Outcomes of cataract surgery in microophthalmia

Objective: To find out outcomes of cataract surgery with Microophthalmia in children less than two years

Methods: This cross-sectional study was conducted at Al-Ibrahim Eye Hospital, Karachi from January 2016 to August 2017. It included thirty micro ophthalmic eyes of infants with visually significant cataract of age less than two years who had cataract surgery without intraocular lens implantation. Axial length of globe was 19 mm or less in all thirty eyes of seventeen infants. in which thirteen infants had bilateral cataract and four had unilateral cataract

Result: Thirty Simple Micro ophthalmic eyes from seventeen patients having visually significant congenital cataract were studied. Thirteen had bilateral cataract and four had unilateral cataract. Mean preoperative IOP was 9.0 +/- 1.2 mmHg and postoperative IOP after three months was 10.9 +/- 3.2 mmHg. Three patients had secondary capsular opacification 17.6%. Two patients had posterior synachae 11.8% after three months

Conclusion: The results suggest that cataract surgery in simple microophthalmia is safe procedure. Postoperative complications in this study were within acceptable limits. Long term study with intraocular lens is required to confirm our observation

Relationship of oral tumor thickness with the rate of lymph node metastasis in neck based on CT scan

Objective: To determine the relationship of tumor thickness of oral lesions with metastasis in neck based on CT scan

Methods: A total of 58 oral squamous cell carcinoma patients having the median age of 46 [39-55] years, with either gender presented with malignant tumor of buccal mucosa and tongue were prospectively enrolled. A CT Scan with contrast was performed on all patients. Correlation of tumor thickness level with metastasis in neck was calculated using spearman's rank correlation coefficient test

Results: Median age of the patients was 46 [39-55] years with preponderance of male gender, i.e. 48 [82.8%]. Strong positive significant correlation was observed in between transverse dimension [TS] tumor size and stages of tumor [rho 0.673, p-value <0.001], Anterioposterior [AP] tumor size and stages of tumor [rho 0.675, p-value <0.001], and Craniocaudal [CC] tumor size and stages of tumor [rho 0.771, p-value <0.001]

Conclusion: CT scan of neck with contrast can be used for predicting the positive presence of lymph node in neck with primary tumors having a size of more than 4 mm

Diagnostic accuracy of multislice CT scan in the detection of occult cervical lymph node metastasis in head and neck cancers

Objective: To determine the diagnostic accuracy of CECT in detecting occult cervical lymph node metastasis in primary head and neck squamous cell carcinoma [SCC] patients with clinically negative cervical nodes, keeping histopathology as gold standard

Study Design: Cross-sectional analytical study

Place and Duration of Study: Department of Radiology, Dow International Medical College, DUHS, Karachi from October 2015 till April 2016

Methodology: Two hundred patients of head and neck squamous cell carcinoma patients with clinically negative cervical nodes were enrolled at Department of Radiology, Dow International Medical College, DUHS, Karachi from October 2015 till April 2016. Multidetector computed tomography [MDCT] was done and lesions were assessed for presence or absence of tumor to metastasis into cervical lymph nodes. Histopathology was used as gold standard

Results: The mean age was 44.89 +/- 9.82 years as majority of the patents were males [58.0%]. CECT findings showed 48.5% positive cases, while histopathology findings showed that there were 48.39% positive cases with sensitivity, specificity, NPV, PPV and overall diagnostic accuracy of 100%, 93%, 93%, 100% and 96.21%

Conclusion: MDCT is a very effective modality in early diagnosis of cancerous involvement of SCC and its invasion into cervical lymph node metastasis promising early detection and treatment

Prevalence of Lumbosacral Transitional Vertebra in Individuals with Low Back Pain: Evaluation Using Plain Radiography and Magnetic Resonance Imaging

