Comparative evaluation of conventional medical treatment alone versus conventional medical treatment with amniotic membrane transplantation in infective corneal ulcer

To compare the effect of amniotic membrane transplantation along with conventional therapy and the conventional therapy alone for the treatment of infective corneal ulcer. This study was conducted at Ophthalmology Department, Hayatabad Medical Complex Peshawar. The duration of study was 6 months, i.e., from April 2010 to October 2010, in which a total of 68 patients were included using WHO software for sample size determination. They were divided into two equal groups of 34 each. Non probability purposive sampling technique was used. In this study, mean age was 50 +/- 0.24 years. Forty six [67.6%] patients were male while 32.4% [n=22] patients were female. Conventional Medical Treatment alone was effective in 87% [n=30] cases while Conventional Medical Treatment with Amniotic Membrane was effective in 96% [n=33] cases with a p-value of 0.03. This study showed encouraging results of amniotic membrane trans plantation along with conventional treatment in corneal ulcer in improving both symptoms and signs

Risk factors of preseptal and orbital cellulitis

To estimate the frequency and major risk factors of preseptal and orbital cellulitis. A cross-sectional analytical study. The Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar from July 2003 to December 2006. All consecutive patients between ages 6 and 40 years, admitted to the institute with the diagnosis of preseptal and orbital cellulitis were included in the study. The patients were divided into two groups. Group I included patients with ages 6-16 years and group II with ages 17-40 years. The clinical features, diagnosis and risk factors were entered on a specially-designed proforma. The risk factors included were trauma, insect bite, localized or systemic infection and postsurgical. Odd ratio and p-values were calculated for potential risk factors. The frequency of orbital cellulitis was 0.1% of total admission. Out of 26 patients, 42.30% patients were in group I and 57 in group II. In group I, insect bite was the most common risk factor identified in 40% of patients with preseptal cellulitis and trauma as a common cause in 50% with orbital cellulitis. In group II, trauma was the leading cause in 50% of patients with preseptal cellulitis and sinusitis as a common cause in 18.1% with those of orbital cellulitis. In both groups the p-values were found insignificant [p > 0.5]. Complications included cicatricial ectropion in 44.4% and orbital abscess in 41.1%. For preseptal cellulitis, insect bite was the most common cause in group I and trauma was the leading cause in group II. For orbital cellulitis, trauma was important cause in group I and sinusitis in group II

Comparison of epidural steroid injections with conservative management in patients with lumbar radiculopathy

To determine the difference in short- and long-term pain improvement between lumbar Epidural Steroid Injections [ESIs] and conservative management in patients with lumbar radiculopathy. Quasi-experimental study. The Postgraduate Medical Institute of Hayatabad Medical Complex, Peshawar, from April 2005 to March 2007. Fifty elective patients fulfilling the inclusion criteria were randomly divided into two groups. Patients in the steroid group were treated with 80 mg of methylprednisolone injected in combination with 3 ml of 2% plain xylocaine and 3 ml of normal saline in the lumbar epidural space, while patients in the conservative group were treated with bed rest, non-steroidal anti-inflammatory agents, muscle relaxants, and opioids. All the 50 patients in the two groups were regularly assessed at 2 weeks, 1 month, 3 months and 6 months of periods for pain score by the Visual Analogue Scale [VAS], patients satisfaction score and any unwanted side effects. A marked improvement of the pain score and patients satisfaction score were noticed in the steroid group. Less significant improvement was seen in the conservative group during the initial period i.e 2 weeks and 1 month [p <0.05]. The difference in Visual Analogue Scale [VAS] and patients satisfaction score was non-significant in chronic stages of treatment in both groups [p > 0.05]. Epidural steroid injections in acute symptoms of sciatica are considered to be a better option compared to conservative treatment

Comparison of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children undergoing hypospadias surgery

