution for irrigation during intra operative use during phacoemulsification than ringer lactate

medical student's stigmatizing attitude towards psychiatric label

To evaluate the effect of a psychiatric label attached to a normal person, on the attitude of final year medical students in Pakistan. Cross-sectional survey. This survey was conducted among final year medical students in Chandka Medical College Larkana, Pakistan in July 2009. Self administered questionnaire was used consisting of a demographic details, a single-paragraph vignette depicting a normal person and a modified social distance scale was used to elicit responses from final year medical students. The randomly selected students were divided in to two groups; group A received a case description with a psychiatric label attached while group B received the same case description without a label. Response rate was of more than 99%. Out of them 61.4% were males. More than half responded to the questionnaire with the attached psychiatric label and 48.8% responded to the questionnaire without label. Mean [SD] age of the participants was 23.76 [4.43]. Significant number of Students were, unwilling to do shopping from the market run by the person with label [p = 0.025], and to have him in his work place [p = 0.024] or share room with him [p = 0.023] as compared to the willing students. Also significant number of students thought that friendship with the psychiatric patient will adversely affect their mental health [p=0.03]. These results confirm that label does affect view of medical students towards individual the irrespective of his/her behavior

Antipsychotic treatment and weight gain: does risperidone behave differently in Pakistani psychiatric patients?

Studies from the Western world have shown that antipsychotic medications in psychiatric patients result in weight gain and other metabolic diseases. This study was undertaken to investigate whether any one of the five most commonly prescribed antipsychotics, [risperidone, olanzepine, trifluoperazine, quetiapine and haloperidol] could behave differently in terms of causing weight gain among patients attending the psychiatric outpatient clinics in a tertiary care hospital in Karachi, Pakistan. For this retrospective cohort study, data were collected from outpatient records of the Aga Khan University Hospital, from 2003 to 2007. Demographic and clinical data were analysed. Repeated measures ANOVA, using a linear mixed model approach was used to assess weight gain over time due to the use of antipsychotic medications. A total of 124 subject records [68 males and 56 females] were evaluated. One-way ANOVA revealed that the groups being prescribed with antipsychotics were comparable with respect to age, duration of treatment and weight measurements. Frequencies were calculated which showed that weight increases significantly over time with respect to the prescribed antipsychotic medications, except for risperidone. Repeated measures ANOVA using the linear mixed model approach showed that the serial weight measurements were significantly different across the follow up times [p<0.05]. Four of the commonly prescribed antipsychotic drugs do result in an increase in weight; however risperidone has no such effect, making it an option in treating psychiatric disorders without worrying for any gain in weight. In view of the increased prevalence of obesity and other metabolic diseases, measures should be taken towards careful prescription of antipsychotic medications

Surgically induced astigmatism after phacoemulsification with clear corneal 5.2 mm incision; temporal vs superior approach

The purpose of this study was to compare the amount of surgically induced astigmatism [SIA] by a sutureless clear corneal incision of 5.2 mm while using a superior and temporal approach. It was carried out at the department of Ophthalmology Nishtar Medical College and Hospital Multan. The sample size was 150 eyes of 130 patients. Clear corneal incision was used in all the patients. The patients were divided into two groups Group-1 included 75 eyes of 61 patients who underwent surgery via temporal approach. Group-2 included 75 eyes of 69 patients in whom superior approach was used. Keratometry was performed preoperatively, on first post operative day, after 1 week and 6 weeks. Surgically induced astigmatism was calculated by comparing pre operative and post operation keratometric readings at 6 wks. The surgically induced astigmatism in Group-1 [Temporal approach] ranged from 0.4-1.3D, mean 0.95 D whereas for Group-2 [Superior approach] range was 1.0-2.9D and mean was 1.98D. For a suture less clear corneal incision temporal approach results in considerably lesser degree of surgically induced astigmatism

Efficacy of SRKT biometry formula

To evaluate the predictive accuracy of SRKT formula in biometry. Two hundred eyes which underwent cataract extraction by phacoemulsification and implantation of a posterior-chamber intraocular lens were included in the study. Depending upon the axial length the patients were divided in four groups. Group-l: Axial length<22 mm, n=28 eyes [14%].Group-2: Axial Length 22.00-24.5 mm, n=136 [68%]. Group-3: Axial Length 24.6-26 mm, n=25 eyes [12.5%]. Group-4: Axial Length > 26 mm, n=11 eyes [5.5%]. In all patients SRKT formula was used to calculate the power of intraocular lens. Group-I: The mean deviation in refraction was 0.42D with SRKT and 0.56D with RCOphth guidelines. Group-2: The mean deviation in refraction was 0.62D with SRKT and 0.59D with RCO guidelines. Group-3: The mean deviation in refraction was 0.43D with SRKT and 0.41D with RCOphth guidelines. Group-4: The mean deviation in refraction was 0.42D with SRKT [RCOphth recommends the same formula for this length of eye ball]. When the overall mean deviation [of all four groups] was calculated, it was 0.56D for SRKT [range 0 to 2.81D] and was 0.52 D if RCOphth guidelines had been followed. Postoperative BCVA of 6/12 or better was achieved in 197 eyes [98%]. SRKT formula performed credibly in average-length eyes as well as in the long eyes. For short eyes results would have been better if Hoffer Q formula had been used

Comparison of functional and cosmetic outcome in merseline mesh and silicone band used as a frontalis sling in ptosis surgery

The idea to use merseline mesh and silicone band in ptosis surgery and to find an effective, durable, simple, flexible and easily avaible material having less complications and best cosmetic results. Both the silicone band and merseline mesh were used as brow suspension in the form of rhomboid. Most of the cases [85%] were operated under local anaesthesia. Thirty four [Silicone band 18, merseline mesh 16] had good results i.e. within 1 mm of normal and 15% [Silicone band 02, merseline mesh 04] had fair results i.e. they were 2 mm under corrected. Both the materials were effective, inexpensive and provided good results with no recurrence but using silicone band showed better results with lesser complications

Do pharmaceutical companies selectively report clinical trial data?

Many studies have shown that there is an association between a positive outcome of clinical trials, economic analyses and systematic reviews, and funding by the manufacturer of the drug of interest. Selective reporting of clinical trial data has been suggested as one of the possible explanations of this so-called funding bias. We conducted a review of the literature to find out if there is any evidence that this selective reporting of clinical trial data occurs. We report the several systematic reviews and cross-sectional surveys, and many case studies of this phenomenon that we found in the medical literature. We searched Medline, Embase and PsycINFO databases for this study besides hand searching BMJ from January 2003 to November 2005. We included systematic reviews, cross-sectional surveys, letters, editorials, comments or news items that referred to actual incidences of withholding, suppression, selective release or selective publication of clinical trial data by pharmaceutical companies