STUDY DESIGN: Descriptive cross-sectional study. PURPOSE: To determine the frequency of lumbosacral transitional vertebrae (LSTV) in patients with low back pain (LBP) and the role of iliolumbar ligament (ILL) origin from L5 in LSTV cases. OVERVIEW OF LITERATURE: Transitional vertebrae are developmental variants of the spine. LSTV is a common congenital abnormality, and failure to recognize this anomaly may result in serious consequences during surgery. METHODS: All patients aged 11–90 years of either gender with LBP for any duration, who presented for X-ray and magnetic resonance imaging (MRI) of the lumbosacral spine, were included. X-rays of the lumbosacral spine in anteroposterior and lateral views were acquired. In addition, T1- and T2-weighted sagittal and axial MRI was performed. Images were evaluated on a workstation. RESULTS: Of 504 patients, transitional vertebrae were observed in 75 patients (15%). Among them, 39 (52%) patients had Castellvi type III and 36 (48%) patients had Castellvi type II. However, on MRI, 42 (56%) patients had O'Driscoll type II, 18 (24%) patients had O'Driscoll type IV, and 15 patients (20%) had O'Driscoll type III. ILL origin from L5 was significantly higher (n=429, 100%) among patients with a normal lumbosacral junction than among patients with a transitional lumbosacral junction (n=22, 29.3%) (p < 0.001). CONCLUSIONS: LSTV occurs at a high frequency in patients with LBP. Furthermore, in the presence of LSTV, the ILL is not a reliable marker for the identification of L5.

Facture of the Pars Interarticularis with or without Spondylolisthesis in an Adult Population in a Developing Country: Evaluation by Multidetector Computed Tomography

STUDY DESIGN: Descriptive cross-sectional study. PURPOSE: To determine the prevalence of lumbar spondylolysis and spondylolisthesis in a general adult population unrelated to lower back pain as evaluated by multidetector computed tomography. OVERVIEW OF LITERATURE: There is a significant paucity of information related to the prevalence of spondylolysis and spondylolisthesis and its degenerative changes in a general adult population unrelated to lower back pain in developing countries. METHODS: A retrospective study was conducted on abdominopelvic computed tomography (CT) scans performed between January 1st 2015 and December 31st 2015 for various clinical indications. Patients with lower back pain, with a history of trauma or road traffic accident, or referred from orthopedic or neurosurgery departments were excluded to avoid any bias. CT scans were reviewed in axial, sagittal, and coronal planes using bone window settings for evaluating spondylolysis and spondylolisthesis. RESULTS: Of 4,348 patients recruited, spondylolysis and spondylolisthesis were identified in 266 (6.1%) and 142 (3.3%) patients, respectively. Age was significantly higher in both spondylolysis and spondylolisthesis patients than in those without spondylolysis and spondylolisthesis (47.19±15.45 vs. 42.5±15.96, p60 years old, both spondylolysis (p=0.018) and spondylolisthesis (p=0.025) were significantly more prevalent in females. CONCLUSIONS: The prevalence of pars interarticularis fracture observed higher with gradual increase in the prevalence with advancing age. In particular, preponderance was significantly higher among older females.

Evaluation of the Causes of Erectile Dysfunction in Patients Undergoing Penile Doppler Ultrasonography in Pakistan

PURPOSE: In patients with erectile dysfunction, it is important to differentiate psychogenic from organic causes. Penile Doppler ultrasonography is a relatively inexpensive and minimally invasive tool for this purpose. This study was conducted to evaluate the causes of erectile dysfunction in an adult male population, using penile Doppler ultrasonography. MATERIALS AND METHODS: A retrospective study was conducted in a single center. All patients who presented with complaints of erectile dysfunction and underwent penile Doppler ultrasonography between July 2014 and June 2016 were included in this study. All examinations were performed using GE Voluson S6 and GE Logiq P5 devices. Following baseline scans, an intracavernosal injection of 20 µg of prostaglandin E1 was given. Peak systolic and end diastolic velocities were measured in each cavernosal artery. Patients with a peak systolic velocity of 5 cm/s was considered to indicate venous incompetence. RESULTS: Out of 97 patients (mean age, 37.09±11.59 years; range, 19~69 years), 50 patients (51.5%) had normal findings, 24 patients (24.7%) had arterial insufficiency, 15 patients (15.5%) had a venous leak, and 8 patients (8.2%) patients had arterial insufficiency with a venous leak. Psychogenic erectile dysfunction was significantly higher among patients aged ≤40 years, while arterial insufficiency with or without a venous leak was significantly higher among patients aged >40 years (p=0.022). CONCLUSIONS: A majority of the studied individuals demonstrated no organic cause of erectile dysfunction, thus confirming a high prevalence of the psychogenic etiology, particularly in relatively young individuals.

