Cell cannibalism: a diagnostic and prognostic marker of breast cancer

Background: Cell cannibalism (cytophagocytosis) is defined as a tumor cell within a tumor cell, such that smaller tumor cells are found in the cytoplasm of larger tumor cells with crescent shaped nuclei. Aims and Objectives were to study the cytomorphological characters of cell cannibalism in primary and metastatic breast cancer, to correlate the histologic type and grade of tumors with positive rate of cannibalism and to study the role of Cannibalism as an independent prognostic factor in breast cancer.Methods: The study was conducted during the period of July 2003 to June 2005 in the Department of Surgery and Pathology, JNMCH, Aligarh. A total of 42 cases were included in the study. A minimum of 3 FNAC smears per case were assessed for cytophagocytosis. Presence of metastasis was also noted to establish the cytological grade and aggressiveness of the tumor.Results: Out of 42 cases, significant cannibalistic activity was noted in 30 (71.42%) cases. All grade III (33.4%) breast tumors were found positive for cytophagocytosis (4.28/smear), while the rate was much lower (2.33/smear) in grade II and (1.63/smear) in grade I tumors. LN metastasis was confirmed by histopathological examination in all high grade tumors showing significant cannibalistic activity.Conclusions: Cannibalism in breast carcinoma is an indicator of both the anaplastic grade and invasiveness. The rate of cytophagocytosis may have a prognostic significance.

Development and evaluation of eudragit based microparticles of dexibuprofen for site specific drug release

The main purpose of work was to formulate dexibuprofen loaded eudragit L-100 micro particles to acquire site specific delivery of dexibuprofen. Micro particles were formulated by an emulsion solvent evaporation method. Four formulations F1, F2, F3 and F4 having drug to polymer ratio 1:1, 1:2, 1:3 and 1:4, respectively were prepared and characterized. The rheological properties manifested that micro particles were worthy for further pharmaceutical exploitation. No notable drug polymer interaction was perceived in FT-IR spectroscopy. SEM micrographs showed rough surface of micro particles. The resulting micro particles had high entrapment efficiency greater than 70%. The in vitro dexibuprofen release at pH 1.2 exhibited poor drug release with less than 21% while at pH 6.8, 60% of the dexibuprofen was released up till 8th hour. The dexibuprofen release was modified by altering polymer concentration in the formulation. The subsequent micro particles were found to be best fit with zero-order release model. Micro particles were efficiently formulated with a focus to release the drug majorly in small intestine. With increase of polymer concentration enhanced entrapment efficiency and decelerated dexibuprofen release from the micro particles has been achieved. In vitro dexibuprofen studies verified the gastro-resistant property of micro particles thus qualify site specific release in gastrointestinal tract

Outcome of Judet's quadricepsplasty for knee contractures and the effect of local infiltration of epinephrine on reducing blood loss / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the effectiveness of Judet's quadricepsplasty for treatment of knee contractures and to identify the effect of local infiltration of epinephrine on blood loss associated with this procedure.</p><p><b>METHODS</b>A retrospective cohort study was conducted in which all cases of knee contractures managed with Judet's quadricepsplasty from 1st January 2009 to 31st December 2013 were included and were divided into two groups. The epinephrine group included patients who were infiltrated with diluted epinephrine (1:400,000) along with xylocaine, around the operative field 15 min prior to the incision time, while the control group did not receive any infiltration. Judet's outcome, blood loss, drop in hemoglobin and required blood transfusion were noted for all patients and compared between both groups.</p><p><b>RESULTS</b>Most common preceding pathology identified for the development of knee contractures was periarticular fracture while ilizarov application was the most common etiology. Both groups were found similar in all preoperative characteristics except preoperative flexion contracture (p = 0.02). All functional outcome measures including Judet's outcome were similar in both groups. In contrast, duration of surgery (p = 0.01), blood loss (p = 0.02), drop in hemoglobin (p = 0.01) and number of transfusions (p = 0.03) were significantly reduced in epinephrine group.</p><p><b>CONCLUSION</b>Judet's quadricepsplasty is a useful procedure to increase the range of motion of rigid knees and local infiltration of epinephrine is effective in decreasing the amount of subsequent blood loss and transfusion requirements.</p>

Prevalence of bilateral cataract blindness in persons ≥50 years of age in Pulwama district, Jammu & Kashmir, India.

