profile of 60 patients of cutaneous leishmaniasis visiting dermatology departments of Hayatabad medical complex and lady reading hospital, Peshawar

To document the profile of patients of cutaneous leishmaniasis [CL] visiting Dermatology departments of Hayatabad Medical Complex and Lady Reading Hospital, Peshawar. Irrespective of age and sex, a total of 60 patients with a clinical diagnosis of CL were enrolled for the study. A total of 38 male and 22 female patients were enrolled for this study. Age range of the patients was 15 months to 50 years. A sizeable number of patients presented with nodular presentation. CL is usually seen in males on exposed areas as noduloulcerative lesions.

Efficacy of terbinafine vs. griseofulvin in tinea capitis in the Northern areas of Pakistan

Since longtime griseofulvin has been in use to treat tinea capitis. However due to its decreasing efficacy, higher doses and side effects a search is going on to find out a better treatment. alternative. Terbinafine is one such therapeutic option. To compare the efficacy and safety of terbinafine and griseofulvin in tinea capitis in Northern Areas of Pakistan. Children 3 to 12 year-old who were clinically diagnosed for tinea capitis and confirmed by potassium hydroxide microscopy were included in the study. One group was treated with terbinafine at a dose of 62.5mg for children weighing less than 20kg and 125mg for those weighing 20-40kg and other group with griseofulvin at a dose of 15mg/kg body weight. Both groups were treated for a period of 4 weeks. Visits were scheduled at baseline and week 2, 4 and 6 for evaluation of efficacy and safety monitoring. Efficacy was evaluated on the basis of clinical improvement and mycological cure. Terbinafine showed comparatively higher clinical cure in our patients as compared to griseofulvin at week 2 [35% vs. 22%], week 4 [50% vs. 38%] and week 6 [70% vs. 55%] [p<0.05]. Similarly, mycologic cure with terbinafine was better than griseofulvin at week 2 [30% vs. 20%], week 4 [45% vs. 35%] and week 6 [60% vs. 50%] [p<0.05]. Trichophyton tonsurans was the most common organism isolated. There were no major side effects except nausea and abdominal pain in either group. Terbinafine is more effective than griseofulvin in treating tinea capitis in our part of the world

Effectiveness of trabeculectomy in primary open angle glaucoma

To analyze the change of intraocular pressure [IOP] brought about by trabeculectomy and to analyze any further changes in intraocular pressure after trabeculectomy during three months follow-up. Material and Patients who presented to eye department of Khyber Teaching Hospital Peshawar and were diagnosed as primary open angle glaucoma [POAG] and selected for trabeculectomy were included in the study, from 1998 to 2001. History, examination and relevant investigations were performed. All cases of trabeculectomy were analyzed and the follow up period was three months. The total number of patients included for trabeculectomy was 44 and the total trabeculectomies performed were 50 as in six cases, bilateral operations were done. Out of 44 patients, 34 [77.2%] were male and 10 [22.8%] were female. The age of the patients ranged from 43 to 80 years. The pre-operative infra ocular pressure ranged from 12 to 60 mm of mercury. The lower ranged intra ocular pressure was those cases of primary open angle glaucoma that were on maximum medical treatment. The post-operative intra ocular pressure was recorded on 1st and 15th post-operative days, one month after surgery and three months after trabeculectomy. The mean intra ocular pressure on 1st and 15th post-operative days, one month and 3 months after surgery was 10.2, 9.8, 12.55 and 10.7 mm of mercury respectively. Overall 92% cases were declared as complete success. Trabeculctomy is a safe and effective procedure for primary open angle glaucoma

Renal biopsy in elderly patients -aged 60 years and olders

To study the histological diagnosis of renal biopsy in elderly patients - aged 60 years and older at Govt. Lady Reading Hospital, Peshawar Prospective study. Department of Nephrology, Govt. Lady Reading Hospital, Peshawar. Study was conducted from January 1998 to December 2005. We peformed renal biopsy in 153 patients, aged 60 years and older from multiple reference centers. Significant differences in the disease spectrum were found in the elderly population when compared with the studies of the other developed centers. Minimal Change Disease [MCD] was the most common diagnosis in the patients aged 60 years and older [40%], followed by Membranous Nephropathy [21%], Crescentic Nephritis 19.6%, Focal Segmental Glomerulosclerosis [FSGS; 6.5%], Hypertensive Nephropathy [5.8%], Messengiocapillary Glomerulonephritis [MCGN; 3.9%] and Diffuse Proliferative Glomerulonephritis [3.2%]

