Prevalence of innocent murmur in rural communities of pakistan

Background: Innocent murmurs are important clinical signs detected by clinicians

Objective: To determine the prevalence of innocent murmur in general rural population of Rahim Yar Khan

Methodology: This was a cross sectional study conducted during 2012. A representative sample of general rural population of Rahim Yar Khan was selected by random sampling technique. Eleven villages were screened by auscultation and confirmed by echo/Doppler studies at Sheikh Zayed Medical College/Hospital, Rahim Yar Khan

Results: 404 persons were found with murmurs, 148 individuals on initial screening have innocent murmur [IM]. 203 persons have suspect murmur and they underwent echocardiography. IM was found in 96 subject after echocardiography. The prevalence of IM was 244 [12.2%] in this study

Conclusion: This study indicate high prevalence of innocent murmur in general rural communities

Clinical application of multicolor optical coherence tomography in the diagnosis of retinal pathologies

Objective: To assess the clinical application of multicolor optical coherence tomography [OCT] using confocal scanning laser ophthalmoscopy [cSLO] in different retinal pathologies

Methods: This observational study was conducted at the Layton Rahmatullah Benevolent Trust [LRBT], Free Base Eye Hospital, Karachi, from April 2018 to June 2018. It includes 36 patients suffering from different retinal pathologies including diabetic retinopathy, age related macular degeneration, and vitreomacular interface disorders using multicolor optical coherence tomography as a screening tool

Results: It was found that automated eye tracking system of this new version tool enables ophthalmologists to take high-resolution cSLO reflectance images. The light scatter can be avoided with the use of confocal optics. Appearances of pigment changes and hemorrhages were some of the differences found when compared to the conventional CFP. About 20% in AMD, 37.5% with diabetes and 100% patients with vitreomacular interface disorders could have be easily missed by CFP

Conclusions: Multicolor OCT can provide information and figures far more authoritatively than the conventional CFP, which is highly affected by media opacities. To interpret Multicolor OCT ophthalmologists should be watchful with plenty of understanding

Outcomes of retinectomy in rhegmatogenous retinal detachment with proliferative vitreoretinopathy

Objective: to evaluate the anatomical and functional outcomes of retinectomy in the management of primary rhegmatogenous retinal detachments with inferior retinal breaks and advanced proliferative vitreoretinopathy [PVR C]

Study Design: quasi-experimental study

Place and Duration of Study: LRBT, Free Base Eye Hospital, Karachi, from July 2015 to June 2017

Methodology: forty eyes of 40 patients with primary inferior retinal breaks macula off detachments and advanced proliferative vitreoretinopathy [grade C] in which retinectomy was performed were included. Primary outcome measured was anatomic success, defined as complete retinal reattachment between neurosensory retina and retinal pigment epithelium at six months follow-up. Secondary outcomes included changes in best corrected visual acuity and postoperative complications. The follow-up period was up to six months after the last surgery. Association was determined between the retinectomy extension and the best corrected visual acuity postoperatively

Results: retina was reattached after single operation in 29 eyes [72.5%], after the second operation in eight eyes [20%], and after the third operation in two eyes [5%]. Final retinal reattachment was achieved in 39 out of 40 eyes [97.5%]. The preoperative visual acuity was counting fingers CF in eight eyes [20%], hand motion HM in 28 eyes [70%], and light perception PL in four eyes [10%]. The postoperative visual acuity improved in 27 eyes [67.5%], remained stable in 11 eyes [27.5%], and worsened in 2 eyes [5%]. There was no statistically significant association between the retinectomy extension and maximum postoperative best corrected visual acuity [p=0.098]. The significant postoperative complications were retinal redetachment and hypotony

Conclusion: retinectomies are effective in managing primary rhegmatogenous retinal detachment with severe PVR [PVR C], and Increase the final retinal reattachment rate

To evaluate the effectiveness of maitland technique in treatment of knee osteoarthritis in female patients

