Effect of half adult dose of oral Rifampicin [300mg] in patients with idiopathic central serous chorioretinopathy

Objectives: To evaluate the effect of half adult dose of oral Rifampicin on mean change in best corrected visual acuity and central macular thickness in patients with central serous chorioretinopathy

Methods:Thirty-eight eyes of 31 patients with idiopathic central serous chorioretinopathy [CSCR] were registered. Unaided Visual acuity, best corrected visual acuity was documented and detailed slit lamp examination along with dilated ophthalmoscopy was performed. All subjects were treated with oral Rifampicin 300 mg [half adult dose] daily for 03 months. Patients underwent a complete ocular and systemic examination as well as central macular thickness [CMT] measurement by optical coherence tomography [OCT] every month after starting treatment until four months. Fundus fluorescein angiography [FFA] was performed in recurrent cases. Liver function tests were carried out prior to the treatment and during follow up period

Results:A total of 38 eyes of 31 patients [24 males, 07 females] were included in the study. Mean age of patients was 36.16+/-3.19 years [range 30-44]. Mean best corrected visual acuity [BCVA] before treatment was 0.56+/-0.11 and improved to 0.47+/-0.14 at 04 weeks [P<0.001] of treatment. The mean CMT at the time of presentation was 494.39+/-96.29 um and was decreased to 306.90+/-50.71 um after 04 weeks of treatment [P<0.001]. The mean induced reduction in CMT was 187.48+/-122 um [P<0.001] while that in BCVA 0.41+/-0.16 at 04 weeks of treatment [P<0.001]. Liver function tests were within normal range before and after the treatment

Conclusion:Half adult dose rifampicin [300mg] is effective and safe in treatment of central serous chorioretinopathy without causing any systemic imbalance

Acute appendicitis mean platelet volume

Objectives: To study mean platelet volume [MPV] in acute appendicitis and its correlation with leukocyte count

Study Design: Case control study

Place and Duration: Department of Surgery, Liaquat University of Medical and Health Sciences Jamshoro/Hyderabad from January 2013 to February 2014

Subjects and Methods: Subjects with clinical suspicion of acute appendicitis were selected according inclusion and exclusion criteria. A sample of 49 acute appendicitis patients and 37 controls were studied. The Blood samples were collected in sodium citrate vacutainers and processed on Sysmex KX 21 analyzers. The main analysis was the comparison of the difference of MPV between acute appendicitis and controls. Data was analyzed on SPSS version 21.0 by student's t-test, Chi-square test and Pearson's correlation [r] was used to evaluate association of MPV with platelet counts and leukocytes. A p-value of

Results: The mean platelet volume and leukocytes were significantly elevated in patients with acute appendicitis. MPV and leukocytosis in controls and cases were noted as 7.93 +/- 2.1 vs. 9.10 +/- 2.9fl [p=0.0001] and 6980 +/- 120 vs. 13980 +/- 340 micro L[-1] respectively. MPV was positively correlated with leukocytosis [r=0.419] [p=0.0001], while Platelets showed a negative correlation

Conclusion: Elevated MPV and leukocytosis are observed in acute appendicitis. MPV may be exploited for clinical diagnosis of acute appendicitis but in a proper clinical context along with leukocytosis

Visual acuity outcomes after intra vitreal ceftazidime in acute post-operative endophthalmitis

To determine effectiveness of ceftazidime as an intraocular antibiotic in the treatment of acute post operative endophthalmitis. This was an observational clinical analysis conducted on patients presenting with acute post-operative endophthalmitis. The study was conducted at Liaquat University Eye Hospital of Liaquat University of Medical and Health Sciences /Jamshoro, Pakistan. Both culture positive and negative subjects were enrolled. Anterior segment slit lamp examination and if possible posterior segment examination was performed. After completing emergency investigations, vitreous tap was carried out followed by intravitreal injection of ceftazidime [2.25%] through pars planna approach. The post-resolution best corrected visual acuity was recorded. Out of thirty four subjects, 32.4% [11 Eyes] showed good response with post treatment visual acuity of 6/24 and better. 41.2% [14] eyes had moderate improvement with visual outcome of 6/60 and better. Intravitreal injection ceftazidime was repeated on nine subjects after forty eight hours of first injection. Four [11.7%] patients out of nine with repeat injection improved to 6/60 and better, and five [14.7%] with poor response were referred to vitreo retina department. Ceftazidime has proved to be quite effective in acute post operative endophthalmitis caused by both gram positive and gram negative organisms