Ocular emergencies

To describe clinical data about ocular emergencies [OE] and their management. Design: Descriptive study. Place and Duration of Study: This study was conducted from 1st January, 2000 to 31st December, 2002 at the Department of Ophthalmology, Khyber institute of Ophthalmic Medical Sciences, Lady Reading Hospital, Peshawar. Material and A comprehensive analysis of the computer record available for admitted ocular emergencies was undertaken in terms of gender, age, etiology, procedure performed and hospital stay. Ocular emergencies [1961] were 18.49% of total admissions. Male to female ratio was 2:1. Non-traumatic ocular emergencies were 1058 [53.95%] with male to female ratio of 1.47:1. In the non-traumatic ocular emergencies, majority [67.2%] were 40 years or above. Traumatic ocular emergencies were 925 [47.16%] with male to female ratio of 2.77:1. Majority [83.78%] of traumatic ocular emergencies were below 40 years and 562 [60.75%] below 20 years of age. Only 150 [16.21%] cases were 40 years and above. Corneal ulcers [44.51%] and glaucoma [24.38%] were the most common non-traumatic ocular emergencies, whereas, open globe injuries [73.4%] were leading the traumatic ocular emergencies. Total surgical procedures performed were 1382 [13.7% of total major ophthalmic surgery]. Average stay in hospital was 5.5 days. Ocular emergencies predominantly affected the males in this series. Trauma related OE are almost as common as non-traumatic. Majority of OE need surgical intervention and the average hospital stay is longer than routine admissions

Three years retrospective study of patients undergone trabeculectomy in Lady Reading Hospital Peshawar

To know the effect of trabeculectomy on controlling intra ocular pressure [IOP] and thus glaucoma progression and the final visual outcome of the patient. Material and A descriptive study of trabeculectomies performed for different types of glaucoma, during a period of three years [from Jan. 2000 to Dec. 2002] in Ophthalmology Unit of Postgraduate Medical Institute, Lady Reading Hospital, Peshawar was carried out. Trabeculectomies performed on all ages were included. A proforma was made showing name, age, sex, file number and diagnosis. Preoperative and postoperative visual acuity and I.O.P. recorded. Any postoperative complication was also noted. The use of Mitomycin-C was also noted which was restricted only to failed trabeculectomy and younger patients. Trabeculectomy was performed on 232 eyes of 191 patients. About 85% of patients were above 40 years of age. The most common type of glaucoma was open angle glaucoma accounting for 51.31% with male predominance followed by angle closure glaucoma 40.32% with female predominance. Congenital glaucoma and steroid induced glaucoma were present in 4.71% and 3.66% of patient respectively and these were present in younger patients. Mitomycin-C was used in 10.78% patients. Visual acuity after trabeculectomy remained unchanged in 69.86%, improved in 17.35% and deteriorated in 12.79%. Postoperative IOP below 15 mmHg was found in 72.41% showing a good success rate, 23.7% patient has IOP between 16-20 mmHg and only 3.88% patient had IOP above 20mmHg. Shallow anterior chamber after trabeculectomy was found in 27.59% and hyphema in 6.47% both of which usually relieved in few days after conservative therapy. Postoperative endophthalmitis was not noted in any case. Trabeculectomy is still one of the most used approaches for surgical reduction of IOP. Primary trabeculectomy is a better method for cases in which a larger reduction in IOP is the aim of the treatment, especially in glaucoma patients who can not afford costly medicines, having poor compliance and still having high IOP despite maximum tolerable anti glaucoma medication

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

Management of childhood squint

To evaluate the outcome of various modalities of treatment of childhood squint.The study was conducted from November 1994 to August, 1996 at the Department of Ophthalmology, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar. A st and ard proforma was designed. After complete history and ocular examination; glasses, occlusion and surgery was advised accordingly. These children were re-examined after one month for glasses and on weekly, monthly and three monthly intervals after surgery. Out of these 50 patients 54% were males and 46% were females with the age range of 6 months and 16 years. The majority needed glasses, followed by surgery and occlusion. Improvement in visual acuity and fusion was observed and acceptable visual alignment was seen in most of the patients. A good number of patients can be managed with the use of proper glasses alone and improvement in visual acuity and binocular single vision [BSV] can be achieved with early recognition of the disease and timely intervention

Hyphaema due to blunt trauma

To study the causes, clinical presentation, complications and visual outcome of hyphaema following closed globe injury. Design: Prospective study. Place and Duration of Study: The study was conducted at the Department of Ophthalmology, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan, from May, 1996 to June 1997. Patients and All cases of hyphaema, due to closed globe injury, were included and history of patients was recorded on a comprehensive proforma designed for this purpose. All cases were admitted for at least 5 days. Ocular examination included checking visual acuity [VA], intraocular pressure [IOP], slit lamp and fundus examination. Patients were treated accordingly and followed up for 90 days. Thirty-six eyes of 36 patients with hyphaema were included in our study. Out of this, 88.89% were males and 11.11% females while 86% were 20 years of age or below. Almost 91.66% presented with primary hyphaema, 44.44% received trauma with stone and 27.77% with tennis ball while playing cricket. Trauma during playing was noted in 66.66% of cases. Almost 62% of cases were having visual acuity in the range of CF to perception of light with good projection. IOP was raised initially in 41.66% cases. Only 33.33% needed surgical intervention. Secondary glaucoma was present in 13.88% and 5.55% had corneal blood staining. Majority of patients [75%] improved to VA range of 6/6 to 6/12 and 19% patients in our study ended up with legal blindness in the affected eyes. Traumatic hyphaema is more frequently found among children and young male. Angle recession, traumatic cataract and maculopathy were common co-morbidities. Secondary glaucoma and corneal staining were the main complications. Nearly 1/5th of patients ended up with legal blindness in the affected eyes