Objective The purpose of this study was to explore the efficacy of knee osteoarthritis treatment with Maitland technique over general exercises in aged female patients

Methodology A Cross sectional experimental study was performed on 80 osteoarthritic female patients of age between 45-60 years which were randomly selected from LNH. They were divided into 2 groups of 40 patients each. Group A received Maitland technique application while Group B received general knee ROM ex's. All participants have received 24 sessions of Maitland and general exercises. Data has been collected and analyzed on SPSS 20through assessment form used by Physiotherapist via pre-and post-evaluation of Visual Analogue Scale, Muscle Power, Muscle Tone and Range of Motion

Results The results revealed that Group A having vasual analogue scale score =5.4 +/-0.9, while Group B having vasual analogue scale score=6.25+/-1.4, the muscle power was 5.0+/-4.8 in group A, while in group B it was4.05 +/-0.58, Geno-Flexion of group A was 129.5+/-5.2, Geno- Flexion of group B was 121.57+/-10.9. The results of all tests were significant with the P-value < 0.05 of Group A as compared to B

Discussion During the OA of knee joint the decrement of a proteoglycan content of cartilage and the disintegration of collagen fibers occurs, which leads to rise in water content so there will be loss of osmotic pressure. The net result will be the degradation of cartilage, as proteoglycan has protective effects on collagen fibers

Conclusion It was concluded that Maitland technique relieved more effectively the symptoms of knee osteoarthritis in females than general exercises

Characteristics of chronic pain patients attending a primary health care center in Oman

Objectives: To determine the characteristics of patients presenting with chronic pain in a primary health care setting in Oman

Methods: A retrospective cross-sectional study was carried out including all patients aged >/= 18 years who attended Sultan Qaboos University Health Center during 2010. Patients were identified to have chronic pain if they were prescribed an analgesic medication for at least three months. Patients were compared to a control group which consisted of age- and gender-matched patients with no chronic pain

Results: Out of 6 609 patients, 241 [3.6%] were found to have chronic pain. The mean age of patients with chronic pain was 54.0 +/- 13.0 years. The majority of patients were female [n = 174; 72.1%], and most were Omani [n = 201; 83.4%]. The prevalence of chronic pain was found to be significantly higher among females compared to males [4.5% vs. 2.5%; p < 0.001] and also among Omani nationals to non-nationals [83.4% vs. 70.1%; p < 0.001]. Chronic pain was significantly associated with the following comorbidities; diabetes [33.1% vs. 20.7%; p < 0.001], obesity [35.2% vs. 26.5%; p = 0.001], and hypertension [51.0% vs. 38.5%; p = 0.002]. Osteoarthritis was the most common pain condition [n = 104; 43.1%]. Diclofenac was the most commonly prescribed drug [n = 168; 69.7%]

Conclusions: The findings of our study point towards a higher prevalence of chronic pain in Omani females. These patients were also found to have a higher prevalence of other common comorbid conditions

Anatomical outcome following indocyanine green assisted internal limiting membrane peeling for stage 3 and 4 macular hole surgery

Objective: To evaluate the anatomical success of stage 3 and 4 macular hole surgery after removal of internal limiting membrane [ILM] with the help of Indocyanine green [ICG]

Study Design: An experimental study

Place and Duration of Study: LRBT Tertiary Care Eye Hospital, Karachi, October 2015 to August 2016

Methodology: Twenty patients with stage 3 and 4 macular hole [confirmed by spectral domain optical coherence tomography] underwent standard 3 ports pars plana vitrectomy. Staining of ILM was performed with the help of 0.5% ICG to aid in visualization. ILM was removed by using intraocular forceps in circular fashion. Finally, gas fluid exchange with internal tamponade of SF6 20% was performed. Postoperative face down posture was maintained for seven days. Patients were followed-up for 8 months and assessment of macular hole closure was done using SD-OCT