To compare the effectiveness of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children undergoing hypospadias surgery. Quasi experimental study. The Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, from February 2006 to August 2007. The study was conducted on 60 male children undergoing elective hypospadias surgery at the study centre. Patients were divided into two groups of 30 each. Patients in group 'B' [bupivacaine] were given 0.5 ml/kg of 0.25% plain bupivacaine, while patients in group 'BT' [bupivacaine and tramadol] were given 0.5 ml/kg of 0.25% bupivacaine in combination with 1 mg/kg of tramadol in caudal epidural space just after induction of anaesthesia. ASA status, duration of anaesthesia,duration of surgery, type of anaesthesia and maintenance of anaesthesia were similar for both groups. In the recovery room, patients were compared for pain scores, sedation score, need for rescue analgesia and any unwanted side effects for 24 hours postoperatively. All patients were assessed haemodynamically at regular intervals intraoperatively in both groups. A t-test was used to compare the mean values of the group with significance at p < 0.05. Mean age of the children was 4.2 +/- 2.35 and 5.5 +/- 1.51 years in group B and BT respectively. Their weight ranged from 10-30 kg. A lower pain score was observed in the bupivacaine-tramadol group during the first 24 hours in the recovery room, as well as in the postoperative ward. The mean duration of analgesia was significantly prolonged and the requirement for rescue analgesics were significantly less in the bupivacaine-tramadol group [p < 0.0001] postoperatively. Demographic data, haemodynamic variables, sedation score, and minor complications were not significantly different in the two groups. Caudal tramadol with bupivacaine provides prolonged and good quality postoperative analgesia compared to plain bupivacaine in children undergoing hypospadias surgery

Midazolam with bupivacaine for improving analgesia quality in brachial plexus block for upper limb surgeries

To compare the onset, duration and postoperative pain scores of supraclavicular block with bupivacaine alone and bupivacaine-midazolam combination. Randomized controlled clinical trial. The Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, from April 2005 to June 2007. A randomized controlled clinical trial was conducted on 50 ASA-I or II adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly allocated into two groups of 25 each. Patients in group A were administered 30 ml of 0.5% bupivacaine and those in group B were given 30 ml of 0.5% bupivacaine with midazolam 50 micro g.kg-1. Hemodynamic variables [heart rate, noninvasive blood pressure, oxygen saturation], pain scores, rescue analgesic requirements and sedation score were recorded for 24 hours postoperatively, and compared using ANOVA with significance at p <0.05. The onset and duration of sensory and motor block was significantly faster and longer in group B compared to group A [p < 0.001]. Pain scores were significantly lower in group B for 24 hours postoperatively [p < 0.001]. Demand for rescue analgesic were significantly less in group B. Hemodynamics and sedation scores did not differ between the groups in the studied period. Bupivacaine [0.5%] in combination with Midazolam [50 micro gúkg-1] quickened the onset as well as prolonged the duration of sensory and motor blockade of the brachial plexus for upper limb surgery. It improved postoperative analgesia without producing any adverse events compared to plain bupivacaine [0.5%] in equal volume

Spectrum of ocular surface squamous neoplasia

To describe the pattern of ocular surface squamous neoplasia [OSSN], clinical presentations, the risk factors and treatment options. An observational case series. Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, from April 2003 till August 2006. The study included 36 eyes of 35 patients with biopsy-proven ocular surface neoplasia. The details of patients regarding age, gender, laterally and risk factors were entered into a specially-designed proforma. Each patient was also assessed blomtcroscoplcally for type and complications of ocular surface neoplasia. The frequency of OSSN was 0.37 among admitted hospital patients. Among 36 cases of OSSN, squamous cell carcinoma of the conjunctiva was the most common type of OSSN seen in 63.9%, followed by carcinoma in situ of conjunctiva in 25% and carcinoma in situ of cornea in 11.1%. Male patients outnumbered female [65.7% vs 34.3%] with 71.42% of patients above 60 years of age. The risk factors identified were: old age, ultraviolet B exposure and xeroderma pigmentosa. Treatment consisted of local resection with or without adjuvant therapy in 61.1%, exenteration in 30.5%, enucleation in 5.5% and chemo/radiotherapy in 2.7%. Intraocular invasion was seen in 5.5% and orbital spread in 30.5%. The frequency of OSSN was 0.37% among admitted patients. Identification of exact etiological factors will enable to formulate strategies that are likely to decrease the incidence of this disease and the associated morbidity and mortality

Induction and emergence characteristics of propofol in two different concentrations in day case eye surgery in children

To compare the induction characteristics of two different concentrations of propofol i.e. 1% and 2% in children undergoing eye surgeries. Material and In this cross-sectional comparative study 100 consecutive patients of ASA status 1 and II coming for elective eye surgeries were divided into two groups of 50 each. Group A were given propofol 1% while patients in Group B were given propofol 2% for induction of anaesthesia and were maintained with 1% isoflurane and 60% nitrous oxide in oxygen. Induction characteristics i.e. loss of consciousness or onset time of anaesthesia, pain on injection, spontaneous or purposeless movements, spasm just after intubation and conditions of intubation were assessed and compared in two groups. Student't test and chi- square test were applied. Loss of consciousness was more rapid with propofol 2% compared with propofol 1% [40s Vs 48s; P = 0.02]. Pain on injection occurred in 5[10%] and 10 [20%] patients [P = 0.09] after propofol 1% and 2% respectively. Spontaneous movements during induction occurred in 8 [16%] and 12 [24%] patients [P=0.18]; satisfactory intubation was done in 40 [80%] and 45 [90%] patients [P=0.19], while spasm just after intubation was noticed in 1 [2%] and 3 patients [6%], receiving propofol 1% and 2% respectively. Haemodynamic changes were not different in the two groups. Propofol 1% and propofol 2% are equally effective and safe for induction of anaesthesia in children undergoing eye surgeries

