Dry Eye Among Patients at the Eye Clinic of A Secondary Referral Hospital

Introduction: Dry eye is a common but under-diagnosed problem in the general population. Lack of standardised diagnostic protocol causes prevalence of dry eye varied widely in different populations. Nevertheless, effective management rests largely on the accurate diagnosis and identification of the contributing risk factors. Methods: In a cross sectional study, socio-demographic, lifestyle and medical history data were collected from 157 respondents. A validated six-item questionnaire was used to determine the dry eye symptoms. Dry eye was determined by using Schirmer’s test. Fluorescein staining test and tear break up time (TBUT) test were performed to characterise the dry eye. Results: Using the Schirmer’s test, 33.8% of respondents had dry eyes. The likelihood of dry eye increased among Malay females in the seventh decade. The most frequently reported symptom was sensation of dryness of the eye. Although only 22.6% of dry eye cases were symptomatic, up to 47.2% of them may developed surface changes detectable by fluorescein dye test. Ethnicity (p=0.019) and diabetes mellitus (p=0.049) were significantly associated with dry eye. Conclusion: Dry eye could be subclinical but clinical tests in potential risk groups can lead to better detection of this condition and allow prescription of appropriate treatment for affected patients. Keywords: Dry eye symptoms; Dry eye syndrome

Immunological study of type 2 diabetic patients with periodontal disease

To evaluate the IgA, IgG and IgM levels in the serum samples of type 2 diabetic and Periodontal patients of the Peshawar area having different life style set up. Case control study. This study was carried out on subjects who fulfilled our criteria and agreed to participate in the study were included. They were residents of Peshawar area and visited OPDs of Khyber College of dentistry, Peshawar during July, 2012 to June, 2013. Among 120 participants, 30 were healthy, 30 were with periodontitis, 30 had diabetes and the remaining 30 had both diabetes and periodontitis. All of them had at least 20 natural teeth. Diabetic patients had the disease history minimum of five years while the periodontal patients had clinically confirmed the disease. Blood samples were collected from each of the participant and immunoglobulins A, G and M were measured. The observed data were analyzed accordingly through standard statistical methods. Male patients were found more as compared to females [ratio 1: 0.87] in the two diseases. The age range was 35 to 54 years with the mean 44 +/- 5. As per HBA1C results; 40% had good control of diabetes, 26% moderate while in 34% control was poor. Immunoglobulin A and G levels were found significantly higher [p < 0.05] in the three disease groups as compared to control group. Whereas the concentration of IgM was not changed by the said diseases. Besides, the gender has no influence on the levels of the three immunoglobulins. The IgG levels increased with the increase in severity of the Periodontitis disease. While IgA showed slight decrease with the increase in clinical grades of the Diabetes disease. The result of the current study indicates the role of humoral immune response in the two mentioned diseases. The higher levels of immunoglobins particularly IgA and IgG might be due to protective mechanism against the weak immune response and the increased bacterial challenge in diabetes and periodontitis

Pattern of cigarette smoking among college students of Quetta

Cigarette smoking habit is developed more at the young age, hazardous to health and causes premature mortality. To determine the pattern of cigarette smoking and factors contributing to the said habit among college students of Quetta. Randomized study. This study was conducted at the Bolan Medical College, Quetta during the academic year 2010-2011. a total of 850 students from different colleges of Quetta were randomly selected during the academic year 2010-2011. Prevalence and influence of factors associated with the cigarette smoking were recorded on a predesigned questionnaire. The collected data was analyzed with the help of statistical procedures. Out of the total, 122 students were smokers, 23 ex-smokers and 705 non-smokers. Smokers had the habit for charm and relaxation. While non-smokers and ex-smokers avoided cigarettes use due to family blame, religion and its adverse effect on health. Besides, the habit was found more common among students whose fathers and brothers were smokers. Majority of them knew the hazards and very little number was smoking in the public places. Young age and transition period from school to college is a critical time to adopt the habit of cigarette smoking, hence needs an immense attention of the authority designing tobacco control policies. Healthy recreational activities, awareness programs related to its hazards, non-smoking home environment, increased tax and ban on its advertisements are the essential measures, which can minimize the habit. In addition, the present basic work would serve as a template to conduct further advanced studies on this line

