RESUMEN
Objective: To compare the difference in peripapillary Retinal Nerve Fibre Layer [RNFL] thickness between normal population and Type-II diabetic patients without diabetic retinopathy using Spectral Domain Optical Coherence Tomography [SD OCT]
Methods: This cross sectional study was carried out at PNS Shifa Naval Hospital, from May 2017 to November 2017. Out of 200 eyes, 100 eyes were of normal individuals and 100 eyes were of Type-II diabetic patients without diabetic retinopathy. Both groups were age and gender matched. Average RNFL thickness, along with RNFL of each quadrant of individuals was noted using SD OCT, and compared between two groups
Results: Mean age of study population was 44.63 +/- 4.30 years. Mean axial length was 23.46 +/- 0.59 mm. Mean peripapillary RNFL thickness was 126.98 +/- 10.07 µm in Group-A [normal individuals], and 120.77 +/- 5.41 µm in Group-B [Type-II diabetics]. Difference in mean RNFL thickness, as well as RNFL thicknesses of each quadrant was statistically significant between both groups [p-value < 0.001]
Conclusion: Diabetic patients have thin RNFL as compared to normal individuals, and must be taken in account while making diagnosis of any disease based on thinning of RNFL.
RESUMEN
Objective: To determine diagnostic accuracy of Cerebro Spinal Fluid [CSF] Adenosine De-Aminase [ADA] in detecting Tuberculous Meningitis [TBM] keeping CSF Polymerase Chain Reaction [PCR] for Mycobacterium Deoxy Ribonucleic Acid [DNA] as gold standard
Methods: This cross sectional validation study was conducted at Department of General Medicine of PNS Shifa Naval Hospital Karachi, Pakistan from Oct 2015 to Mar 2017 for a total duration of one and a half year. One hundred and thirty six patients were included. The diagnosis of TBM was based clinically on symptoms like fever, headache, altered mental state and signs of meningeal irritation with CSF findings of increased proteins, low glucose and lymphocytic pleocytosis. Lumbar puncture was done and approximately 4ml of CSF sample was withdrawn for analysis. Diagnosis of TBM was confirmed by doing CSF PCR test for mycobacterium tuberculosis DNA
Results:Total 136 patients were enrolled in this study. Mean age in our study was 47.09 +/- 12.80 years, whereas frequency and percentages of male and female patients was 102 [75 percent] and 34 [25 percent] respectively. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of CSF ADA level in detecting TBM was 71.32 percent, 84.21 percent, 95.45 percent, 98.97 percent and 53.85 percent respectively
Conclusion: The study concludes that diagnostic accuracy of CSF ADA in detecting TBM is high which is proposed as an investigation to differentiate it from other causes of meningitis in places where PCR test is not available
RESUMEN
Objective: To compare corneal morphological parameters between diabetics and age matched non-diabetic control subjects and to evaluate the correlation of these parameters in relation to duration of diabetes mellitus [DM], glycemic status and severity of diabetic retinopathy.[DR]
Methods: This cross sectional comparative study was conducted at the Department of Ophthalmology, PNS Shifa Karachi from February 2016 to January 2017. Patients with ages between 10 to 80 years of either gender who were diagnosed to have DM were recruited in the study. Control group comprised of age matched healthy volunteers who did not have DM. Corneal morphological parameters [CED, Average cell size, CV of cell size and hexagonality] was evaluated in each subject with non-contact specular microscope and findings were endorsed on a pre devised proforma
Results: Data of 298 eyes [149 diabetic patients and 149 healthy controls] was evaluated. Mean corneal endothelial cell density [CED] of diabetic population was 2494.47 +/- 394.10 cells/mm[2], while mean CED of control group was 2574.46 +/- 279.97 cells/mm[2] [p = 0.04]. Between group differences in mean average cell size, CV of cell size and hexagonality was statistically not significant. Analysis of corneal endothelial parameters among subgroups of patients with no DR, with NPDR and PDR did not show statistically significant difference. Moreover, patients with diabetes of more than 10 years duration had significantly lower CED [p <0.01] and larger average cell size [p= 0.03]. Duration of DM was significantly correlated with type of DR, HbA1c level, CED, polymegethism and hexagonality
Conclusion: Mean corneal endothelial cell density [CED] was found to be significantly lower in diabetic population as compared to healthy controls
RESUMEN
To determine the association of steroid receptor expression and HER-2/Neu expression in different age groups in breast cancer patients at Combined Military Hospital Rawalpindi. Descriptive study Department of Oncology, CMH Rawalpindi, from Jan 2009 to December 2010. A prospective study in which 257 patients, of both genders more than 18 years old with histopathological diagnosis of carcinoma breast, were stratified into three age groups [<35 years, 35-50 years and >50 years]. Estrogen and progesterone receptor and HER-2/neu receptor status was determined in all the patients. Positive status of either estrogen or progesterone receptor was considered as steroid receptor positive. Association of HER-2/neu with the steroid receptors was determined in all the age groups. Estrogen receptor was positive in 95 [38.2%] patients. Progesterone receptor was positive in 144 [57.8%] patients. Steroid receptor was positive in 160 [64.3%] patients. One third [32.9%] of the patients were positive for HER-2/neu. Positive cases of HER-2/neu were significantly higher in negative steroid receptor cases as compared to positive cases [50.6% vs. 23.1%, OR = 3.324, p<0.001]. In age groups "35 - 50 years" and "> 50 years", this inverse association of HER-2/neu status with steroid receptor was significant. HER2/neu receptor status should be determined in all patients but if it is not possible due to the local availability of facilities as well as affordablility of the patients, patients who are steroid receptor negative should be referred to laboratories capasle for accurate determination of HER-2/neu receptor status as these patients are more likely to be positive for HER-2/neu receptor status
RESUMEN
Chemotherapy used for malignant diseases may produce severe neutropenia in first cycle which may compel for dose modification and early termination of therapy. This descriptive cross sectional study was planned to see the frequency and severity of neutropenia after first cycle of chemotherapy comprising cyclophosphamide, doxorubicin, vincristine with prednisolon in patients of diffuse large B-cell non Hodgkin's lymphoma presenting at Oncology Department Combined Military Hospital Rawalpindi from August 2009 to July 2010. Thirty patients of diffuse large B-cell non Hodgkin's lymphoma diagnosed on lymph node biopsy presenting for the first time at Oncology Department Combined Military Hospital Rawalpindi were included. They were admitted in the ward and evaluated with history, physical examination and staging investigations. Patients were then planned for first cycle of chemotherapy comprising cyclophosphamide, doxorubicin, and vincristine with prednisolon. After the first cycle of chemotherapy they were monitored for expected neutropenia in the ward. The neutrophil counts were repeated on days 7 and 10 following chemotherapy. Neutropenia was graded as defined in the operational definition and all the data was entered on a specially designed data card. As much as 3.3% of patients suffered from grade IV neutropenia [absolute neutrophil count of <0.5x10[9]/L], 3.3% had grade III neutropenia [absolute neutrophil count of 0.5x10[9]/L- 0.9x10[9]/L], 6.6% had Grade II neutropenia [absolute neutrophil count 1.0x10[9]/L-1.4x10[9]/L and 10% had Grade I neutropenia [absolute neutrophil count 1.5x10[9]/L-1.9x10[9]/L. Overall 23.2% suffered from neutropenia of all grades post 1st cycle of chemotherapy comprising cyclophosphamide, doxorubicin, vincristine with prednisolon in diffuse large B-cell non Hodgkin's lymphoma. Further studies are required to find the risk factors to predict this complication in our population