Results: After a follow-up of 8 months, macular hole was closed in 17 eyes [85%] and vision had improved in 6 patients. Postoperative complications included cataract, hyphema and vitreous hemorrhage

Conclusion: Surgery for stage 3 and 4 macular hole with ILM peeling has high anatomical success rate. Final visual acuity is dependent on preoperative macular hole stage and visual acuity at presentation

Elbow arthodesis with ao external fixator in war injuries

Objective: To analyze the surgical technique of Elbow arthodesis in term of its indications and functional outcome in war injured elbow joints

Study Design: Descriptive study

Place and Duration of Study: This study was carried out at Combined Military Hospital [CMH] Peshawar and CMH Quetta, from Apr 2007 to Sep 2013

Material and Methods: Twenty patients all young males who had complex high velocity elbow joint injuries were selected for the study. Plan X-Rays were done for assessment and planning. Surgical technique for arthodesis involved use of AO external fixator 4mm alone in 15 cases and combination of external fixator with minimal internal fixation using K wires in 5 cases

Results: Average duration of bony alkalosis and complete elbow arthodesis was achieved in 8 months [range 7 to almost 10 months]. Almost 90% of the patients had pain free and stable elbow joint with satisfactory level of daily life activities and personal care hygiene

Conclusion: Elbow joint is a commonly involved body part in the battle field resulting in extensive bone and soft tissue damage along with heavy contamination. In these extensive injuries no surgical reconstruction is possible, therefore, early wound debridement and elbow arthodesis at an appropriate angle with external fixation and vascularized soft tissue coverage whenever required is an effective method of treating such injuries

Impact of acne on quality of life of students at Sultan Qaboos University

The purpose of this study was to assess the impact of acne on the quality of life of students at Sultan Qaboos University [SQU]. Its secondary objective was to assess the influence of gender and severity of symptoms on the quality of life. A cross-sectional study was conducted on 100 students [40 males and 60 females] diagnosed with acne who attended the Student Clinic during a period of three months from September to December 2009. The Acne Quality Of Life index [Acne-QoL] questionnaire was used to assess the patient's quality of life in four different domains: self-perception, social, emotional, and acne symptoms. Acne affected all areas of the patients quality of life with the emotional domain found to be the most affected. Overall, female patients reported more adverse QoL effects. The mean score for self-perception for female students was 2.5 and 2.8 for males [p=0.300]. The role-social domain approached a significant difference between genders [p=0.078]. There was a statistically significant correlation between severity of acne symptoms and the other three domains. The correlation was highest between acne symptoms score and self-perception score. This study showed that acne affects the quality of life of affected SQU students treated by primary care physicians at the Student Clinic. Therefore, physicians should take into account the effect of acne on the persons' quality of life when individualizing treatment

Impaired fasting glucose in Omani adults with no family history of type 2 diabetes

The aim of this study was to estimate the prevalence of impaired fasting glucose [IFG] among Omani adults with no family history [FH] of diabetes and to investigate the factors behind the risk of developing type 2 diabetes [T2D], while excluding a FH of diabetes. A total of 1,182 Omani adults, aged >40 years, visited the Family Medicine and Community Health Clinic at Sultan Qaboos University Hospital, Oman, on days other than the Diabetes Clinic days, from July 2010 to July 2011. The subjects were interviewed and asked if they had T2D or a FH of T2D. Only 191 [16%] reported no personal history of T2D or FH of the disease. Of these, anthropometric and biochemical data was complete in 159 subjects. Of these a total of 42 [26%] had IFG according to the American Diabetes Association criteria. Body mass index, fasting insulin, haemoglobin A[1c] and blood pressure [BP], were significantly higher among individuals with IFG [P <0.01, P <0.05, P <0.01 and P <0.01, respectively]. In addition, fasting insulin, BP and serum lipid profile were correlated with obesity indices [P <0.05]. Obesity indices were strongly associated with the risk of IFG among Omanis, with waist circumference being the strongest predictor. Despite claiming no FH of diabetes, a large number of Omani adults in this study had a high risk of developing diabetes. This is possibly due to environmental factors and endogamy. The high prevalence of obesity combined with genetically susceptible individuals is a warning that diabetes could be a future epidemic in Oman

