Frequency of color blindness in pre-employment screening in a tertiary health care center in Pakistan

Objective: To describe the frequency of color vision deficiency among Pakistani adults presenting for pre-employment health screening in a tertiary care hospital

Methods: The cross-sectional study was carried out at the Aga Khan University Hospital, Karachi, and the data was collected for color vision deficiency, age, gender, and job applied for from pre-employment examination during 2013-2014. IBM SPSS 20 was used for statistical analysis

Results: Three thousand four hundred and thirty seven persons underwent pre-employment screening during 2013 and 2014; 1837 [53.44%] were males and 1600 [46.65%] females. The mean age was 29.01 [+/-6.53] years. A total of 0.9% [32/3437] persons had color vision deficiency with male being 1.4% and female 0.4%

Conclusion: Color vision deficiency was observed in 0.9% of candidates screened for pre-employment health check up in a tertiary care hospital. The color vision deficiency was predominantly present in male individuals

Effect of lymph node retrieval and ratio on the long-term survival and recurrence of colon cancer

Objective: To evaluate the association of lymph node retrieval and ratio with the prognosis of colon cancer

Study Design: A cohort study

Place and Duration of Study: Ninewells Hospital and Medical School, Dundee, UK, from October 2014 to March 2015

Methodology: Data was collected for adult patients who were diagnosed with primary adenocarcinoma of colon between 2003 and 2008. The follow-up period was 5-year. The data was collected from regional electronic colorectal cancer database. Kaplan-Meier graph was used to calculate and depict overall survival in different groups of patients

Results: There were a total of 370 patients with colon cancer. For Dukes stages A and B, there was no significant difference in median overall survival for patients with lymph node retrieval [< 12 nodes vs. > 12 nodes]. For Dukes stage C [n=147], median survival for patients with lymph node retrieval < 12 nodes was 4 years vs. 4 years for patients with lymph node retrieval > 12 nodes [p = 0.85]. Median survival for patients with lymph node ratio [LNR] < 0.125 was 4 years [range 1 -11] vs. 3 years [range 0 -11] for patients with LNR > 0.125 [p = 0.14]. There was no significant difference in the recurrence rate based on lymph node retrieval [p = 0.87] and LNR [p = 0.97]

Conclusion: Lymph node retrieval > 12 and reduced LNR < 0.125 had no significant effect on long-term survival and recurrence of colon cancer

Ocular manifestation, complications and aetiological factors in Stevens Johnson syndrome/toxic epidermal necrolysis

To describe the ocular manifestations of Stevens-Johnson Syndrome/Toxic Epidermal Necrosis among inpatients at a tertiary care hospital. The retrospective observational descriptive study was carried out at the Aga Khan University Hospital, Karachi, and comprised data on age, gender, aetiology and ocular findings related to patients diagnosed with Stevens-Johnson Syndrome/Toxic Epidermal Necrosis between January 2000 and December 2011. SPSS 19 was used for statistical analysis. There were 87 patients; 48[55.2%] of them being males. The overall mean age was 33.2 +/- 22.2 years, ranging from 1 month to 84 years. The most common aetiology was idiopathic 20[23%] followed by non-steroidal inflammatory drugs and anti-epileptics 11[12.6%] each. Besides, 84[96.6%] patients had oral mucosal involvement whereas 45[51.7%] had ocular and 27[31.0%] had genital-mucosal involvement. Glassroding was performed in 16[18.4%] patients due to minor conjunctival adhesions. Ocular manifestations of varying severity were frequent, with drugs being the most common aetiology

Vogt-koyanagi-harada syndrome

Vogt-Koyanagi-Harada [VKH] syndrome is a rare multisystem disease of melanocyte containing organs. It is characterized by diffuse granulomatous inflammation involving various organs including eye. VKH syndrome is usually sporadic, but some familial cases have also been reported indicating a hereditary basis. VKH is not associated with mortality but it may result in long-term complications such as decreased vision associated with cataract, glaucoma and choroidal neovascularization. For successful outcomes, early aggressive treatment using systemic steroids with gradual tapering is essential. This report describes a case of VKH syndrome in a 26-year-old male of Pakistan origin who was successfully treated with systemic steroids. The case is briefly contextualised within wider literature