Pilonidal sinus: excision with primary midline closure versus open method

Objective: To compare the efficacy of primary closure versus open method after excision of pilonidal sinus

Design: Comparative study

Setting: Department of Surgery Liaquat University of Medical and Health Sciences, Jamshoro, Sindh - Pakistan, from January 2003 to December 2006 [4 years]

Material and Methods: Cases of chronic pilonidal sinus were included in this study whereas acute sinuses and recurrent sinus were excluded. Patients were conveniently selected for excision with closure and without closure [group A and group B]. Both groups were followed up for 18-months. Efficacy assessed and compared on the basis of operating time, duration of postoperative hospital stay, time off work and recurrence rate

Results: Each group comprised of 20 patients. The mean age of all 40 patients was 27-years [17-42 years]. Males were 37 [92.5%] and females were 3 [7.5%]. Respective observations for both groups were mean operative time 91 min [85-95 min] and 69 min [60-75 min], mean postoperative hospital stay 6 days [4-8 days] and 11 days [9-13 days], mean time of wound healing was 11 days [9-13 days] and 39 days [19-42 days], mean off work time was 21 days [10-26 days] and 42 days [22-46 days]. Recurrence rate was 11.1% and 5.2% in group A and group B respectively

Conclusion: Though it takes longer to excise pilonidal sinus with primary closure and it has higher recurrence rate, it appears more beneficial due to reduced hospital stay, reduced healing time and early return to work

Surgical outcome of 7-millimeter bilateral medial rectus recession in large angle child esotropia

To evaluate the surgical success in the patients undergoing bilateral 7 mm medial rectus recession for large angle esodeviation. The subjects less than 15 years of age presenting with concomitant esotropia with deviations of 60 prism diopter [PD] and more were registered for bilateral medial rectus recession surgery. Anterior segment slit lamp examination and posterior segment examination was performed with 90 D and 78D fundoscopes in selected cases. Angle of deviation was measured. All necessary investigations were completed. Surgical procedures were performed under general anesthesia. Postoperative follow-up was done. Almost 71% children underwent successful surgery with residual deviation of less than 15 PD, while 29.0% subjects developed residual strabismus. Four patients presented with foreign body granuloma. Two children developed limitation in adduction. The preoperative deviations of 60 PD showed good results with residual deviation of fewer than 15 PD. There is a need for guarded muscle correction during bilateral medial rectus recession for improvement in visual alignment and binocular function

Imipramine induced ECG changes in rabbits

An uncontrolled In-vivo study was conducted to assess alterations in heart rate, QT interval and QRS complex duration in male chinchilla rabbits. Animals [n=10] were treated with 25mg/5ml/day imipramine, through oral route of administration for five days. The electrocardiographic tracings were recorded by needle electrodes in all conscious animals first before and then after drug administration, following every day up to five days. It showed cardiotoxic effects like QT interval prolongation in addition to significant widening of QRS complex, along with decrease in heart rate. Because of these cardiotoxic effects prescribing imipramine to patients with prominent cardiovascular risk factors desires added attentiveness

Montelukast versus nigella sativa for management of seasonal allergic rhinitis: a single blind comparative clinical trial

To compare the therapeutic role of leukotriene receptor blocker Montelukast with N. Sativa seeds in seasonal allergic rhinitis patients. Comparative uncontrolled single blind clinical assessment was carried out over forty seven untreated adult patients torment from seasonal allergic rhinitis and staring for outpatient management. All patients were chosen from different primary care health centers, registered and were divided in a single-blind approach to obtain Montelukast, 10 mg/day, group I [n=24] and 250 mg/day of N. Sativa, group II [n=23] orally for two weeks. Patients joined-up the study has completed the therapeutic plan. Montelukast and N. Sativa both demonstrated a significant and early decrease in daytime as well as ophthalmic symptoms, while montelukast showed diminished and late effects on nighttime symptoms when compared with N. Sativa. In addition montelukast has also been showing to cause drug allied side effects like headache, dizziness and heart burn. It would come into view that N. Sativa is safe and thoroughly free from threat of adverse effects. So it is a liable management alternative for seasonal allergic rhinitis patients

