Comparison of topical versus peribulbar anesthesia for 23g pars plana vitrectomy

Objective: To compare the safety and efficacy of topical anesthesia versus peribulbar anesthesia for 23-gauge pars plana vitrectomy

Study Design: Randomized controlled trial

Place and Duration of Study: Ophthalmology Department, Lahore General Hospital, Ameer-ud-Din Medical College, Postgraduate Medical Institute, Lahore from April 2013 to March 2016

Methodology: A total of 110 patients were equally divided [n=55] in group A [topical anesthesia] and group B [peribulbar anesthesia]. In group A, pledget soaked with 0.5% proparacaine hydrochloride were placed in the superior and inferior fornices three minutes before surgery, and removed just before surgery. For group B patients, 3 ml of 0.5% bupivacaine was used for peribulbar anesthesia three minutes before surgery. Surgical time was noted from the placement of pledget in fornix till the eye pad placed in group A, and from the time of peribulbar anesthesia in group B till the eye pad placed at the end of surgery. All data was recorded in Excel sheet and p-values were calculated using online OpenEpi

Results: The mean age of the patient was 56.28 +/-13.76 years. Male patients were 78 [70.9%] and female patients were 32 [29.1%]. Mean duration of surgery was 30.32 +/-7.07 minutes and mean pain score was 2.30 +/-0.98. There was a significant difference with respect to mean duration of surgery in patients who were given topical anesthesia [32.52 +/-6.92 minutes] versus those given peribulbar anesthesia [28.12 +/-6.57 minutes, p<0.001]. Mean pain score in topical anesthesia group [3.11 +/-0.89] was significantly higher as compared to peribulbar anesthesia group [2.67 +/-0.91, p=0.011]

Conclusion: Topical anesthesia is as effective as peribulbar anesthesia in terms of patient comfort and duration of surgery for 23-G pars plana vitrectomy in patients with vitreous hemorrhage

Rationalization of routine crossmatched blood arrangement for caesarean deliveries and analysis of risk factors requiring blood transfusion

Objective: To assess the incidence of blood transfusions required in Caesarean section [CS] and evaluate the rationale of routinely arranging cross matched blood for every patient

Study Design: A chart review retrospective descriptive study

Place and Duration of Study: This study was conducted at the Anesthesia Department of Combined Military Hospital [CMH], Lahore, from June 2011 to May 2013

Patients and Methods: In this retrospective study we reviewed all singleton CS performed using data from blood bank registry and all CS patient's charts obtained from the Records Department of the hospital. Clinical variables including demographic characteristics, estimated blood loss, indications for CS, preoperative haemoglobin and indications for transfusion were gathered. Patients transfused with blood had their medical records reviewed by two reviewers to confirm accuracy and identify risk factors for haemorrhage

Results: A total of 6250 caesareans deliveries were performed over the study period. Out of these 381 patients were transfused [6.09%]. Blood typing and screening was done for 3260 cases [52%] and blood was arranged for 2320 [37%]. Among blood receiving patients 250 patients [65.62%] were emergencies. Ninety eight patients [25.72%] were primigravida. Indications for transfusion mentioned in the charts were preoperative anaemia [18.37%], repeat caesarean sections [39.37%], placenta previa [6.56%], severe preeclampsia [17.06%], failed progress in labor and other rare causes [18.37%]

Conclusion: Transfusion risk in patients undergoing routine CS is low. Factors indicating risk for transfusion include preoperative anaemia, repeat caesareans, severe preeclampsia, obstructed labor and placenta previa. In the absence of these risk factors routine arrangement of the blood does not enhance patient care

Visual outcome and complications of phacoemulsification catract surgery performed by residents at al ibrahim eye hospital, karachi

To describe visual outcome and the complications related to cataract surgery performed by phacoemulsification technique by fourth-year ophthalmology residents at Al-ibrahim eye hospital, Karachi, who are trained to perform phacoemulsification with prior experience with manual extracapsular extraction. Prospective, observational case series. We prospectively analyzed the incidence of complications and visual outcomes in the initial 575 phacoemulsifications [575 patients] performed by the 5 residents learning phacoemulsification in our training programe. All were experienced in standard [manual] extra capsular cataract extraction. Postoperative follow up of 6 weeks was available in 547 eyes. The 28 patients [28 eyes] lost to follow up did not have any intra-operative complications. Of 575 cataract surgeries, 559 eyes [97.2%] were performed using phacoemulsification technique. Posterior capsule disruption without vitreous loss occurred in 16 [2.8%], vitreous loss in 15 [2.6%] and IOL displaced into vitreous in 4 [0.7%] of 559 cases that underwent phacoemulsification technique. Other complications encountered in-Cluded localized corneal edema [23 eyes], iris damage interiorly [1 eye] and clinical cystoid macular edema [1 eyes]. A best corrected visual acuity of 6/ 12 or better was obtained in 521 eyes [95.2%] of the 547 eyes available for the six week follow up. In the eyes with vitreous loss, 10 out of 15 had visual acuity better than 6/12. The residents can perform phacoemulsification well with a very low complication rate, with prior training with extra capsular cataract extraction technique

National study of reproductive tract infections among high risk groups of Lahore and Karachi

To estimate the prevalence of reproductive tract infections [RTIs] among the Female Sex Workers [FSWs], Male Sex Workers [MSWs], Injecting Drug Users [IDUs] and truck drivers. Cross-sectional. Lahore and Karachi, from March to August, 2004. Four hundred FSWs, 400 MSWs, 200 eunuchs, 400 IDUs and 400 truck drivers were interviewed and examined. Biological testing included PCR and ELISA. The mean prevalence of syphilis was 17.7% [95% CI: 15.1-20.3%]. Genital gonorrhoea was found among 0.8-12.3% of subjects with mean of 4.5% [95% CI: 0.8-5.2%]. Genital chlamydia was seen in 0.2-11% individuals with mean of 2.6% [95% CI: 2.1-3.1%]. Trichomonas was present in 19.3% FSWs of Lahore and 5.52% FSWs of Karachi. Only 0.8% truckers in Lahore had trichomonas. In Lahore, 47.6% FSWs and in Karachi, 27.4% FSWs were positive for bacterial vaginosis. A vast majority of IDUs, 91.8% in Lahore and 87% in Karachi were hepatitis C positive. The prevalence of syphilis is very high among all high-risk groups; particularly so among eunuchs [60.2% in Karachi and 32.3% in Lahore]. Such a high levels of RTIs indicate a serious threat for HIV epidemic because of socially transmitted infection