Rapid assessment of cataract blindness has been accepted as a robust tool to help planners in developing countries. Prevalence of cataract blindness can give important information about the impact of a cataract intervention programme. A study in this direction was carried out in Pulwama district of Jammu & Kashmir. Our results clearly showed that with the increase in age, the prevalence of bilateral cataract blindness increases manifold. However, gender did influence the prevalence of cataract in the present survey. The prevalence of bilateral cataract decreases considerably, with the increase in education of both the genders. Among both male and female respondents examined, 89 percent were having both eyes phakia. Similarly 79 percent of study population were not having lenticular opacity either in R/E or L/E in both males and females. Results show that the prevalence of bilateral cataract blindness in district Pulwama is 4.16 percent.

Pre-analytical errors in a peripheral hospital laboratory

To analyse pre-analytical errors which account for the major contribution towards laboratory errors. Cross-sectional descriptive study. Combined Military Hospital Kohat, Pakistan from 1[st] January to 30[th] June 2012. For six months laboratory staff was asked to register rejections and causes for rejection of all samples; including in-patient samples from wards as well as out-patient samples collected in the laboratory. In addition all samples where disparity was noted by the clinicians in the laboratory results were also included for analysis. Suspected samples were reanalyzed, tests were also repeated on fresh samples of the patients and a critical appraisal was made. Among a total of 328418 analyses, clinicians/laboratory staff notified 350 questionable findings, 270 of which were confirmed errors. Out of total 270 errors, 77% were pre-analytical, 8% were analytical, 15% were post analytical errors. Out of total pre-analytical errors 8% were incorrect samples, 21% were misidentifications, 51% were faulty sampling techniques and 20% were incomplete/illegible laboratory request forms. The pre-analytical phase in the total testing process currently appears to be more vulnerable to errors than the other phases. Consequently, the pre-analytical phase should be the main target for further quality improvement. Therefore identifying the critical steps in the pre-analytical phase is a prerequisite for continuous quality improvement, further error reduction and thus for improving patient safety

Complications of total hip replacement

To determine the factors causing complications in unilateral total hip replacement. Analytical study. The Aga Khan University Hospital, Karachi, between 2000 and 2010. During the study period, 199 patients underwent elective unilateral total hip replacement at the Aga Khan University Hospital. Patients were divided into two groups on the basis of postoperative complications within 30 days of surgery. Significant factors at 5% significance level on univariate analysis were further analyzed by multivariate logistic regression. Postoperative complications occurred in 39 patients [19.6%]; dislocation being most common in 13 patients [6.5%], followed by wound infection in four [2%], all of these patients required intervention. Other minor complications which were managed conservatively included wound infection [2.5%], urinary tract infection [2.5%], dislocation [1%], pleural effusion and pneumonia [2%], deep venous thrombosis [0.5%] and myocardial infarction [0.5%]. On univariate analysis, patients with ASA III and IV, peri-operative blood transfusion, pre-operative hip deformity and post-operative bisphosphonate use were significantly associated with complications. On multi-variate analysis, adjusted odd's ratio for perioperative transfusion [3; 95% CI: 1.17-7.7] and hip deformity [3.2, 95% CI: 1.4-3.4] was found statistically significant. Pre-operative hip deformity and perioperative blood transfusion significantly influence the rates of complication after unilateral THR

Psychological distress and manifestation of symptoms in dhat syndrome patients in relation to parental strictness

Dhat Syndrome also known as semen loss anxiety is commonly reported among men from the Indian subcontinent. The present study examined Dhat syndrome symptoms manifestation and psychological distress in patients with Dhat Syndrome in relation to perceived parental strictness. It was hypothesized that: patients perceiving their parents strict are likely to manifest significantly more symptoms and are likely to experience more distress compared to those perceiving their parents non strict. Sample comprised of 318 Dhat Syndrome patients recruited from clinics of health professionals. Dhat Syndrome Symptom Checklist [DSSC]and General Health Questionnaire [GHQ-28] were used for assessment. Individual assessment was carried out at the premises of professional clinics. Analysis revealed that patients perceiving their parents strict reported significantly more physical symptoms, somatic complaints and anxiety as compared to those who perceived their parents non strict. The findings highlight the importance of parental attitudes on the sexual behavior and perceptions