Frequency of various clinical and electrocardiac manifestation in patients with acute organophosphorous compound [OPC] poisoning

Background: worldwide, OPC are the most widely used insecticides in developing countries like Pakistan, where agriculture is the main occupation and easily available everywhere, therefore, the OPC poisoning is very common. WHO recently reports that pesticides poisoning occurs about 3 million/year with mortality > 3 lac/year and 99% belong to developing countries

Objective: to determine the frequency of various clinical and electro cardiac manifestation in OPC poisoning

Methodology: prospective observational study, conducted from Dec 2008 to April 2010 in Department of Medicine and Intensive Care Unit [ICU] at Liaquat University of Medical and Health Sciences, Jamshoro / Hyderabad

Results: out of 70 adult patients, 28[40%] were males and 42[60%] were females. The nature of OPC poisoning was suicidal in 58 [82.86%] and accidental/incidental in 12 [17.14%]. There were 43 [61.43%] farmers, 21 [30%] house-workers and 6 [8.57%] college students. There was a high ratio of insecticides [Melathion, Parathion, and Mite/rat House fly killer Carbamates] by ingestion/ inhalation route. The cardiac manifestations were Sinus Tachycardia in 20[28.6%], Non Cardiac Pulmonary Edema and Sinus Bradycardia 15[21.4%] each, Hypertension in 13[18.6%] and Hypotension in 07[10%]. Common ECG changes noted in our study were prolonged QTc - interval among 28[40%], prolonged P-R interval in 11[15.7%], atrial fibrillation, ventricular Tachycardia and extra systole were found as; 06 [8.6%], 05 [7.1%] and 05 [7.1%] respectively. Common neurological findings were flaccid paralysis in 28[40%] patients with respiratory muscle involvement in 10 cases, delirium in 11[17.5%], impairment of consciousness in 8[11.4%], and extrapyramidal features, fasciculation's, convulsions, and cranial nerve involvement were in 6 [8.6%], 5[7.1. %], 7[10%] and 5[7.1%] respectively

Conclusion: in routine hospital practice, the suicidal cases are very common due to acute OPC poisoning. Many cases are hospitalized with critical condition with predominant involvement of cardiac and neurological features. Early diagnosis with appropriate treatment with specific antidotes and ICU management can minimize the fatal consequences of OPC poisoning. It is further recommended that more studies are required to provide awareness regarding this important public health problem

Frequency of helicobacter pylori among hepatic encephalopathic patients in liver cirrhosis

Objective: to determine the frequency of H. pylori in cases of hepatic encephalopathy with liver cirrhosis

Study design and place: cross-sectional study to observe the role of H. pylori in HE patients of liver cirrhosis, conducted in Department of Medicine with collaboration to Intensive Care Unit [ICU] from January 2009 to December 2009 at Liquate University of Hospital Jamshoro/ Hyderabad

Results: out of 66 patients of HE, 44[66.7%] were male and 22[33.3%] were female, between 20 and 80 years of age. Based on Child-Pough's criteria, severity of hepatic decompensation Grading was as; in grade 1= 07 [10.6%], in grade 2= 21 [31.8%], in grade 3= 20 [30.3%] and in grade 4= 18 [27.3%]. Based on Child-Pough's criteria in class A= 01 [1.5%], in class B= 27 [40.9%] and in class C= 38 [57.6%]. Etiological factors for HE were as; HCV antibodies were positive in 32 [48.48%], HBsAg was positive among 18 [27.27%], HBsAg and HCV antibodies both were positive in 09 [13.64%], Alcoholics were 07 [10.6%] and Frequency of H. pylori was found in 47 [71.2%]