Open globe injuries in the child population in hyderabad / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To evaluate the causes, frequency, severity of eye injury, management, visual outcome and prevention in children with penetrating ocular injury.·METHODS: The study was conducted on patients under 15 years presenting with penetrating ocular injuries. Anterior segment slit lamp examination was performed for cornea and corneo-scleral penetration, hyphema, iris prolapse, etc. Posterior segment slit lamp examination wih 90D funduscopes was done in selected cases. After performing necessary investigations, urgent surgical intervention was carried out. ·RESULTS: Out of 43 (55%) registered patients; boys were 67%, and girls 33%. The agents of trauma were glass, pencil, stick, etc. The site of entrance through cornea was 62.7%, sclera 25.6%, and limbus 11.7%. The presenting visual acuity was 6/60 and above in 32.5% children, 6/24 in 9.3%, and 6/12 and above in 2.3% cases. 37.2% cases had perception of light. Out of 36 operated eyes, twenty-nine completed post operative follow up. 10 4% subjects had final visual acuity (FVA) of 3/60. 24 2% had FVA of 6/60. 17.2% children had FVA of 6/24 partial. In 34.4% subjects, the FVA was restricted to perception of light. 10.4% developed phthisis bulbi.·CONCLUSION: Ocular trauma is a significant cause of visual loss in child population. Preventive efforts are extremely important in domestic and outdoor activities.

Surgical outcome of 21 patients with congenital upper eyelid coloboma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the surgical outcome of congenital upper eyelid coloboma repair.METHODS:All patients underwent complete ophthalmic and general examination before going to surgery,and then examination under anesthesia was performed to assess the site and size of eyelid defect,conjunctival involvement.The status of cornea and ocular motility with forced duction test was also being noted.The surgical procedure was performed according to the size of defect.RESULTS:Out of 21 cases of congenital upper eyelid coloboma,18 occurred in isolation with upper eyelid medial defect,13 were bilateral and 5 were unilateral.Others were associated with Goldenhar syndrome and CHARGE syndrome with bilateral upper lid medial defects.All patients were presented for surgical corrections during age of 2.5-4.0 years except one that presented at 25 years of age.Cosmetically surgical results were acceptable,except one that was already presented with opaque corneal.CONCLUSION:In this study overall surgical results were satisfactory except one that was presented late with compromised cornea.

A study on surgical management of 17 patients with consecutive strabismus in hyderabad / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To determine the clinical course and management of patients undergoing surgery for consecutive strabismus.METHODS: Patients less than 45 years of age presenting with consecutive strabismus were divided into two groups (1-Esodeviation and 2-Exodeviation). Angle of deviation was measured in prism diopter (PD). Conservative therapy was experienced during the course of follow-up after first surgery. All the subjects with deviation of more than 15PD after six months of follow-up were selected for repeat surgery. Compulsory investigations were performed. Secondary surgical procedures were performed under general anesthesia. Postoperative follow-up was done at 3 days, 15 days, 3 months and 6 months.RESULTS: Subjects(28.8%)developed consecutive stra-bismus within the study period. Second surgery on a dominant (fixating) eye in all patients was performed within 6 to 9 months after first surgery. After second surgical interven-tion, good surgical outcome was obtained and the tendency towards over correction was not observed in both groups during follow-up period.CONCLUSION: There is a need for guarded muscle correction during second surgery to avoid over corrections in future.

