Mobilizing slit lamp to the field: A new affordable solution.

We are describing a simple and affordable design to pack and carry the slit lamp to the field. Orbis staff working on the Flying Eye Hospital (FEH) developed this design to facilitate mobilization of the slit lamp to the field during various FEH programs. The solution involves using a big toolbox, a central plywood apparatus, and foam. These supplies were cut to measure and used to support the slit lamp after being fitted snuggly in the box. This design allows easy and safe mobilization of the slit lamp to remote places. It was developed with the efficient use of space in mind and it can be easily reproduced in developing countries using same or similar supplies. Mobilizing slit lamp will be of great help for staff and institutes doing regular outreach clinical work.

Management of moderate and severe corneal astigmatism with AcrySof [registered sign] toric intraocular lens implantation - our experience

Purpose: Visual performance following toric intraocular lens implantation for cataract with moderate and severe astigmatism

Setting: Cataract services, Shroff Eye Centre, New Delhi, India

Design: Case series

Method: This prospective study included 64 eyes of 40 patients with more than 1.50 dioptre [D] of pre-existing corneal astigmatism undergoing phacoemulsification with implantation of the AcrySof[registered sign] toric IntraOcular Lens [IOL]. The unaided visual acuity [UCVA], best corrected visual acuity [BCVA], residual refractive sphere and refractive cylinders were evaluated. Toric IOL axis and alignment error was measured by slit lamp method and Adobe Photoshop [version 7] method. Patient satisfaction was evaluated using a satisfaction questionnaire at 3 months

Results: The mean residual refractive astigmatism was 0.57 D at the final follow-up of 3 months. Mean alignment error was 3.44 degrees [SD = 2.60] by slit lamp method and 3.88 degrees [SD = 2.86] by Photoshop method. Forty-six [71.9%] eyes showed misalignment of 5 degrees or less, and 60 [93.8%] eyes showed misalignment of 10 degrees or less. The mean log MAR UCVA at 1[st] post-op day was 0.172 [SD = 0.02], on 7th post-op day was 0.138 [SD = 0.11], and on 30th post-op day was 0.081 [SD = 0.11]. The mean log MAR BCVA at three months was -0.04 [SD = 0.76]

Conclusion: We believe that implantation of AcrySof[registered sign] toric IOL is an effective, safe and predictable method to correct high amounts of corneal astigmatism during cataract surgery

Awareness of leprosy - knowledge and practices among general practitioners in leprosy endemic areas of Larkana region, Sindh, Pakistan

To assess awareness about leprosy among general practitioners in endemic areas of Larkana region Sindh, Pakistan. The survey was carried out during January to March 2010 among general practitioners practicing in leprosy endemic areas of Larkana region. A total of 250 general practitioners were surveyed by questionnaires. 225 properly filled questionnaires were scrutinized and included in the study. Out of these, 172 [76.4%] practitioners had enough knowledge of the leprosy symptoms, while remaining 53 [23.5%] were unaware of them. Among 172 aware practitioners, 133 [77.3%] had enough knowledge regarding source of leprosy infection while 39 [22.6%] had no such knowledge. Out of these, 133 practitioners who knew the source, 60 [45.2%] were sure about the disease cure but 73 [54.8%] were unsure. Among 60 practitioners who knew about the cure of the disease, 21 [35%] showed social acceptance like having cup of tea with leprosy patients or working in same environment or keeping them as helpers with while 39 [65%] practitioners rejected them socially. Leprosy control needs more efforts to create awareness and to combat irrational fear still largely associated with this disease.

