Transepithelial corneal crosslinking in treatment of progressive keratoconus: 12 months' clinical results

Objective: The purpose of this study was to evaluate the safety and efficacy of transepithelial corneal collagen cross linking [TE-CXL] with modified riboflavin and accelerated UVA irradiance in thin corneas with pachymetry less than 400 microns at thinnest point, untreatable by epithelium off corneal collagen cross linking[CXL] in adult Pakistani population with progressive keratoconus

Methods: This quasi experimental study included twenty six eyes of 26 patients with progressive keratoconus who underwent accelerated transepithelial CXL in Armed forced institute of ophthalmology with 12 months follow up. Modified riboflavin, ParaCel [[riboflavin 0.25%, Benzalkonium chloride, EDTA, Trometamol, hydroxypropyl methylcellulose] and vibeX Xtra [riboflavin 0.25%] [Avedro, USA]] were applied to cornea in two stages. Uncorrected and Corrected Distant Visual Acuities [UDVA, CDVA], spherical equivalent [SE], astigmatism, pachymetry at thinnest point [Pachy thin], apex keratometry [Kmax], simulated and steep keratometry [Sim K, steep K] were measured at baseline and at 3, 6 and 12 months post operatively. The cornea was then exposed to accelerated UVA irradiance of 9mW/cm[2] for 10 min [total dose 30 mW/cm[2]]

Results: The mean age of the patient was 24.54 +/- 5.16 years. UDVA, CDVA, SE, astigmatism significantly improved at all postoperative test points [p=0.000, 0.004, 0.000, 0.004 respectively]. Kmax and pachy thin were significantly reduced over baseline at 1 year [p=0.000, 0.004 respectively]. Topographic indices Sim K and steep K did not show significant changes. No intra or post-operative complications were reported

Conclusion: Transepithelial accelerated CXL with modified riboflavin is a safe and effective procedure which halt disease progression in thin corneas with progressive keratoconus

trends of CRP levels at different waist-to-hip ratios among normotensive overweight and obese patients: a pilot study

Objective: To determine the correlation between CRP [C-reactive protein] and Waist to Hip Ratio [WHR] among over weight and obese patients with normal blood pressure. Study Design: An analytical study. Place and Duration of Study: Medical indoor and outpatient clinics of Mayo Hospital, Lahore, from March to August 2013

Methodology: Willing patients with Body Mass Index [BMI] of > 23 kg/m[2], normal blood pressures, and age between 18 - 65 years were inducted in the study. Patients with signs of fluid retention, collagen vascular disease, CAD, on corticosteroids, immunomodulators or lipid lowering medications, hypertensives and febrile patients were excluded. Patients were considered to be at low risk for cardiovascular events if WHR among males and females was < 0.95 and < 0.80, respectively. Similarly, males and females with WHR > 1 and > 0.85, respectively were taken as high risk. Levels in-between these ranges were taken as moderate risk. Data was analyzed on SPSS 15. Descriptive statistics were determined. The p-value was calculated by ANOVA and independent sample t-test among males and females respectively, to compare WHR in relation to different CRP levels and < 0.05 was taken as significant

Results: There were 34 male and 74 female patients. The gender-wise mean WHR did not show statistically significant difference categorized CRP levels [p=0.072 in male, and 0.052 in females]. There was an increasing trend in CRP levels as WHR increased among females, but this was statistically insignificant [p=0.05]

Conclusion: Although the impact of central obesity on cardiac health is well known, however, WHR alone is an unreliable indicator of systemic inflammation and raised CRP level

Frequency of spontaneous bacterial peritonitis in hospitalized patients with cirrhosis and hypoalbuminemia

Background: Spontaneous bacterial peritonitis [SBP] is one of the complications in patients of cirrhosis. These patients when exposed to infection are likely to develop SBP. Various studies refer its frequency to around 30%, yet no study has estimated its frequency in hospitalized cirrhotic patients with serum albumin <3.5 g/dl

Objectives: To find out the frequency of SBP in hospitalized patients with cirrhosis and hypoalbuminemia