Current status of presentation and prognosis of retinoblastoma in Pakistan

To determine the current presentation pattern and prognosis of retinoblastoma in Northern Pakistan, we reviewed 26 retinoblastoma cases [13 boys and 13 girls] admitted to the Department of Ophthalmology, Lady Reading Hospital, Postgraduate Medical Institute, Peshawar between April 1985 and November 1988. Of these patients, 25 were children ranging in age from eight months to seven years, and one was a woman of 22. The tumor was unilateral in 15 patients and bilateral in 11. The presenting signs were fungating mass in 10 [38.36%] patients, proptosis in seven [26.92%], leukokoria in five [19.26%], orbital cellulitis in one [3.85%], loss of vision in one [3.85%], strabismus in one [3.85%], and quadriplegia in one [3.85%]. Because of nearly universal late presentation, the mortality rate in our cases was 88.46%, which is similar to retinoblastoma with biopsy proven orbital extension. The only treatment suited for a great majority of our patients was enucleation followed by external beam radiotherapy [EBR]. One female patient's elder sister was known to have suffered from retinoblastoma, but their parents were clinically free of the disease. Finally, although some improvement has been made in the treatment of retinoblastoma, no noticeable progress in public health education regarding this tumor has occurred in the past decade in Pakistan

Incidence and prognosis of concessive hyphema in northwest frontier province of Pakistan

Sixty-three consecutive cases of concussive traumatic hyphema admitted to the Department of Ophthalmology, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from May 1987 to July 1988 were studied prospectively. Majority of the patients [61.9%] were under the age of 15, and male to female ratio was 7:1. Eye Injury mostly occurred during sports, while at play, by flying objects such as stones, mudballs and goli dandas. Only a little over one half of the patients, 35 [55.6%], sought medical attention within 24 hours. Twenty-seven [42.9%] patients had total hyphema. Recurrent hyphema occurred in 12 [19.0%] patients, and nine of these had delayed presentation. Glaucoma, corneal staining, necessity of surgical intervention, and poor visual outcome often accompanied recurrent hyphema. Of the 36 patients with known final visual acuity, 12 [33.3%] had a visual acuity of 20/200 [6/60] in the affected eye. These figures are much higher than the figures reported from the developed countries, despite the fact that in the developing countries the incidence of hyphema in more or less similar to that of our study. The reason for delayed presentation, higher number of total hyphemas, and poor visual outcome are poverty, illiteracy, poor public awareness, and a lack of eye care facilities in the rural areas of Pakistan. An aggressive public health education and implementation of sound epidemiological principals are needed to improve the situation

YAG laser iridotomy for narrow angle glaucoma in pakistani patients

We undertook a study to evaluate the efficacy and complications of neodymium:yttrium, aluminum, garnet [Nd:YAG] laser iridotomy in the Pakistani patients. Neodymium:YAG laser iridotomy was performed in 43 [98%] out of 44 eyes of 36 Pakistani patients, ten [26%] of whom were men and 28 [74%] were women. Iridotomy was performed for acute angle closure attack in four [9%] eyes, for prodromal attacks in 10 [28%] eyes and as a prophylaxis in 30 [68%] eyes. The brown irides needed much higher total energy [304 mj] as compared to the blue irides [44 mj]. The immediate complications included small hyphema in 21 [48%] eyes, raised intraocular pressure in six [14%] eyes and iritis after 24 hours in one [2.3%] eye. We did not see corneal edema or cataract formation in any of the patients included in this preliminary report

Tuberculosis of the conjunctiva, eyelid, and periocular skin

Over a period of 4 years, we saw 10 cases of tuberculosis involving conjunctiva, eyelids, and periocular skin. The presentation was usually in the form of conjunctival and lid ulcers and lid edema. Only one case presented as a tumorlike granuloma of the conjunctiva. The investigations included complete dermatologic and ophthalmologic examinations, culture, histologic study and guinea pig inoculation of the biopsy material, tuberculin skin test, chest x-ray, and routine blood workup. Discussion includes comments on diagnosis and treatment. Primary tuberculosis was commonly seen in under 20-year-olds. Unlike the previous reports, more males were affected than females