Frequency of hodgkin's lymphoma in patient with cervical lymphadenopathy presenting in a public hospital in Pakistan

Objectives: To determine the frequency and pattern of presentation of Hodgkin's lymphoma in cervical lymph node at Liaquat University Hospital, and to see its pathological variants. Study design: Case series. Study Setting: Surgical departments of Liaquat University Hospital. Study Duration: Five years from January 2000 to December 2004

Sampling: Non-probable purposive. Inclusion Criteria: All patients of cervical lymph node enlargement of more than four weeks duration irrespective of age and sex. Exclusion Criteria: Cervical lymph node less than 1cm. Study Variables: Study variables used were age, sex, symptom, clinical finding, stage and histopathology. Data Analysis: Data analysis was done by using SPSS version 10

Results: A total of 500 patients with enlarged cervical lymph nodes were studied, amongst them 40 [8%] patients were diagnosed with Hodgkin's lymphoma [32 males and 8 females]. Mean age of 40 patients was 23 years [range 9-44 years]. Out of these 40 patients, in 8 [20%] patients it was difficult to differentiate lymphoma clinically from tuberculosis on clinical examination. Cervical swelling was the commonest symptom [100%] while fever, night sweats and weight-loss were present in 45% patients, 55% of patients were in stage III and IV [advance disease]. Mixed cellularity was the commonest histological variant. All 40 patients after diagnosis and staging were referred to Nuclear Institute of Medical Radiotherapy for further management

Conclusion: Although tuberculous cervical lymph node enlargement is very common, but Hodgkin's lymphoma has a definite possibility of occurrence [8% in our study]. Therefore all patients with enlarged cervical lymph node should not be treated with anti-tuberculosis therapy on empirical basis. Diagnosis should be confirmed by biopsy, otherwise patients may land up with advanced stage of Hodgkin's lymphoma with poor prognosis

To determine prevalence of pseudo exfoliation at a tertiary eye care centre: a hospital based study

To report the prevalence of pseudo exfoliation in association with Cataract and other ocular diseases at a tertiary eye care centre in Sindh, Pakistan. This was a hospital based study at Liaquat University Eye hospital, Hyderabad Sindh, Pakistan conducted from July, 2005 to November, 2006. A total of 1450 subjects of more than fifty years with senile cataract were registered who underwent a comprehensive ophthalmic evaluation. Visual acuity, refraction, Goldmann applanation tonometry, gonioscopy, slit lamp examination, and dilated pupil fundus examinations were performed. Pseudo exfoliation was diagnosed on slit lamp biomicroscopy by the presence of white dandruff-like material at papillary margin, on the anterior lens capsule, and trabecular meshwork, in one or both eyes. Out of 1450 patients, sixty five [4.48%] subjects was diagnosed having senile cataract with pseudo exfoliation. There was a significant increase in prevalence with age. Out of 65 cases, 15 cases [23.0%] were unilateral and 50 cases [76.9%] bilateral. Forty one eyes [63.0%] had raised intraocular pressure, in which four eyes [9.7%] had angle closure glaucoma, and 37 eyes [90.2%] had pseudo exfoliation [open angle] glaucoma. The prevalence of nuclear cataract was significantly higher [66.1%] in patients with pseudo exfoliation. It appears to be a common disorder in older individuals in the notified area. The association of pseudo exfoliation [PXF] with aging and cataract has public health implications

Clinical pattern and management outcome of phyllodes tumor of breast

To determine the clinical and histopathological pattern, surgical protocol and need of adjuvant therapy for phyllodes tumour of breast Case series. Surgical department of Liaquat University Hospital Jamshoro, from November 2000 to October 2006. All female patients with phyllodes tumor of breast diagnosed after triple assessment were included. Non probable purposive sampling technique was used. Female having carcinoma breast were excluded. After taking consent data related to age, parity, site, size of tumor, treatment options, histopathology and metastatics work up done [in case of malignant disease]. Patients were advised follow up for minimum period of two years. Data was collected on proforma and analysed by SPSS version 10. A total of 35 patients with phyllodes tumor were studied. Out of these 23[67.5%] were benign, 5[14.3%] were borderline and 7[20%] were malignant. Mean age was 24 years. All patients were assessed by triple assessment. Nine[25.7%] patients had lumpectomy and 26[74.3%] underwent mastectomy. Patients with proven malignancy and borderline disease on histopathology were submitted for adjuvant chemoradiotherapy. Patients were followed for minimum period f two years. There was one recurrence after lumpectomy among benign disease [16.66%] while there was no recurrence after mastectomy with or without chemoradiotherapy. Phyllodes tumor must be vigorously treated with wide local excision or mastectomy followed by adjuvant chemoradiotherapy in malignant or borderline tumor to minimize recurrence