Pattern of eye diseases at the primary health centers in a Pakistani district

Pakistan has an extensive network of public facilities aimed to provide primary health care including eye care. Yet no data exist on the number and purpose of eye visits to these facilities. This study aimed to describe the pattern of eye diseases in public primary care hospitals in a district in Pakistan's Sindh province. This study was conducted in 14 randomly selected government primary health care centers 10 Basic Health Units and 4 Rural Health Centers in district Nawab shah, a central district of Sindh province. Doctors in these centers were trained in diagnosis and management of common eye diseases at the primary level and requested to record data prospectively on the total number of patient visits, total number of eye consultations and reasons for eye consultation. Data were entered and analyzed using EPI Info Software. Over a period of one month, 9759 visits were made to the 14 selected primary health care centers. Eye diseases accounted for 1.8% of the total visits. Adults were more likely to have an eye consultation compared with children [Odds Ratio: 2.96; P < 0.01]. Conjunctivitis [34.1%], cataract [22.0%], and corneal problems [6.9%] were the most common reasons for eye consultations. Despite solid evidence of a high burden of eye diseases at the community level in Pakistan, eye diseases accounted for only a very small proportion of the total consultations in the primary health care facilities. Efforts are needed to assess barriers to optimal utilization of existing primary health care services for eye diseases

Visual outcome of cataract surgery

The aim of this study was to assess whether the visual outcome of cataract surgery in the institution was in accordance with the World Health Organization recommendations. In this retrospective case series, all patients who underwent cataract surgery by a single surgeon from January 2009 till June 2011 were included. Date were collected from medical records on age, gender, visual acuity and causes of sub-optimal outcome. The main outcome was best-corrected visual acuity in the operated eye, measured 4 - 6 weeks after surgery. Data on visual outcome was grouped using WHO's classification. Of the 495 eyes that underwent cataract surgery, 58% were female. Overall, 93.3% of the operated eyes had good visual outcome, while 4.4% and 2.2% had borderline and poor outcomes, respectively. Pre-existing diseases accounted for 93.9% of the borderline/poor outcome. The study showed good visual outcome of cataract surgeries performed using phacoemulsification with intraocular lens [IOL] insertion

Periocular infantile haemangioma and the role of propranolol

This case of a four and a half-month-old girl describes periocular infantile haemangioma which was treated successfully with propranolol. She developed a red coloured lesion around the left upper eye lid at one week of age. A gradual increase was noticed in the size of the lesion and by the age of four and a half months, the swelling had increased enough to cover her visual axis, completely occluding her left eye. Oral propranolol therapy was initiated with a daily dosage of 1 mg/kg body weight. The dose was increased gradually, and there was an excellent response to propranolol treatment. A complete eye opening was observed 8 months after the initiation of this treatment

Long-term outcome of primary external dacryocystorhinostomy

To assess the long-term functional outcome of external dacryocystorhinostomy [DCR] in terms of epiphora. Single-group cohort study. Section of Ophthalmology, The Aga Khan University Hospital, Karachi, from January 2000 to June 2010. This study included adults who underwent external DCR surgery at the AKUH during January 2000 to June 2010. The main outcome measure was the proportion of patients reporting to have developed epiphora after surgery. During the telephonic interviews participants were asked if they had a recurrence [symptoms such as watering or discharge] after surgery. Individuals answering in affirmative were asked when the symptoms started. Data on age at surgery, gender and pre-operative symptoms were collected from medical records. Recurrence-free curves were calculated according to the Kaplan-Meier method. A total of 44 persons who underwent DCR surgery were contactable by telephone in 2011 and all agreed to participate in the study. The mean age of the patients at the time of surgery was 48.0 +/- 15.8 years. Overall, 38.6% [17/44] participants reported having developed epiphora after surgery. The overall median recurrence-free time was 1.7 years; there was no statistically significant difference in the median recurrence-free time between men and women. The long-term functional outcome of external DCR surgery does not appear to be optimal and, in fact, far worse than the short-term results reported in the international literature

Healing of cornea following an electric burn

Electrical injuries have become a significant health problem in developing countries because of increase in access to electricity in the last few decades and lack of adequate safety measures. Electrical injuries of eyes are relatively uncommon. A case report of a rapid and complete corneal healing accompanied by satisfactory visual recovery after an electric burn event in a 20-year-old male is reported. The patient had accidental exposure to high voltage live wire while he was repairing it, resulting in severe ocular and superficial body burn. He was not wearing any protective equipment at the time of injury. On examination, the best-corrected visual acuity was counting fingers in the left eye with severe corneal epithelial loss and diffuse corneal oedema. The patient was treated medically, with a rapid corneal healing and resolution of oedema over the next few days. Visual acuity in the worse eye [left] improved to 20/25 from counting fingers