Cortical changes in orthopantomogram [OPG] of human mandible as early detector of osteoporosis

To see whether the cortex of mandible on an OPG can be employed for early detection and screening tool for osteoporosis. Cross sectional study. The study was conducted in IBMS, DUHS Karachi and stretched over a period of eight months from December 2011 to July 2012. One hundred and seventy four female subjects, aged 25 to 85 years, were divided into premenopausal [Group I] and postmenopausal [Group II] groups. Each group was subdivided into normal [pre A, post A], osteopenic [pre B, post B] and osteoporotic [pre C, post C] groups by Dual Energy X- ray Absorptiometry [DXA] Scan. Mandibular morphological changes seen on OPG in subgroups of Group I were compared with each other and with subgroups of Group II. Cortical thickness at mental foramen [CMF] was observed on OPG. Statistical analysis was performed by SPSS version 16 using One Way Analysis Of Variance [ANOVA] to evaluate intra group significance and for intergroup significance independent samples T-test was applied. The thickness of Mandibular cortex at mental foramen [CMF] was found to be significantly decreased in osteoporotic patients. In conclusion a simple method of screening was established which can be used as early detector of osteoporosis in a cost effective manner

Efficacy of topical Bevacizumab in high-risk corneal transplant survival

Objective: To evaluate the effectiveness of topical Bevacizumab in preventing neovascularisation on high risk corneal grafts

Methodology: This study was a randomized, controlled, parallel group study, carried out from February 2008 to April 2012 [51 months] at Isra Postgraduate Institute of Ophthalmology and Yasin eye hospital, Karachi. Eyes with high risk corneal transplantation with corneal neovascularization were included in this interventional study/randomized clinical trial. Patients were randomly allocated to 2 groups. Group A and Group B. After penetrating keratoplasty, group A patients received topical bevacizumab [2.5%, 25 mg/ml] which was self-administered 4 times a day for 24 week while group B patients received only sham eye drops. Group B was the control group. Corneal neovascular invasion area i.e. the fraction of area on transplanted cornea in which vessels were present was measured using mathematical software program MatLab. Data analyses was done using SPSS version 19. Frequencies of age gender and groups were measured. Neovascular invasion area and change in visual acuity was compared between the 2 groups using paired t test. P value of less than 0.05 was considered significant

Results: Among the 2 groups mean Corneal neo vascular invasion area was minimum in group A [6.23%] while in group B it was [26.7%]. Maximum number of patients [26] attained visual acuity of 6/36 or better in the topical bevacizumab group compared to 17 sham group

Conclusion: When topical Bevacizumab is used, it reduces the recurrence of neovascularisation and thus helps increasing the frequency of graft survival in cases of high risk corneal transplants

Causes of hand impairment

The objective of this study was to identify the causes leading to impairments of hand. Descriptive case series. This study was conducted at Rehabilitation Medicine department of Combined Military Hospital, Abbottabad from July 2010 to June 2011. 100 patients diagnosed to be having hand impairments were sampled by convenience sampling and through a face-to-face interview. Data was collected and analyzed using SPSS 10. Frequencies and descriptive statistics were calculated for the various variables. 84% [n=84] of the participants were males whereas 16% [n=16] were females. Mean age of study participants was 37.36 years [SD +/- 16.18 yrs]. Among these patients 94% [n=94] were right-handers and 6% [n=6] were left-handers. Dominant hand was affected in 51% [n=51] of patients, non-dominant hand was affected in 37% [n=37] of patients while in 12% [n=12] of patients both hands were affected. The most common cause of hand impairment was road traffic accidents at 28% [n=28], followed by falls 16% [n=16] and firearm injuries at 12% [n=12]. Number of genetic causes, sharp injury, blast injury and overuse were 7% [n=7], 6% [n=6], 6% [n=6] and 5% [n=5] respectively. Carpal tunnel syndrome, electric shock, infection, iatrogenic injury and sports injury were 3% [n=3] each. While cubital tunnel syndrome, and occupational injury were found to be 2% [n=2] each and Neuroma was 1% [n=1]. A large number of patients had hand impairments resulting from trauma. At the top of the list of causes of impairment was road traffic accidents followed by falls. Traumatic causes of hand impairment were 75% while non-traumatic causes were 25%

Treatment supporters and their impact on treatment outcomes in routine tuberculosis program conditions in Rawalpindi district, Pakistan