Demography of patients with periocular dermoid cysts

To study the demographics of patients admitted in the hospital with histologically proven periocular dermoid cysts. A retrospective descriptive case series. Department of Ophthalmology Khyber Institute of Ophthalmic Medical Science, Hayatabad Medical Complex, Peshawar from July, 2004 to March, 2007. Clinical characteristics of patients with dermoid cysts admitted to the hospital were retrieved from patient charts. A note was made of its frequency, age, gender and laterality. Other features like site, size, depth, histology and presenting features were also looked for. Patient's age at the time of surgery was also noted. The frequency of dermoid cysts was 40.8% amongst orbital cases. Majority [65.7%] were females and 73.6% patients were below 15 years of age. The disease was right sided in 55.2%. Majority were superficial dermoids [71.0%] followed by conjunctival dermoids [15.7%] and deep dermoids [13.1%]. The most frequent clinical finding was a mass in 84.2%. Most patients [44.7%] were below 10 years at the time of surgery. The disease is more common in females and children. Superficial dermoids are more frequent. Presentation is usually with a subcutaneous mass and treatment of choice is surgical excision

Evisceration, enucleation, and exentration: painful but life saving surgical procedures

To determine the indications for Evisceration, Enucleation and Exentration in patients operated at the eye department. It was a prospective study done at Khyber Teaching Hospital, Peshawar, from May 2001 to October 2003. A total of 110 cases comprising of 50 enucleations, 34 evisceration, and 26 exentration were seen. Ocular malignancy was the commonest cause for eneucleation while postoperative panophthalmitis and trauma were the reasons for evisceration and for exentration the indication was squamous cell carcinoma involving lid and conjunctiva followed by basal cell carcinoma. Only a minority of cases of eye globe surgery are preventable and/or treatable, while rest are due to malignancy. Early diagnosis in these cases is likely to make surgery easy with promising postoperative cure

Congenital nasolacrimal duct obstruction at agency headquarter hospital Batkhela NWFP

To find out the frequency of congenital nasolacrimal duct obstruction [CNLDO] and the of its management. Material and A prospective study of 160 consecutive patients with congenital nasolacrimal duct obstruction, conducted from January 1999 to December 1999 at the Department of Ophthalmology Agency Head Quarter Hospital Batkhela, NWFP. Only patients below the age of twelve months were included the study. Diagnosis was made by history of epiphora beginning early in life with obstruction clinically confirmed on examination. Antibiotic drops and massage of the lacrimal sac was advised. Probing was carried out for the nonresolving cases at the age of one year. A total of 160 patients CNLDO were included in the study. Seventy Two [45%] of these infants presented within the first two months of life. Out of these 160 patients 18 patients were lost to followup. Out of remaining 142, 132[93%] of the patients resolved spontaneously with conservative treatment using topical antibiotics within one year. Only 10 [7%] of the patients required probing. Parents of CNLDO patients should be counseled about the disease and advised them to wait for spontaneous improvement. Probing for unresponsive cases is recommended

Presentation of diabetic retinopathy

The aim of this study is to evaluate the presentation of diabetic retinopathy in diabetic patients presenting to Ophthalmology out patient.The study was conducted at the Department of Ophthalmology, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar over a period of 1 year from January 1999 to December 1999. A total of hundred cases were evaluated. A thorough and complete history was followed by careful Ophthalmological examination. Systemic evaluation for diabetic complications was also carried out. Male to female ratio in our study was 1.4: 1. Ninety one [91%] were cases of non-insulin dependent diabetes mellitus [NIDDM] and only 9% cases were of insulin dependent diabetes mellitus [IDDM]. Non proliferative diabetic retinopathy [NPDR] was found in 28.6% of NIDDM cases and 22.2% of IDDM cases. Proliferative diabetic retinopathy [PDR] was found in 9.8% of NIDDM cases and 11% of IDDM cases. Diabetic maculopathy was found in 15.4% of NIDDM whereas it was present in 33.3% of IDDM cases. Diabetic retinopathy is common sequalae of diabetes. Its presence and complications are strongly related to duration and control of diabetes. Diabetic maculopathy is commonest cause of visual impairment in diabetic patients