Conclusion: in our study we found that before and after 10 days H. pylori eradication therapy, there was no significant improvement in HE grade and other parameters. While the finding of high frequency of H. pylori in HE patients may be either co-incidence or co-relation that needs further vast studies

C-reactive protein [CRP] and other risk factors in acute ischemic stroke patients

Introduction: Stroke is a common cause of mortality and morbidity in developing countries; stroke is second leading cause of death after cardiac disease worldwide. Apart from established major risk factors for Ischemic Stroke [IS] i.e.; Hypertension, Diabetes Mellitus, Smoking and Hyperlipidemia, a burning but still debatable issue is raised serum C - reactive protein [CRP], that is also thought to be the major risk factor for acute IS due to participation in formation of Atherosclerosis in the cerebral vessels in genetically prone patients

Objective of study: To find out significance of serum levels of CRP among CT scan proved acute ischemic stroke patients

Study Design and Place: This is a prospective observational study was conducted at Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad from July 2009 to June 2010

Data Collection: Patients meeting the inclusion criteria were enrolled in this study after obtaining informed consent, and were evaluated thoroughly for c reactive protein and other risk factors. All the selected cases were investigated for; Complete blood count, Urine detail report, CT scan brain plain, Serum C-Reactive Protein [CRP] Level, Fasting and Random Blood Sugar, Fasting Lipid Profile ECG and X-Ray chest PA View. The data was collected on a predesigned proforma designed for this study

Results: Out of 150 selected adult cases of CT scan proved Ischemic Stroke, male were 120 [80 %] and female were 30 [20 %]. Male to female ratio was 4:1. Their ages were between 20-80 years. Among these patients high level of CRP [> 10mg / L] was found in 132 [88 %]. Out of these Male were 110 [73.3 %] and that of Female were 22 [14.7%] respectively. Frequency of other major risk factors in male and female IS patients was also observed

Conclusion: A close relationship between high level of CRP and acute IS was found, because in acute IS patients high levels of CRP was observed but again it needs further studies high sample size to establish the c reactive protein as a independent risk factor for acute ischemic stroke

Frequency of helicobacter pylori in ischemic stroke

Objective: To find out the frequency of helicobacter pylori antibodies [IgG] among cases of ischemic stroke

Study Design: Cross-sectional study

Place and Duration: Medical Unit-II, Liaquat University Hospital Jamshoro/Hyderabad, from July 2009 to June 2010

Methodology:Helicobacter pylori [H.pylori] antibodies [IgG] on ELISA and color doppler ultrasound of carotid arteries were performed in CT Scan confirmed cases of ischemic stroke along with other routine investigations. A pre-designed proforma was used to record the data

Results: Among 150 CT scan confirmed ischemic stroke cases, 110 [73.3%] were males and 40 [26.7%] were females [2.7:1]. The H.pylori antibodies [IgG] were present in 121 [80.7%] cases among which males were 99 [66%] and females were [14.7%]

Conclusion: H.pylori antibodies [IgG] were present in very high proportion [80.7%] among cases of ischemic stroke

Diurnal variations in the levels of progesterone during late pregnancy

Progesterone is a C-21 steroid hormone, plays a major role in the occurrence, maintenance and termination of pregnancy. To study the diurnal variations in the levels of progesterone at the start and end of the day during late pregnancy in women having different life set ups. Experimental and Observational Study. This study was conducted at the Department of Gynae and Obs., Khyber Medical College, Peshawar. Blood samples of 50 women between 26-40 weeks of gestation were collected at two different intervals with a gap of 12 hours. Progesterone level was estimated by Serozyme EIA method. The concentration of progesterone was found low in the early morning and high in the late evening in our population. Besides, the magnitude of fluctuations in the samples of two different intervals declined with progress of age and weeks of gestation. Our findings support the recommendation of restricting progesterone measurements to morning hours at all ages particularly during late pregnancy which is important information for clinicians at the time of interpretation of results