Frequency of glaucoma in children with vernal conjunctivitis using steroids

To determine the frequency of glaucoma in children with vernal conjunctivitis using topical steroids, referred to a tertiary eye care centre. Descriptive case series. This study was carried out at department of Ophthalmology, Liaquat University Eye Hospital Hyderabad, Sindh - Pakistan, from July 2002 to December 2004 [Thirty months]. A total of 200 patients with chronic allergic conjunctivitis using topical steroids [Betamethasone, Dexamethasone, Prednisolone] for more than six months were examined. A thorough examination including visual acuity, Goldmann applanation tonometry, Schiot'z tonometry, Gonioscopy, slit lamp examination and dilated Ophthalmoscopy were performed. Out of 200 patients examined, fifteen [7.5%] were found having raised intraocular pressure [secondary glaucoma] due to prolonged use of topical steroids. The rise of intraocular pressure was bilateral in three patients [1.5%], and unilateral in twelve patients [6.0%]. The topical steroids were discontinued. One patient with vernal conjunctivitis using topical steroids since more than two years developed left optic disc pallor with constriction of visual field, and posterior sub capsular cataract. The intraocular pressure was not controlled by ocular hypotensive agents, and glaucoma filtration surgery was advised. This study identifies the risk of intraocular pressure elevation in patients with allergic conjunctivitis, using topical steroids for longer periods. Long term use of topical and systemic steroids produces secondary open angle glaucoma similar to chronic simple glaucoma. We can conclude that Dexamethasone and Prednisolone are possible risk factors for producing glaucoma

Role of Diosmin in the treatment of hemorrhoids

To determine the role of diosmin in the management of haemorrhoidal disease. Interventional study. Department of Surgery, Liaquat University Hospital Jamshoro/Hyderabad and Sindh Employees Social Security Institute [SESSI] Hospital Kotri, from 1[st] January 2003 to 31[st] December 2004. A total number of 147 patients [99 males and 48 females] with haemorrhoids presented to outpatient department. All of them after evaluation of symptoms and signs of haemorrhoidal disease were prescribed diosmin [Tab. Daflon 500-mg 2xBD] for four weeks and patients were reviewed weekly for four weeks. Improvement of symptoms and proctoscopic findings were observed, and comparison done between first visit and last visit. Patients were followed for the maximum period of six months. Out of total 147 patients 142 [96.5%] came up to 3-months and 136 [92.5%] followed up to 6-months. Out of these 136 patients 67 [49.3%] patients had no recurrence of symptoms while 43 [31.6%] patients had no improvements in symptoms and 26 [19.1%] patients had recurrence of symptoms after temporary relief. Therefore these 69 [50.7%] were submitted for surgery. It was concluded that diosmin improves haemorrhoidal symptoms significantly for sufficient time so patients should initially be treated with diosmin

Sublingual dermoid cyst

A case of 22 years old male with a sub lingual swelling causing discomfort in deglutition and speech is reported. The pathology was diagnosed as sub lingual dermoid cyst. It was completely excised from an oral approach. Later, the normal functions of tongue were restored without any residual complaint

Prevalence of trachoma in thar desert area of Sindh

To determine the prevalence of trachoma in a given population. A cross - sectional study. Department of Ophthalmology, Civil Hospital, Mirpurkhas - Sindh from January to December 2001. A total of four thousand [4000] patients of different age groups undergone a clinical examination of anterior eye during study period. Those with the clinical findings of trachoma underwent further detailed examination including visual acuity, tonometry and dilated ophthalmoscopy. The diagnosis of different stages of trachoma was confirmed clinically using simplified trachoma grading system of World Health Organization. Out of 4000 patients, 515 [12.87%] were found having clinical findings of trachoma. Among these, 215 [41.74%] were male and 300 [58.25%] female patients. The prevalence of active trachoma was higher in female children. Trachoma has become endemic in the increasing poor population of District Tharparkar. The disease is increasing due to deficient water supply, poor sanitation and unhygienic living standards of the people of area