Methodology: This cross sectional study was conducted in Medical wards of Mayo hospital, Lahore from August 2010 to January 2011. A total of 110 cirrhotic patients recently hospitalized and having serum albumin < 3.5 g/dl in their initial investigations were investigated. Relevant history, examination and investigations were carried out and recorded in the proforma

Results: Of 110 patients under study, 60 were males[54.5%] and 50 were females[45.5%]. Total 54 patients [49.1%] had SBP. Patients having SBP were older [52.6 +/- 12.8 years] compared to others [45.4 +/- 10.2 years]. Among those having SBP, 38[70%] patients were > 40 years of age. The mean ascitic fluid white cell count in SBP patients was 884 +/- 260 cells/uL versus 236 +/- 108 cells/uL. The mean neutrophil count in ascitic fluid was 643 +/- 181 cells/uL versus 137 +/- 65 cells/uL. HCV was the commonest etiology of cirrhosis 59 [54%], HBV in 29 [26%], combined HBV and HCV in 10 [9%], and non-viral in 12 [11%]

Conclusion: SBP is a common complication of cirrhosis and its frequency is higher in those cirrhotic patients who also have hypoalbuminemia [<3.5gm/dl]

Role of MRI in functional prognosis of metastatic cord compromise

Objective: primary objective of our study was to establish the strength of association of MRI findings at presentation with clinical outcome of patient i.e. Motor deficit and Sphincter control. Secondary objectives included Incidence of tumors affecting spinal cord and Correlation of motor weakness and sphincter control with patient presentation

Methods: this retrospective study was conducted in Department of Radiology,Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, between Jan 2013 and June 2013. The study included series of 64 patients, including 38 men and 26 women, ranging between 35 and 70 years [mean, 48.5+/-13 years], presenting with symptoms and signals of spinal stenosis

Results: results for tumors involving less than 25%, N: 24 [37%] were included in this group. All showed stable appearance or improvement on follow up. Data was not significant [when expecting stability/improvement in 75-100% of patients].When further divided into 2 groups. Improvement was seen in [6] p> 0 and stability in [18] p< 0.05 significant. Results for tumors involving less than 25-50%, N: 26 [40.6%]. 45% showed improvement, when expecting stability/ improvement in 50-75% of patients. Data was statistically insignificant data with p > 0.05.Moreover, the results for tumors involving less than 50-75%, N: 4 [6.2%]. 50% showed improvement/stability post treatment. 50% showed progression. In patients tumors involving less than 75-100%, N: 10 [15%]. 20% showed improvement. Statistically significant data with p< 0.05.Cord signal was compromised in 28 [34.3%]. 22 had muscular weakness. Improvement was seen in 45%. 12 had sphincter dysfunction. 50% showed improvement in clinical symptoms

Conclusion: MRI has a potential to predict the functional outcome in patients with metastatic cord compromise

Comparison of post operative complications in mandibular angle fractures treated by single versus two miniplates

The ojective of this study was to compare the complications [infection and non union] when fractures through the angle of the mandible are treated with a single noncompression miniplate versus 2 noncompression miniplates. 300 patients were randomly divided in two groups, 150 patients in each. Group A was treated by single non compression miniplate plate at superior borber of angle of mandible using intraoral approach. Group B was treated by two noncompression plates one at superior border as in group A, and other plate at lower border using extra oral approach. Patients were assessed for infection and non union on 21st, 45th and 60th days after the procedure. Mean age of patients in Group-A was 35.87 +/- 1.90 and in Group-B mean age of patients was 31.30 +/- 3.45 years respectively. Gender distribution showed that there were 241 [80.34%] [Group-A=124, Group-B=117] male and 59 [19.67%] female patients [Group-A=26, Group-B=33]. There were 10[6.67%] patients in Group-A and 22[14.67%] patients in Group-B who got infection at fracture site at 21st day.. At 45th day 6 [4%] patients in Group-A and 17[11.33%] patients in Group-B had infection. At 60th day infection was present in 10 [6.67%] patients and in Group-A only 2 patients had infection. This study shows that there are less chances of Infection when the patients are treated with one miniplate as compared to two miniplates for the treatment of displaced mandibular angle fractures