Early experience with intravitreal bevacizumab combined with laser treatment for retinopathy of prematurity

This study was designed to present our early experience with intravitreal bevacizumab combined with laser treatment for retinopathy of prematurity [ROP] at a single institution over a 13-month-period. A retrospective case series of eight children with ROP who received intravitreal bevacizumab combined with laser treatment between June 2007 and July 2008 were reported. A chart review was conducted to evaluate if stability of the ROP lesions had been achieved. Main information collected included data on demographics, gestational age, birth weight, length of stay in neonatal intensive care unit, and stage of ROP. Fifteen eyes of eight subjects were treated. One eye did not receive any treatment due to complete retinal detachment. The median age at treatment was 8 weeks [range, 6 weeks to 1 year]. The most common stage of ROP was 3+. All eyes remained stable at 1 year or later after treatment. Intravitreal bevacizumab in conjunction with laser treatment had promising results at our institution. We recommend prospective, randomized, controlled clinical trials to compare the effects of laser treatment alone, of bevacizumab treatment alone [at different doses], and of combined bevacizumab and laser treatment

comparison of treatments offered to patients with nonalcoholic steatohepatitis

To compare various treatment options provided to patients with Nonalcoholic Steatohepatitis [NASH] and assess improvement in liver status via reduction in serum Alanine Aminotransferase [ALT] levels. Study Design: Retrospective cohort study. The Aga Khan University Hospital, Karachi, from April 2000 to April 2007. Methodology: All available records of patients aged between 20-70 years, fatty liver on ultrasound, elevated serum ALT and having at least one follow-up, after a baseline visit were included. The patients had variable number of follow-ups and a maximum of 3 follow-ups were considered. Information was collected on demographic and clinical characteristics of the subjects. The treatment options were categorized as weight reduction alone, with statins, and with other medications. Serum ALT level was the main outcome measured in IU/l. Repeated-measures ANOVA, using a mixed model approach was performed with treatment options as between subject factor, and follow-up as within subject factor and p-value < 0.05 was considered significant. Sixty-nine records of subjects, consisting of 50 males and 19 females were selected. The mean [ +/- SD] age was 40 +/- 12 years. Thirty-one subjects [45%] were advised weight reduction only, and experienced a 72% reduction in serum ALT levels, over the mean follow-up time of 9 +/- 3 months. Twelve subjects [17%] received statins along with weight reducing advice, and experienced a 56% reduction in mean ALT over the mean follow-up of 11 +/- 7 months. Twenty-six subjects [38%] received other medications along with advice for weight reduction and experienced a 73% reduction in serum ALT levels over the mean time of 10 +/- 4 months. The mean ALT declined at follow-up times, irrespective of the prescribed treatment, and that the decline with time was different for males and females. Serum ALT levels among patients with NASH decreased with time, regardless of the provided treatment, and the decrease was different for males and females

Prevalence of diabetic retinopathy among individuals screened positive for diabetes in five community-based eye camps in nrthern Karachi, Pakistan

Population-based data on the prevalence of diabetic retinopathy in Pakistan are lacking. We determined the prevalence of diabetic retinopathy among individuals screened positive for diabetes in five community-based eye camps in northern Karachi, Pakistan. In summer 2002, five community-based eye camps were set up in Karachi, Pakistan's largest city. All individuals aged 30 years or older who visited the camps were requested to participate in the study. Those who agreed were screened for diabetes and those found to have the disease were referred to an eye hospital for diabetic retinopathy screening. Verbal informed consent was obtained from all participants at the examination site. Our main outcome measure was diabetic retinopathy, which was classified as non-proliferative diabetic retinopathy [NPDR], severe NPDR, and proliferative diabetic retinopathy [PDR]. Our grading was based on clinical examination. A total of 912 subjects were screened for diabetes mellitus. Of these, 160[17.5%] had diabetes- 1.8% had type I diabetes and 15.9% had type II diabetes. One hundred and eight individuals visited the hospital for ophthalmic examination. Of them, 15.7% had diabetic retinopathy. The prevalence of diabetic retinopathy was higher among individuals with type I diabetes, with greater duration of diabetes, and among women. The commonest form of diabetic retinopathy was non-proliferative [76.5% [mild: 35.3%, moderate: 29.4%, and severe: 11.8%]], followed by maculopathy [17.6%] and proliferative diabetic retinopathy [5.9%]. More systematic and population-based research is needed to estimate the prevalence of and identify risk factors for diabetic retinopathy in Pakistan