Outcome of primary percutaneous coronary intervention [PCI] of ostial versus nonostial occlusion of left anterior descending artery [Study conducted at National Institute of Cardiovascular Diseases, Karachi]

Object: The object of this study was to compare the outcome of primary PCI of ostial versus non ostial occlusion of LAD artery

Materials and Methods: This observational study was conducted at National Institute of Cardivascular Diseases Karachi, Pakistan from January 1[st], 2008 to December 31[st], 2008. A total of 70 patients presented to the catheterization laboratory for primary PCI of LAD artery in whom baseline coronary angiogram showed acute occlusion of left anterior descending artery were enrolled for the study. All patients received Aspirin, Clopidogrel and Platelet Glycoprotein IIB IIIA inhibitor. Patients were followed at one month, 3 months and 6 months

Results: Out of 70 cases 50 had nonostial and 20 had ostial occlusion. Baseline characteristics were similar between both groups. Stenting was done in 95% of all patients and was similar in patients with ostial or nonostial narrowing. Procedural success was the same for ostial and nonostial Primary PCI [100% vs. 96%]. Six months event free survival was also similar in both groups [75% vs. 76%]. Total event rate and mortality was also same in both groups [25% vs. 24% and 10% vs. 10%]

Conclusion: Primary PCI of ostial LAD occlusion with suitable anatomy is as safe and similar as non ostial LAD occlusion and optimal results can be achieved in this high risk group of patients in a developing country at a tertiary care public sector hospital. To validate our results further studies with larger cohort are needed

audit of hypertension at university health center in Oman

To audit the documentation of medical care provided to hypertensive patients and to evaluate the management of hypertension in a primary healthcare center, Family Medicine Staff Clinic, Sultan Qaboos University [SQU] in Oman. An audit of electronic medical records [EMR] was carried out during 2007and 2008 on a representative sample of 150 patients, selected randomly using a simple randomization method. The mean age of the patients was 54.8 +/- 9.9 years. The majority were Omanis; 53.3% were female, 46.7% were male. All patients' records were reviewed for proper recording in a pre designed structured form. Re-auditing was done in 2008. McNemar's test was used to compare data in 2007 with data in 2008. Age, gender, blood pressure recording, renal function tests, and lipid levels were sufficiently recorded [>75%] in the computer system. Histories of pertinent symptoms and smoking history were poorly recorded [<1%]. Fifty-five percent of the hypertensive patients were sufficiently controlled [BP<140/90]. There were significant differences between 2007 and 2008 with respect to documentation and recording of pertinent symptoms [p<0.001] and renal function tests [p=0.026]. Conducting an audit of EMR is essential to evaluate clinical performance and to determine what changes should be made to improve quality of care. There was significant improvement in documentation of pertinent symptoms in the second audit

Effects of Pranayam breathing on respiratory pressures and sympathovagal balance of patients with chronic airflow limitation and in control subjects