Prevalence of hepatitis C virus in blood donors

To determine the prevalence of hepatitis C virus in healthy blood donors. A prospective descriptive study. This study was conducted in the Pathology Department Combined Military Hospital, Multan within 3 years from 01-07-2007 to 30-06-2010, A total of 18042 blood donors ranging from 18-55 years of age were screened for hepatitis C virus antibodies by ELISA method. Hepatitis C virus antibodies were positive in 602 [3.3%] Seroprevalence of hepatitis C is high even in healthy young blood donors

Prevalence of hepatitis B virus in blood donors

There is no treatment available once get infected with hepatitis B virus. Transfusion of blood contaminated with HBV is one of the major risk factors for increasing its Seroprevalence. To determine the prevalence of Hepatitis B virus in healthy blood donors. A prospective descriptive study. This study was conducted in department of pathology Combined Military Hospital Multan during a period of three years from 01.07.2007 to 30.06.2010. A total number of 18042 blood donors in between 18-55 years of age were screened for transfusion related carriers of infectious diseases including hepatitis B virus by ELIZA technique. Hepatitis B virus suface antigen was detected in 561 [3.1%] Seroprevalence of hepatitis B is high even in healthy and young blood donors. Therefore every donor should be screened for it

Bottom up and top down: a comprehensive approach to improve care and strengthen the health system

To describe how building and deploying a network of quality assurance teams can strengthen the health system and the quality of care it delivers. The intervention described consists of a multidisciplinary core team at the national level, trained as trainers, that provides oversight of regional and district quality assurance teams whose purview is to improve the quality of care and operational functions. Quality assurance teams continuously identify and address systemic barriers to the timely delivery of quality services. In parallel, the process involves improving the management capabilities of facility directors and administrators through the use of quality improvement activities that identify and resolve local management and clinical care problems. A case study of Garissa Province in Kenya shows how this approach was used over a period of several years. National and provincial teams provided systematic oversight, feedback and support. Strong leadership at the district hospital promoted numerous quality improvement strategies that involved local institutional and community problem solving. They achieved greater financial transparency and security, substantially increased utilization of services, decreased response time and raised staff morale and commitment. Policies and strategies on paper neither improve care nor the health system unless they are implemented and there is a dedicated trained team to provide oversight. Continuous quality improvement processes at facility level and prompt resolution of system problems lead to increased accountability, quality of care and a stronger health system

Tinnitus matching

To study the pitch and loudness of tinnitus and to find minimal masking level. Descriptive analytical study. This study was conducted at Combined Military Hospital Rawalpindi, the tertiary referral center for Pakistan Armed Forces from 1998 to 2001. Patients with tinnitus were included in the study. Exclusion criterion was transient tinnitus settling on removal of offending agent like foreign body and not having tinnitus as major presenting feature. Patients were thoroughly interviewed and tinnitus card [questionnaire] was filled. Thorough general physical and Ear Nose Throat examination was carried out including relevant tests to elucidate any cochleovestibular pathology. All patients had pure tone audiometery and tinnitus testing and sophisticated investigations were carried out whenever indicated. Most patients of tinnitus were seen between age of 40 to 60 years and 76.6% patients were male. Hearing loss accompanied tinnitus in 90% patients and 53% patients had tinnitus of moderate intensity. Pitch match frequency of 4 kilohertz was seen in 25.3% while 29% patients had loudness match of tinnitus ranging from 55 to 70 decibel [dB]. In vast majority [24%] minimal masking level ranged from 41 to 55 dB. Seventy nine percent patients had pitch match frequency at or around frequency of maximum hearing loss. Tinnitus is seen predominantly among males and its frequency increases with age .It is usually of moderate intensity and is of high pitch which corresponds to frequency of maximum hearing loss. Pitch of tinnitus is not a good indicator of degree of annoyance while loudness match gives a good measure of annoyance. Minimal masking levels are at or around loudness match. Tinnitus in majority of patients is associated with mild to moderate degree of hearing loss

