Comparison of retinal nerve fiber layer thickness in patients having pseudo exfoliation syndrome with healthy adults

Objective: To compare mean retinal nerve fiber layer [RNFL] thickness in patients having pseudo exfoliation [PXF] with normal age matched controls using spectral domain optical coherence tomography [SD-OCT]

Methods: This was a case control study conducted at Armed Forces Institute of Ophthalmology [AFIO] Rawalpindi from 12 June 2013 to 12 January 2014. Seventy eyes [Group A - 35 patients with PXF and Group B - 35 healthy age matched subjects] of more than 40 years of age were included in the study. Intraocular pressure [IOP] was measured with Goldmann applanation tonometer [GAT] and peripapillary RNFL thickness was measured in four quadrants with SD-OCT [Topcon 3D OCT-1000 Mark II] in all subjects. Data was analyzed using the SPSS version 14

Results: Mean age of group A [PXF patients] was 65.63 +/- 8.47 years and of group B [Healthy subjects] was 64.31 +/- 6.51 years [p = 0.470]. Both groups were gender matched with male preponderance [p = 0.673]. Mean IOP in each group was 13.80 +/- 2.59 mm Hg, and 13.49 +/- 2.07 mm Hg respectively [p= 0.578]. Mean average peripapillary RNFL thickness was 77.46 +/- 12.17 micro m in group A and 83.96 +/- 10.58 micro m in group B. Statistically significant differences were detected between two groups for mean average RNFL thickness [p= 0.020] and mean RNFL thickness in inferior quadrant [p=0.014]

Conclusion: PXF patients with normal IOP and visual fields have thin RNFL as compared to healthy age matched controls. Therefore routine assessment and follow up of PXF patients with OCT may help in early diagnosis of PXF glaucoma

Role of intra umblical oxytocin injection in the management of retained placenta

To determine the efficacy of intra umbilical oxytocin injection as a treatment for retained placenta. Quasi experimental study. This was conducted at DHQ Hospital Faisalabad over a period of two year from January 2005 to January 2007. A total 30 haemodynamically stable women having singleton pregnancy and vaginal delivery with retained placenta admitted in labour ward were selected. 20i.u of oxytocin diluted in 20cc normal saline was injected through umbilical vein. Thirty cases of retained placenta were managed during study period. The highest percentages of patients [66.6%] with retained placenta were between the ages of 20-30 years. Majority of patients [46.6%] having parity between 1 to 4. 56.6% of patients having gestation between 38-39 weeks. Intra umbilical oxytocin injection was successful in 70% of patients while 30% of patients required manual removal of placenta. 60% of patients expelled placenta in less than 10 minutes. Amount of blood loss was less than 80ml in 71.4% of patients and 28.5% of patients received blood transfusion. None of patient developed side effects of drug. Injection of oxytocin into the umbilical vein is safe procedure that can cause placental separation and delivery and thus avoiding the anaesthetic risk, genital tract trauma, and infection associated with manual removal of placenta

Presentation and management of ectopic pregnancy in a tertiary care teaching hospital

To identify risk factors, presentation, correlation between clinical signs, symptoms and final diagnosis and treatment of ectopic pregnancy. A cross sectional analytical study. This study was conducted at DHQ Hospital Faisalabad over a period of one year, from January 2004 to January 2005. All the patients, with suspicion of ectopic pregnancy by their presentation, underlying risk factors, were admitted through emergency and gynaecology out patient department. Initial diagnosis of ectopic pregnancy was made in patients presented with amenorrhoea, abdominal pain and irregular bleeding. Ultrasound and urine for pregnancy test were done for confirmation of diagnosis. Any underlying risk factors for ectopic pregnancy were also recorded. A total of 24 cases of ectopic pregnancy were managed during study period. Initial diagnosis was correct in 18 patients [75%], while 6 patients [25%] were assigned a different diagnosis on admission. The highest percentage of patients 66.6% [16 cases with ectopic pregnancy were between the age of 30-35 years. 6[25%] patients were nullipara and 18 [75%], were multiparos. 16[66.6%] of patients had underling risk factors for ectopic pregnancy, while no risk factor was detected in 8[33.3%] patients. The most frequently experienced symptoms of ectopic pregnancy were abdominal pain [66.6%], amenorrhoea [58.3%] and vaginal bleeding [41.6%]. Salpingectomy through laparotomy was done in all cases. No patients qualified for expectant or medical treatments because of late presentation and rupture of the tube beyond the scope of repair. The mortality was nil because of effective resuscitative measures and immediate surgical correction