Comparison of visual outcome between superior scleral tunnel and temporal scleral tunnel approaches in Manual Small-Incision cataract surgery

To compare the postoperative visual acuity, per-operative and post-operative complications and the magnitude of the post-operative astigmatism in [Manual Small Incision cataract surgery [MSICS]] in superior and temporal scleral tunnel approach. A comparative interventional study. The study was conducted at LRBT Secondary Eye Hospital Lar, Multan from Jan 2008 to September 2008. 250 patients, aged from 45 to 90 years, were enrolled and divided into two groups, group A [N=125] and group B [N=125]. Group A underwent MSICS by superior while group B underwent MSICS by temporal scleral tunnel incision approach. The patients were followed up at 1st and 3rd post-operative days and 2nd, 4th and 6th postoperative weeks. 107 patients in group A and 119 patients in group B completed their 6 week follow up. The intraoperative complications, post-operative complications, postoperative visual acuity and magnitude of postoperative astigmatism were recorded at 6 week follow up and compared between two groups. At 6th week postoperatively, 46 of 107 [42.9%] of group A and 79 of 119 [66.1%] of group B had uncorrected visual acuity of 6/18 or better. 98 of 107 [91.3%] of group A and 110 of 119 [92.2%] of group B had best corrected visual acuity of 6/18 or better. There was no significant difference between the two groups for intra-operative and post-operative complications. Minimum and safe stigmatism is present in temporal approach. Both superior and temporal scleral tunnel approaches are safe and effective for MSICS but the temporal approach gives better un-corrected visual acuity and minimum and safe astigmatism

Cost of acute stroke care at a tertiary care hospital in Karachi, Pakistan

To evaluate cost of acute stroke care and its determinants at a tertiary care hospital in Karachi and to find out predictors of high cost care. Acute stroke is a leading cause of morbidity and mortality. Cost of care is the single most important determinant in availability of acute stroke care at a tertiary care hospital in Pakistan. It is also an important factor in development of public health policies and medical insurance plans. Average annual income in Pakistan is 4881 rupees [U$ 85]. Medical and billing records of 443 patients with acute stroke were retrospectively reviewed from 1998-2001 at The Aga Khan University Hospital [AKUH], Karachi. Acute stroke care at AKUH usually includes routine laboratory investigation including Lipid profile, Magnetic resonance imaging/angiography [MRI/MRA], Echocardiogram, Carotid Doppler's ultrasound and medical management in the Stroke care unit. 443 patients were included in study. Age range was 25-98 years [Mean 58 years]. 269 [61%] were male. Length of hospital stay was 1 day; 67 patients, 2 days; 83 patients, 3 days; 70 patients, 4-5 days; 87 patients, 6-10 days; 75 patients, 11-30 days; 49 patients and more than 30 days; 12 patients. Average length of stay was five days and median length was three days. Average total cost was 70,714 rupees [U$1179] which included average radiology cost; 12,507 rupees [U$ 208], average laboratory cost; 8365 rupees [U$139], average pharmacy cost; 13,320 rupees [U$222] and average bed/room charges; 27, 552 rupees [U$459]. Length of hospital stay is the most important determinant of cost. Average total cost for patients who stayed for 1 day was 19,597 rupees [U$ 326], 2-3 days; 25,568 rupees [U$426], 4-7 days; 49,705 rupees [U$828], 8-30 days; 153,586 rupees [U$2559], more than 30 days; 588,239 rupees [U$9804]. Average cost for general ward was 60,574 rupees [U$1010], private ward was 74,880 rupees [U$1248] and intensive care unit was 155,010 rupees [U$2583]. Cost of acute stroke care is extremely high as compared to average national income at our hospital. Most important determinant of cost is length of hospital stay. Cost cutting measures and increased funding from state are necessary to increase the availability of acute stroke care

Present status of digitalis therapy

Therapeutic benefits of digitalis have been questioned in the recent past. Its use in heart failure with sinus rhythm has been given up and replaced by diuretics and vasodilators except in some cases of systolic overload. It is indicated in heart failureee with atrial fibrilation. Verapamil, diltiazem and beta-blockers can be an adjunct to digitals therapy in this situation and obviate the necessity of near-toxicc doses. Its useee in arrbytbmias has also been largely replaced by calcium and beta-blockers. The majority of investigators do not approve its use in eitber acute or chronic ischemic beart