Frequency of metabolic syndrome in patients with type-2 diabetes

Diabetes, Hypertension, Obesity and Ischaemic Heart Disease have become a problem of public health magnitude with substantial economic burden both in the developed as well as the developing countries. Obesity is quite frequent in Type 2 diabetics and also plays a central role in causing Metabolic Syndrome [MetS]. Metabolic Syndrome significantly increases the incidence of cardiovascular complications. This study was done to determine the frequency of MetS in our Type 2 diabetic patients as most of the components of MetS can be modified and identifying/managing these at an early stage might be of considerable help in reducing cardiovascular complications. This cross-sectional study was done in Medical 'B' and Medical 'A' wards of Ayub Teaching Hospital, Abbottabad from Nov, 08 to April, 09. Type 2 Diabetic patients aged above 40 years who gave informed consent were included in the study. Data was collected through a structured proforma. Frequency of Metabolic Syndrome was estimated according to the IDF consensus worldwide definition of the MetS. Of the 100 patients enrolled in this study 56 were females and 44 were males with a mean age of 59.9 years. Out of these 100 participants seventy six [76%] were diagnosed to have metabolic syndrome. Of the 56 females, forty eight [85.71%] were having metabolic syndrome while twenty eight [63.63%] of the 44 male participants were having the syndrome. The difference was statistically significant [p<0.05]. Frequency of MetS was found to be significantly high in this study with female preponderance. All the components, except Hypertension were more frequent in females. Diabetic patients with metabolic syndrome need more aggressive approach in management so as to decrease the incidence of cardiovascular complications

Thrombocytopenia and prolonged bleeding time in cirrhosis of liver

Platelets play central role in normal hemostsis. Thrombocytopenia is a common problem in cirrhosis of liver. This study was designed to correlate thrombocytopenia with the bleeding tendency in known cirrhotic patients. This retrospective study was done in Department of Pathology Gomal Medical College Dera Ismail Khan, from Jan 2006 to December 2008. Blood was taken from the selected patients and routine hematological tests were performed on all the EDTA collected samples. The tests were run on automatic hematology analyzer Nihon Model. In every case a thin film was made and stained with Giemsa and examined under microscope to verify manually the platelets count. Bleeding time was measured in all the patients by using Ivys method. The present study encompassed the evaluation of platelets count in 100 patients of hepatic cirrhosis and 50 normal controls were also included in the study. The mean age of the patients was 49+14 years. The most common physical signs were splenomegaly and ascites. Among these patients 92 had thrombocytopenia [p<0.01] and 44 had prolonged bleeding time [p<0.001]. Thrombocytopenia and prolonged bleeding time are significant findings in cirrhosis of liver

Per-operative findings of blocked ventriculoperitoneal shunt: a study of 72 cases

Most patients with hydrocephalus are treated with ventriculo-peritoneal [VP] shunt placement; however, malfunction is common and is usually caused by mechanical failure. The aim of this study was to evaluate the per-operative findings accompanying presumed VP shunt malfunction. This is a descriptive study of 72 patients operated for shunt malfunction in the Department of Neurosurgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from January to December 2008. Presenting symptoms and signs, clinical shunt function, operative findings and outcome were recorded. Common presenting features were vomiting, irritability and general toxic look of patients. Male to female ratio was 3:1. Upper end block was observed in 39 patients while lower end and reservoir block was noted in 13 and 2 patients respectively. Choroids plexus was found in 29.2% of cases with upper end block, shunt revision was performed in most of cases [80.6%]. The importance of clinical features cannot be overlooked in a patient with shunt malfunction. Upper end block due to choroids plexus is common operative finding

Clinical features and hematological investigations pattern in Acute Promyelocytic Leukaemia patients

Acute Promyelocytic Leukemia [AML-M3] patients, though amenable to treatment, present with early and sometimes severe bleeding manifestations. In our setup, for various reasons, patients are diagnosed rather late and therefore these bleeding manifestations are a limiting factor in the early and effective treatment of leukemia in such cases. To look into the clinical, peripheral blood and bone marrow features of AML-M3 patients in our setup. A total of 40 consecutive cases of AML-M3 diagnosed on bone marrow biopsy over a period of 10 years were analyzed for clinico-morphological features. Majority of patients [75%] were <30 years of age. The male: female ratio was 3:2. The mean duration of symptoms was 4.2 weeks [Range 1-10 weeks]. Commonest clinical features were fever, pallor and bleeding manifestations. The spleen and liver were variably enlarged in 25% and 45.5% of cases, respectively. The hemoglobin levels ranged from 3.1 to 12.8 g/dl with a mean of 6.6 g/dl. The WBC count ranged from 0.5 to 142 x 10[9]/l with a mean of 28.3 x 10[9]/l. Platelet counts ranged from 5-150 x 10[9]/l with a mean of 28.8 x 10[9]/l. Morphologically 36 patients had hypergranular and 4 had hypogranular promyelocytic leukemia. The features identified in our study can help in early diagnosis of APL, which is known to be extremely important in effective management of patients