Tuberculosis [TB] is a major cause of mortality affecting millions of people in third world countries. In DOTS monitoring of patients is facility based and treatment supporter-based; by these two ways patients' compliance to treatment is monitored. The aim of this study was to evaluate the role of treatment supporters and their impact on patients' treatment outcomes. The study was a cross-sectional survey in the routine TB control program operational context. All sputum smear positive TB patients that were diagnosed and registered by the public sector in the urban and rural diagnostic centers in 2008 with available outcomes were included in the study. Data of 451 patients were collected during August-October 2010 from 15 health facilities. The majority of patients [89.6%] were provided with treatment supporters. Of 404 [89.6%] cases with treatment supporters, in 203 [50.2%] the supporters were lady health workers, in 46 [11.4%] were community health workers and health facility workers, and in 155 [38.4%] were family members and community volunteers. A total of 384 [85.1%] were categorized as "treatment success", 31 [6.9%], as "transferred out", 17 [3.8%], as "expired", 16 [3.5%] as "defaulted" and three [0.7%] as "treatment failure". The treatment success rates in patients supervised by Lady health workers, community health workers and health facility workers, and family members and community volunteers were 93.1%, 89.1% and 73.5%, respectively. We found a significantly higher treatment success rate [93.1%] in patients supervised by lady health workers compared to others. The overall treatment success rate was 85.1%

MRI characterization and histopathological correlation of primary intra-axial brain glioma

Objective: To determine the diagnostic accuracy of magnetic resonance imaging [MRI] in preoperative diagnosis and grading of intra-axial gliomas compared with histopathology

Study Design: Prospective, comparative, study

Place and Duration of Study: Radiology Department, Aga Khan University Hospital, Karachi from July 2004 to June 2006

Methods: Fifty-three patients having different neurological symptoms referred to Radiology Department Aga Khan University Hospital for MRI examination were included in the study. These patients were provisionally diagnosed radiologically having intra-axial brain tumor or subsequently found to have pathologically proven primary intra-axial brain tumors. MRI scans were evaluated for location, consistency, hemorrhage, necrosis, margins, edema, MRI signals contrast enhancement and any additional features for staging the tumor. Preoperative diagnosis was compared with postoperative pathological diagnosis by using Pearson's Chi square test. Accuracy of magnetic resonance imaging in diagnosing and staging the brain tumors was determined. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRI in characterizing the lesion was also calculated

Results: The study included 53 patients with age ranging from 1-year 10-months to 60 years [mean 32.7 years]. Twenty-eight patients had supratentorial tumors [52%] and 25 had infratentorial tumors [47%]. Twenty-eight patients had Astrocytoma [52%], 10 had Oligodendroglioma [19%], 6 had Medulloblastoma [11%], 5 had Lymphoma [9%], and 4 had Hemangioblastoma [7%]. Preoperative MRI diagnosis was correct in 50 patients with accuracy of 94%. No significant difference was found between preoperative MRI grading and postoperative histopathological grade of intra-axial tumor [p-value>0.05]. Sensitivity, specificity, positive predictive value and negative predictive value of MRI in detecting tumor necrosis were 93%, 77%, 80% and 90% while for detecting tumor hemorrhage were 57%, 93%, 57%, and 93% respectively

Conclusion: MRI is very accurate in preoperative diagnosis, staging and assessing the tumor characteristics of primary intra-axial brain tumors. It can be used reliably in our usual clinical practice

Computed tomography [CT] scan for pulmonary embolism

Objective: To determine the role of helical CT scan in the diagnosis of pulmonary embolism in our population and compare the results with published data

Methods: One-hundred ten cases of pulmonary embolism were selected for this study. Helical CT chest scanning was performed in all patients. Other imaging tests for pulmonary embolism [PE] including scintigraphy, Doppler ultrasound of leg veins and pulmonary angiography were performed at clinician's discretion. The helical CT findings were obtained from medical record and three months follow up was done in those patients in which CT findings were negative for pulmonary embolism. Sensitivity, specificity, negative predictive value [NPV], positive predictive value [PPV] and accuracy of helical CT scan was calculated. SPSS version 14 was used for data analysis

Results: Among 50 patients diagnosed of having pulmonary embolism, CT scan was positive for PE in 40 patients. There were 10 false negative and no false positive results. Sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV] and accuracy of helical CT was 80%, 100%, 100%, 86% and 91% respectively

Conclusion: Helical CT chest is a very quick, easy, non-invasive and accurate imaging modality in the diagnosis of pulmonary embolism