Visual outcome and complications after ND-YAG laser capsulotomy in patients with posterior capsular opacification

Cataract remains the most common treatable cause of blindness in the developing world including Pakistan. Posterior capsular Opacification is a natural consequence of extra capsular cataract extraction and phacoemulsification. To see complications during and after Nd-YAG laser capsulotomy and evaluate the visual outcome in aphakic and pseudophakic patients with posterior capsular Opacification. The study was conducted on consecutive aphakic and pseudophakic patients suffering from posterior capsular Opacification who were admitted for Nd-YAG laser capsulotomy at Ophthalmology Department of Saidu Teaching Hospital, Saidu Sharif, Swat, from November 2006 to May 2007. Out of 45 cases, 28 [62.2%] were males and 17 [37.8%] females. The mean age was 56 years and the mean time interval between cataract surgery and Nd-YAG capsulotomy was 31.2 months. Fifty eyes of 45 patients with posterior capsular Opacification underwent Nd-YAG laser capsulotomy, of which 27 [54%] were right and 23[46%] were left sided. Twenty nine [58%] eyes had capsular fibrosis, 14[28%] had Elschnig pearls, 6[12%] had both capsular fibrosis and Elschnig pearls and one [2%] eye had capsular wrinkling. Damage to intraocular lens in two eyes and corneal bum in one eye were procedural complications. Post-laser complications were raised intraocular pressure in 7 eyes, corneal oedema and anterior uveitis in two eyes each. Twenty five [50%] eyes had visual acuity of 6/60 or less before capsulotomy. The visual acuity after Nd-YAG laser capsulotomy was 6/60 or less in 15[30%] eyes. Four [8%] eyes had good pre-laser visual acuity of 6/6-6/12; while 14[28%] eyes had post laser visual acuity of 6/6-6/12. No case had further deterioration of visual acuity after Nd-YAG laser capsulotomy. Capsular fibrosis is the commonest presentation of posterior capsular Opacification. Damage to intraocular lens and corneal burn were encountered during procedure. Majority of patients had significant improvement in visual acuity. Raised intraocular pressure, corneal oedema and iritis were seen as post laser complications

Burden of care in caregivers of patients with schizophrenia and epilepsy

To find out the burden of care and associated mental health problems in caregivers of patients with schizophrenia and epilepsy. Cross sectional study. This study was conducted at the Department of Psychiatry, Sir Ganga Raam Hospital, Lahore, from January to September 2010. A total of 100 caregivers [50 each] of patients suffering from schizophrenia and epilepsy presented to the outdoor patient department were included in the study. Burden assessment Scale, General Health Questionnaire-28 and a semi structured proforma for recording their demographic details were used in the study. Forty nine percent caregivers of patients of schizophrenia and epilepsy showed high burden of care on Burden Assessment Scale. Overall, 55% of caregivers had higher scores on General Health Questionnaire showing poor psychological well being and problems with their mental health. There were highly significant positive relationship [p<.001] between BAS, GHQ and all their subscales i.e., objective burden, subjective burden, somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. Almost half of the caregivers showed high burden of care and the majority had problems with their mental health

Severity and risk factors of depression in Alzheimer's disease

To determine the frequency, severity and risk factors of depression in Alzheimer's disease. Descriptive study. The Department of Psychiatry, Sir Ganga Ram Hospital, Lahore, from August 2007 to December 2008. Consecutive patients of Alzheimer's disease reporting to the department during the study period were included and those with extreme cognitive impairment were excluded. The cognitive status was judged by using the Mini-Mental State Examination [MMSE]. The Hamilton rating scale for depression [Ham-D] was used as a symptom checklist to diagnose major depression according to the DSM-IV criteria. Chi-square test was used to check the significance of association. There were 73 patients comprising of 34 males and 42 females. The mean age was 67.74 +/- 6.71 years; 66% were married, 14% were single and 20% were widowed; 47% had family history of depression and medical co-morbidity was observed in 48%. Based on MMSE, 31.5% had mild Alzheimer, 55.3% had moderate and 13.1% had severe Alzheimer. Judging from Hamilton rating scale, 25% patients were free from depression, 19.7% had mild depression, 27.6% had moderate depression and 27.6% were suffering from severe depression. The frequency of depression was significantly higher [p= 0.0013] among females [90%] as compared to males [55.9%]. There is a high frequency of depression among patients of Alzheimer's disease particularly among female patients. This finding is consistent with the reports from other countries