Presentation of retinoblastoma in South Punjab

To study the mode of presentation of retinoblastoma in South Punjab. Department of Ophthalmology, Nishtar Hospital, Maltan. A retrospective study was carried out on children who visited Eye Department, Nishtar Hospital, Multan from March 2005 to February 2007. Forty patients were included in the study. The age of children ranged from 6 months to 6 years. The most children presented were with proptosis. A total of 40 patients were included in the study. Out of these 40 patients, 24 [60%] were male and 16 [40%] were female. Their mean age was 3-5 years. Children [45%] presented with proptosis. Therefore it is mandatory that all the children must be screened keenly and referred to tertiary hospital for proper evaluation and management. The late presentation of retinoblastoma is due to unawareness of people living in far flung areas where people are uneducated and poor and go to hakeems, peers and believe on jaddu and tona etc. Arrangement should be made for early screening of children and education of people for early symptoms and signs of the disease

Acquired spontaneous intercostal hernia

A case of acquired spontaneous intercostal hernia is being presented. The aetiology, clinical features, radiological findings and management are discussed

Rectus sheath haematoma presenting as acute abdomen

Rupture of epigastric vessels or tearing of the recuts abdominis fibres causes rectus sheath hematoma. Diagnosis can be difficult; a high index of suspicion is essential to prevent unnecessary surgery. Investigations of choice are an abdominal ultrasound and CT scan but the former may not always be helpful and the latter not always available. We are reporting a case that was properly diagnosed and treated on clinical grounds only

Small intestinal perforation caused by tape worm

Infestation with tapeworms is common and does not always have serious sequelae. Howerver, some times they can cause serious problems including intestinal perforation. We are reporting a rare cause of intestinal perforation cauded by a 360 cms long tapeworm

Brunner's gland adenoma: Case report with review of literature

Brunner's gland adenoma is a rare benign tumor of the duodenum. Less than 150 cases have been reported in the literature. We are reporting the case of a 50 years old lady who presented with upper gastrointestinal symptoms. An abdominal ultrasonography showed hydatid cyst of liver, but on laparotomy a duodenal mass was found which turned out to be Brunner: gland adenoma on histopathology. A review of literature is being presented

Efficacy and safety of halofantrine in Pakistani children and adults with malaria caused by P. falciparum and P. vivax.

One hundred two patients aged 2-43 years diagnosed with acute malaria due to P. falciparum or P. vivax were treated with 3 doses of halofantrine (500 mg for > or = 18 year old patients and 8 mg/kg of patient body weight for 2-17 year olds), with each dose administered once in 6 hours and followed up for 28 days. Out of 102 patients 63 had P. falciparum, 36 had P. vivax and 3 had unidentified species. Following three dose therapy, 96.1% (98/102) of patients were cured, 0.98% (1/102) showed improvement from baseline, 1.96% (2/102) did not respond and were considered as treatment failures and one patient had indeterminate data. The lone patient, who relapsed after 120 hours post dose 1, was cured following re-treatment on day 7. The median parasite clearance and fever clearance times, from the first dose, were 26 hours and 30 hours, respectively. Eleven point eight percent (12/102) of patients reported adverse events, of which abdominal pain, reported by one subject, was considered to be probably related to the drug and required corrective therapy. There were no serious adverse events or fatalities and none of the patients had a change in QTc interval greater than 10%. Thirteen point seven percent (14/102) of patients had abnormal clinical laboratory parameters that normalized later.

Giant hydronephrosis presenting as acute abdomen

We are reporting an interesting case where the right kidney had undergone hydronephrosis of gigantic proportion due to ureteropelvic junction obstrucion. The patient presented as an acute abdomen with no history of trauma. On laparotomy, he was found to have giant hydronephrosis of the right kidney with extensive oedema of the retroperitoneum due to leakage of urine

Metastatic carcinoma of the gall bladder presenting as obstructed inguinal hernia

Metastatic deposit of an intra-abdominal malignancy in the sac of an inguinal hernia is a rare phenomenon. This is the case report of an elderly gentleman who presented to us with metastasis in the sac of a left inguinal hernia from carcinoma of the gall bladder