Comparative study of dacryocystorhinostomy with and without intraoperative application of mitomycin C

To compare the outcome of dacryocystorhinostomy surgery with and without the intraoperative use of Mitomycin C. Our study is a prospective comparative case study in which 50 patients of primary acquired nasolacrimal duct obstruction were divided on the basis of random sampling into the conventional dacryocystorhinostomy group and the Mitomycin C group in which Mitomycin C 0.2 mg/ml was used intraoperatively. Patients were followed on 1st postoperative day, 1st, 3rd, 6th weeks, 3rd and 6th months. Patient symptoms and satisfaction were noted. Patency of lacrimal passage was assessed by lacrimal syringing and tear meniscus height was recorded on each follow-up. At the end of 6 months of follow-up, 96% of patients were asymptomatic in the Mitomycin C group whereas 80% patients in the conventional group were asymptomatic. On lacrimal syringing 24 [96%] eyes had patent passage in the Mitomycin C group where as only 1 [4%] patient had complete block with regurgitation of mucopurulent fluid. In the conventional group 20 [80%] eyes had patent passage, 4 [16%] eyes had complete block with regurgitation of mucopurulent fluid and 1 [4%] eye had partially patent passage on lacrimal syringing. Out of 25 eyes, 24 had normal tear meniscus height, and 1 had high tear meniscus height in the Mitomycin C group in comparison to the conventional group in which out of 25 eyes 20 eyes had normal, 1 had moderate and 4 eyes had high tear meniscus height. Intraoperative and postoperative complications in both the groups were identical. Although the difference between the two groups was not statistically significant, a distinctly higher success was achieved in patients undergoing dacryocystorhinostomy with intra operative Mitomycin C as compared to conventional dacryocystorhinostomy

Treatment options for Guillain-Barre syndrome [GBS] - a comparative assessment of treatment efficacy between intravenous immune globulin [IVIG] with plasmaphoresis

To compare the therapeutic efficacy of Intravenous immune globulin [IVIG] with Plasma exchange [plasmaphoresis] in patients of Acute Inflammatory Demyelinating Polyneuropathy i.e. Guillain-Barre syndrome [GBS]. Randomized Controlled Trial [RCT]. The study was of 12 months duration conducted at Department of Medicine, Neurology Unit of Military Hospital Rawalpindi from Jun 2008 to Jun 2009. 60 Patients of GBS were randomly assigned to two treatment groups. Group A received Intravenous immune globulin [IVIG] and Group B Plasma Exchange. Patient's functional status according to London scale grade was assessed at the time of admission and at 02 and 04 weeks after giving treatment. Improvement in mean London scale Grades in each group was calculated at different weeks from baseline and then both groups were compared to each other. In each group there was significant improvement [P-value< 0.001] from baseline-2weeks and baseline-4 weeks. But when compared to each other both the groups had comparable improvement [p-value> 0.05]. Both IVIG and Plasma Exchange have equal therapeutic efficacy in the treatment of patients of GBS

Comparative efficacy of amlodipine and hydrochlorthiazide-amiloride in cases of mild essential hypertension in outdoor patients at combined Military Hospital Multan

To compare antihypertensive effect of fixed dose combination Hydrochlorothiazide-Amiloride and Amlodipine in patients of mild essential hypertension. Randomized controlled trial [RTC]. Department of Medicine Combined Military Hospital Multan Cantt from 29 January 2007 to 29 June 2007. After fulfilling the inclusion criteria of mild essential hypertension, defined as per recommendations of Seventh Joint National Committee [JNC 7] for treatment of Hypertension as stage 1 hypertension, systolic blood pressure [SBP] >/= 140-159-mmHg and Diastolic blood pressure[DBP] >/= 90-99-mmHg, 100 patients were randomized into two study groups using a table of random numbers. Group 1 received tab amlodipine [5 mg] and Group 2 received tab hydrochlorothiazide-amiloride [25 mg-2.5mg]. Informed written consent was taken. The patients were followed on subsequent visits [6 in total] for five months and systolic and diastolic blood pressure was recorded carefully. All the data thus obtained were processed and analyzed using SPSS version 10.0. Mean and standard deviation [SD] were calculated for age, diastolic and systolic blood pressure. In group 1 the drop in mean SBP between first and last visit was 15.42 mm Hg. In group 2 the drop in mean SBP between first and last visit was 18.34 mm Hg. In group 1, the drop in mean DBP between first and last visit was 10.08 mm Hg. In group 2 the drop in mean DBP between first and last visit was 14.65 mmHg. Mean drop in SBP of both the groups were compared with each other and found to be significantly different [P=0.003]. Similarly mean drop in DBP of both the groups were compared with each other and found to be significant statistically [P=0.001]. Hydrochlorothiazide-Amiloride had significantly better antihypertensive effect than Amlodipine in patients of mild essential hypertension at the end of five months therapy

Corneal endothelial safety of intracameral preservative-free 1% xylocaine.

PURPOSE: To evaluate the effect of intracameral preservative-free 1% xylocaine on the corneal endothelium as an adjuvant to topical anaesthesia during phacoemulsification and Acrysof foldable IOL implantation. MATERIAL & METHODS: This is a prospective, controlled, randomised, double-masked study. 106 patients with soft to moderately dense (Grade 1-3) senile cataract and corneal endothelial cell density of >1500/mm2 were randomised to the xylocaine group (n=53) and control group(n=53). Central endothelial specular microscopy and ultrasound corneal pachymetry were performed preoperatively. On the first postoperative day the eyes were evaluated for corneal oedema and Descemet's folds. Ultrasound corneal pachymetry was performed at 1, 3 and 12 months. Specular microscopy was performed at 3 and 12 months. Cell loss was expressed as a percentage of preoperative cell density. Six patients could not complete one year follow-up. Chi-square and paired t test (2 tail) statistical tests were applied for analysis. RESULTS: Four (7.54%) patients in the xylocaine group and 5 (9.43%) in the control group had a few Descemet's folds associated with mild central stromal oedema. Corneal thickness increased from 549.3micro +/- 37.2micro to 555.5micro +/- 36.5micro in the xylocaine group and from 553.1micro +/- 36.2micro to 559.3micro +/- 40.5micro in the control group at the one-month postoperative visit. Thickness returned to the preoperative level in xylocaine group 549.6micro +/- 34.5micro and control group 554.7micro +/- 41.1micro at three months. (P=0.484) The percentage of cell loss was 4.47 +/- 2.53% in the xylocaine group and 4.49 +/- 3.09% in the control group at one year. (P=0.97) CONCLUSION: Intracameral preservative-free 1% xylocaine does not appear to affect corneal endothelium adversely during phacoemulsification.