Prevalence of obesity among the school-going children of lahore and associated factors

To determine the prevalence of obesity among the school- going children [6[th] and 7[th] grade] of Lahore and ascertain the associated factors. A descriptive study with sample size of 293 children conducted over a period of four months in two private sector schools of Lahore. Information was gathered by the help of a pre designed questionnaire after getting formal consent from parents. Children included in the study were healthy with no reported chronic illness. Body weight was measured in minimal clothing using a weight scale; body height was measured in erect posture without shoes using a stadiometer. Obesity, underweight and overweight were defined by plotting BMI against age [in months and years] on WHO BMI-for-age [5-19 years [percentiles]] charts. Out of 293 children 11.9% were obese [more than 97[th] percentile] while 21.8% were overweight [85[th]-97[th] percentile]. Among obese children 74.3% were found to watch TV for 1-2 hours daily while 25.7% watch TV for 3-4 hours. 48.6% of obese children did not participate in any field sports while 34.3% have less than 3 hours participation in field sports. Among parents of obese children, 60% were found to have little or no influence on their children's food intake at school whereas 22.9% parents of obese children never advise them against eating junk food. Parents think that ban on advertisements promoting unhealthy foods [75.1%] and use of popular media characters in promoting healthy foods [83.6%] and exercise can help in preventing obesity in children. This study shows that high prevalence of obesity and overweight among children in private schools has direct relationship with decreased physical activity and other factors like watching TV, role of media and lack of diet control by parents

Ocular sequelae of blast injuries: experience at a teaching hospital

To study the ocular sequlae of blast injuries, their management and visual outcome. Retrospective review of over 4 years of the records of the patients admitted during [1 January 2003 to 31 December 2006] with blast injuries in Ophthalmology Department of Saidu Teaching Hospital, Saidu Sharif, Swat. Files of patients with blast injuries of all ages and both gender were retrieved from the record room. A separate data collecting proforma was filled for every patient. Personal data, occupation, nature of blast, duration between the accident and presentation, ocular findings, management and visual outcome were recorded in all cases. A total of 7446 patients were admitted in the department during the study period of whom 34 had blast injuries [31 males and 3 females]. Nature of blast showed that 24 [70.6%] cases got injury while breaking stone in the marble and precious stone excavations or clearing the rocks for house building or road lying; while 6 [17.7%] cases had injury due to explosives planted by others for the same purpose. Three [8.8%] cases had accidental and 1[2.9%] battery blast injury. Ages of the patients ranged from 7 to 55 years [mean 27.4 years]. Of the 47 eyes affected bilateral ocular damage was seen in 13 patients [26 eyes] and unilateral in 21 patients [10 right eyes and 11 left]. Bilateral blindness was seen in 1 case [2 eyes] while 20 patients [20 eyes] got blindness in one eye. The frequency of blindness caused by bomb blast injuries is high and there is a high like hood of psychological trauma to the patient and their families which needs to be addressed

Active trachoma in an out patient clinic

To evaluate the presentation and outcome of active trachoma patients presenting to the Ophthalmology out patient clinic. Material and The study was conducted at Saidu Teaching Hospital, Saidu Sharif, Swat from 1st January 2000 to 31st December 2001. All patients attending the outpatient department of Ophthalmology unit were examined and screened for active trachoma [trachoma follicular and trachoma intense] presentation and outcome. The medical treatment advised was oral Azithromycin 1 gram as a single dose and Tetracycline eye ointment twice a day for 6 weeks. Out of 20193 OPD patients, patients with active trachoma were 52 [0.26%] ranging in age from 9 to 65 years. Trachoma was more common in females [90.4%] than males [9.6%]. Forty-one [79%] cases were bilateral and 11 [21%] were unilateral. 42 cases presented with history of sore eyes and mucopurulent discharge for one month or more. Complications observed were conjunctival scaring in 6 [11.54%] cases, trichiasis in 5 [9.61%] cases and corneal opacity in 3 [5.77%] cases. All the patients came for the 1st follow up visit after 4 weeks [100%] and seven [13.46%] patients had come for 2nd follow up visit after one year, with no signs or symptoms of active trachoma indicating 100% successful medical treatment. Bilateral sore eyes and mucopurulent discharge are the common presentations of Trachoma. Complications like conjunctival scaring, trichiasis and corneal opacity are still seen. Single dose treatment with oral Azithromycin is effective