Possible relation between phenylthiocarbamide taste sensitivity and goitre

The ability or inability to taste the bitterness of phenylthiocarbamide [PTC] is a classic inherited trait that has been studied in relation to various diseases. This study was carried out to find out any possible association between PTC-taste sensitivity and goitre. A total number of 471 subjects were studied. Among them 224 subjects were normal, healthy adults, taken as control and 247 were patients of goitre coming to Nishtar Hospital Multan for treatment. A 0.5% solution of PTC was freshly prepared. A drop of PTC Wution was placed on the dorsum of the tongue and the person was asked to state the taste perceived. Person was asked to spit out the chemical and rinse the mouth with water afterwards. Patients of goitre were clinically diagnosed by inspection and palpation method out of 224 normal healthy adults, 18.3% were non-tasters to PTC. Among 247 patients of goitre 36.84% were non-tasters to PTC. Number of non-tasters was highly significantly [P0 < 001] increased in the goitre patients as compared with the normal subjects. Percentage of non-tasters was non-significantly increased among male patients of goitre as compared with the normal subjects. Among female population, 10.88% of normal healthy females were non-taster to PTC and 37.37% of females having goitres were found to be non-tasters to PTC. Difference was highly significant [P0 < .001]. Female non-tasters to PTC are more prone to develop goitre as compared with the normal healthy females. PTC non-taster status is a vulnerability marker for females

Heterotopic pregnancy-outcome and management

A case of heterotopic pregnancy is reported that presented with 7 weeks of amenorrhea, lower abdominal pain and spotting per vaginum. Ultrasound showed an intra-uterine gestational sac as well as right-sided ruptured tubal pregnancy. Emergency laparotomy and right salpingectomy was performed. Subsequent ongoing alive intra-uterine pregnancy was delivered by vaginal route at term

Pelvic spleen with uterovaginal prolapse

A case of wandering [pelvic] spleen associated with third degree uterovaginal prolapse and ascaris in the biliary and intestinal tract is being presented here. On laparotomy; congested splenomegaly was found in the pelvis. Splenectomy, total abdominal hysterectomy and bilateral salpingo-ophrectomy was performed

Laparoscopic evaluation of endometriosis

To find out number of cases with endometriosis. its relationship with age, parity and socioeconomic condition and to document its different stages. Design: An observational study. Place and Duration: Study was conducted in the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre Karachi, over four years period from 1st January 2000 to 31st December 2003. Subject And Methods Three hundred diagnostic laparoscopies were performed in patients with various clinical presentations such as chronic pelvic pain, dysmenorrhea, dyspareunia, infertility and menstrual irregularities 'to find out those due to endometriosis. Forty cases of endometriosis were diagnosed at laparoscopy. Majority [75%] of the patients with endometriosis were between 20-30 years of age. Endometriosis was more common in infertile as compared to fertile ladies. As JPMC is a tertiary care public sector hospital providing services to relatively poor class of patients, all the cases of endometriosis were found in lower socio economic class. Ten cases [25%] of endometriosis were in stage-I, fifteen cases [37.5%] in stage-II while there were 5 and 10 cases in stage III and IV respectively. Endometriosis is not an uncommon gynecological problem and is commonly found in young and reproductive age group, of patients. Laparoscopy being a minimally invasive procedure requiring minimum time of hospitalization and minor post-operative discomfort is invaluable in diagnosis of endometriosis

susceptibility patterns of methicillin resistant staphylococcus aureus in Quetta, Balochistan

This study was conducted at Pathology Laboratory, Combined Military Hospital, Quetta to evaluate susceptibility patterns of Methicillin Resistant Staphylococcus areus [MRSA] to commonly used anti staphylococcus antimicrobials during the period April 1996 to November 2000. One hundred consecutive, non-duplicate strains of MRSA isolated from different clinical samples were identified by standard microbiological methodology. They were studied for their susceptibility to co-trimoxazole, erythromycin, tetracycline, gentamicin, chloramphenicol, ciprofloxacin, fusidic acid and vancomycin by disc diffusion technique using modified Kirby-Bauer method. All the MRSA were sensitive to vancomycin. Four% strains revealed resistance to fusidic acid, 62% to chloramphenicol, 79% to ciprofloxacin, 80% to gentamicin, 88% to erythromycin 93 to tetracycline and 97% to co-trimoxazole. Most of the MRSA were multidrug resistant. These strains revealed higher degree of resistance [>60%] to routine anti-staphylococcus anti microbials. Vancomycin and fusidic acid could be life saving anti-staphylococcus antimicrobials in MRSA infections in Quettta

Ruptured cornual pregnancy

A case of ruptured cornual pregnancy is presented here. The patient presented with history of 30 weeks gestational amenorrhoea and pain in the lower abdomen and epigastrium for the last seven days. Ultrasound revealed a 29 weeks abdominal pregnancy with blood in the pelvic cavity. On laparotomy; there was a ruptured right cornual pregnancy, treated cornual resection and uterine repair. An alive male baby of one kg weight was delivered from the resected cornua of the uterus