Demographic profile of patients with epilepsy in a community clinic

To study the Demographic profile of patients with Epilepsy. A descriptive study of five hundred patients with Epilepsy was counducted in, Ahbab Hospital, [Psychiatric Epilepsy clinic] Ravi Road, Lahore. All patients presented with seizures during that period were included in the study. Their detailed history and appropriate investigations were recorded on a study proforma. Epilepsy was classified according to EEG findings. Out of a total Five hundred patients with Epilepsy who visited Ahbab Hospital majority [62.9%] were of low socio-economic status and belong to rural areas of Pakistan. Males had Epilepsy [58%] more often compared to females [42%]. The most common type was Generalized Tonic Clonic Seizure.70% of the patients came with Epilepsy only, 13.0%were having Depression and 10.1%were Mental Retardation and 4.1%had a problem of Attention Deficit Hyperactive Disorder. The results of the study conclude that Epilepsy is more common among population with low socioeconomic status in the rural areas and dominantly involves the males.43% of the subjects were suffering from Generalized Tonic Clonic Seizures. The risk factors for developing Epilepsy include a positive family history of Epilepsy. Epilepsy is an important health problem. Identification of Demographic profile in a hospital setting will lead to more opportunities to improve preventive measures and quality of life in rural areas. It will also improve knowledge among rural backgrounds and health officials on the problems associated with this disease

Asian outpatients with schizophrenia: a double-blind randomized comparison of quality of life and clinical outcomes for patients treated with olanzapine or haloperidol.

To examine the quality of life (QoL) and clinical outcomes for Asian schizophrenic outpatients treated with olanzapine or haloperidol. Patients were randomized to 24-weeks' treatment with either olanzapine (n = 144) or haloperidol (n = 132) in a double-blind, prospective, multi-country study. The QLS and WHO-BREF were assessed for QoL; the PANSS, BPRS and CGI scales for clinical status; the BAS, AIMS and SAS scales for physical dysfunction. Regardless of antipsychotic, QoL improved significantly at 8 weeks and maintained this improvement at 24 weeks. Compared with haloperidol, olanzapine treatment was associated with significantly better QoL in the WHO-BREF physical and social relationship domains, better improvements in extrapyramidal symptoms in BAS and SAS scores, as well as lower incidence of adverse events. Patients taking haloperidol were more likely to be co-prescribed anticholinergics. The comparatively superior side-effect profile and tolerability of olanzapine may have contributed to enhance domain-specific QoL for these Asian outpatients.

Serological profile of patients with liver cirrhosis in northern Pakistan

To evaluate the role of hepatitis B and C in the pathogenesis of liver cirrhosis. An observational study. The present study was conducted in the medical wards of Military Hospital, Rawalpindi from Ist January 2002 to 24th September 2004. Patients and Six hundred and fifty patients admitted in the medical wards of Military Hospital Rawalpindi were evaluated for seromarkers of Hepatitis B and C. Viral markers studied were anti HCV, HBs Ag anti HDV, anti HBcIgG, anti HBs, and HBeAg. One hundred and eighty two out of 650 patients were positive for HBsAg positive and 468 patients were negative for HBsAg. Anti HBcIgG was positive in 345 and anti HBs in 322 of HBsAg negative patient. HBeAg was present in 45 and anti HDV in 26 of HBsAg positive patients. Anti HCV was positive in 455 [70%] patients and no seromarkers were seen in 52 patients. It was evident from the seromarkers that exposure to hepatitis B and C had occurred but which one was responsible for cirrhosis was hard to determine. In as much as vaccine against hepatitis B is available, mass vaccination in the population may be consideration to prevent cirrhosis due to hepatitis B virus

Psychosocial factors and male sterilization

To study the demographic profile of vasectomy clients and the psychosocial factors motivating them to be sterilized. One hundred fifty clients attending Reproductive Health Services Center [RHSC] Vasectomy Unit Sir Ganga Ram Hospital, Lahore were interviewed using a specifically constructed interview form. The form was developed on the basis of items generated through Focused Group Discussions [FGDs] with vasectomy clients. The investigators themselves conducted the interviews at Department of Psychiatry, Sir Ganga Ram Hospital, Lahore. Mean age of the sample was 36.13 years. Out of the total sample 62% were illiterate. Majority of clients were employed temporarily as laborers [i.e. 52.7%] and unskilled workers [i.e.15%]. Eighty nine percent of the clients were earning less than Rs. 4000/- per month. Financial reasons were the main motivating factor to go for vasectomy. About 63% of clients reported that they had never tried any other contraceptives. Twenty seven percent reported a history of extra marital or premarital sexual relationships. Sixty one clients were involved in drugs and out of them 57% had no specific hobby and would spend their leisure time at home. The results indicate that majority of the sample belongs to low socio-economic class. They were mostly illiterate, employed as laborers or unskilled workers. Economical constraints came out as the basic motivating factor for decision of male sterilization

Expressed emotions and schizophrenia in Pakistan

To investigate the differences in expressed emotion among families of patients with Schizophrenia and develop an instrument for expressed emotion. A sample of 35 families was selected by using non-probability sampling technique. It was hypothesized that there would be significant difference in expressed emotion among families of patients with schizophrenia and families of normal subjects. A questionnaire based on Likert Scale technique was used to measure expressed emotion of the families. Those members were selected who have spent at least 35 hours with the patient. Independent t-test was performed to see the difference in their expressed emotion on criticism, hostility, positive remarks, warmth and emotional overinvolvement. Descriptive statistics was used to find out the relationship between demographic variables. The research finding showed a significant difference in expressed emotion between parents of schizophrenics and parents of normal subjects. This is the first study on expressed emotions in Pakistani perspective and provides guidelines for future management in schizophrenia

Physical and psychological complications of cannabis ; an update

The use of illegal drug such as cannabis is most common. Young people are more vulnerable for its use. Prevalence is increasing markedly over the past decade. Long term use of cannabis use is found to be associated with increased risk of physical and psychological complications. This a brief review of recent literature on the use of cannabis in European society. Government has successful in increasing public awareness about cannabis misuse through media. More surveys and epidemiology studies are required in future to detect this change and any reduction in its use and dependence

Pseudoexfoliation syndrome and its effects on intraocular pressure

To see the frequency of occurrence of pseudoexfoliation syndrome and its effects on intraocular pressure. This prospective study was done at the Department of Ophthalmology, Saidu Teaching Hospitals, Saidu Medical College, Saidu Sharif, Swat from March 2003 till December 2005. A total of 5581 patients aged 30 years and above were examined for evidence of pseudoexfoliation syndrome and those found positive for the disease were subjected to further examination. One hundred and nine patients [1.9%] had pseudoexfoliation syndrome, of whom 83 patients were males [76.1%] and 26 females [23.8%] with a male to female ratio of 3:1. The frequency of disease in males was 3.1% and in females 0.9%. The disease was bilateral in 84 [77%] and unilateral in 25 [22.9%] patients. A total of 193 eyes were affected. The frequency increased with age. Glaucoma was found in 9.3% [18 eyes], cataracts were found in 64.7% [125 eyes], lens dislocation in 7.7% [15 eyes] and lens subluxation was found in 4.1% [8 eyes]. Other findings were pupillary ruff defects in 7.2% [14 eyes], iris sphincter transillumination defects in 9.3% [18 eyes], increased pigmentation of the chamber angle in 15.% [29 eyes], poor pupillary dilation in 80.8% [156 eyes] and angle width less than Grade-II in 8.2% [16 eyes]. For cataracts in pseudoexfoliation syndrome with normal intraocular pressure extracapsular cataract extraction with intraocular lens implant was performed, sixteen eyes [17.3%] got posterior capsular tears and 17 eyes [18.4%] got zonular dialysis, while vitreous loss occurred in 26 eyes [28.2%]. Twenty six patients were implanted anterior chamber intraocular lenses.For glaucoma, cataract and pseudoexfoliation syndrome, combined extraction with intraocular lens implant was done in ten eyes and trabeculectomy done in five eyes with glaucoma, with satisfactory results. Surgery gave satisfactory results in these cases in short-term follow up. Follow up of these patients was poor and efforts are required to make the public aware of the benefits of early presentation and regular follow up to prevent visual morbidity and mortality