The objective of this study was to compare the effects of Pranayam breathing on respiratory muscle strength measured as maximum expiratory and inspiratory pressures [MEP and MIP] and relevant spirometry parameters in patients with chronic obstructive pulmonary disease [COPD] and in control subjects, and on the sympatho-vagal balance in both the groups. The research was performed in the Clinical physiology Department, Sultan Qaboos University Hospital, Oman. Eleven patients [mean age 43.91 +/- 20.56 yr; mean BMI 21.9 +/- 5.5 kg/m[2]] and 6 controls [43.5 +/- 14.6 yr; 25.4 +/- 3.2 kg/m[2]] learnt and practiced Pranayam. Their respiratory "well being" was noted as a visual analogue score [VAS]. The respiratory parameters were expressed as a percentage change of predicted values. Patients' respiratory parameters were significantly lower than those of controls. Patients' maximum respiratory pressures did not improve after Pranayam; however, they showed significant improvement in VAS 5.4 +/- 2.4 to 7.2 +/- 1.2 [P< 0.03]. Controls showed significant increase in their systolic blood pressure and stroke index after exercise. The vago-sympathetic balance shifted towards sympathetic in both patients and controls after exercise. The improvement in MIP in controls indicated the positive effect of Pranayam exercise; however, it may not be an adequately stressful exercise to produce changes in the respiratory parameters of COPD patients. The increase in VAS in patients suggested improvement in respiratory distress and quality of life

Length of coronary stenosis in patients with unstable angina with elevated versus non elevated troponin T-levels

Background: cardiac troponin T elevation had a strong association with the presence of severe and complex coronary artery Disease

Objective: to determine the length of coronary stenosis on angiogram in patients with unstable angina having elevated versus non-elevated troponin T-levels

Methods: two hundred ten consecutive patients admitted at Punjab Institute of Cardiology, Lahore with clinical diagnosis of unstable angina were enrolled. Serum samples for troponin T were obtained 6 to 12 hours after onset of chest pain. Patients were grouped into positive and negative depending on troponin T levels [cutoff value was 0.1 Ong/ml]. All patients underwent Coronary angiography before discharge. Angiographic films were reviewed to determine the length of lesions. 200 patients had positive angiogram and 10 patients had no significant coronary artery disease. Length of coronary stenosis was described as discrete, tubular and diffuse according to ACC/ AHA criteria

Results: total number of patients was 210 with mean age of 53.3, +/- SD 10.49. Male were 79% [165] and female were 21% [45]. 71% were troponin positive and 29% were negative. Length of coronary stenosis in positive versus negative troponin T were discrete lesions 6.0% vs 33.3%, tubular 59.3% vs 48.3% and diffuse was 30.7% vs 11.7% [P< 0.01]

Conclusion: our study has demonstrated that unstable angina patients with raised troponin Thad severe angiographic coronary artery stenosis, tubular and diffuse lesions comparing patients with negative troponin T levels. Therefore, troponin T positive patients should be evaluated by coronary angiography to determine the extent and severity of coronary lesions

Magnetic resonance pelvimetry for trial of labour after a previous caesarean section

To stratify the magnetic resonance [MR] pelvimetric diameters according to mode of delivery and establish possible reference values for pelvic diameters and outlet index for trial of labor after a previous caesarean section. This is a retrospective study of 125 patients at Sultan Qaboos University Hospital who underwent MR pelvimetry prior to a trial of vaginal delivery after a previous caesarean section between May 2001 and October 2003. Sagittal inlet, Transverse inlet, interspinous diameter, sagittal outlet and transverse outlet diameters were measured in all patients. The mean diameters were stratified according to delivery modality [vaginal delivery or caesarean section]. The outlet index [sum of interspinous, sagittal outlet and intertuberous diameters], biparietal diameter of the foetus and head circumference were compared in women who delivered by caesarean section or vaginally. All the diameters except sagittal inlet, were significantly larger [P < 0.05] in women who delivered normally as compared with those who had a caesarean section for any indication. The mean outlet index in the spontaneous delivery group with vertex presentation 31.89 +/- 2.05, was significantly larger than that of the elective and emergency caesarean section, which were 29.69 +/- 1.85 and 30.62 +/- 1.80 respectively. The mean head circumference was also found to be significantly larger in the caesarean section deliveries. An outlet index of 31.89 +/- 2.05 and the pelvic diameters, transverse inlet 12.56 +/- 0.80cm, sagittal outlet 10.54 +/- 1.00 cm, interspinous diameter10.46 +/- 0.89cm, and intertuberous diameter [transverse outlet] 10.89 +/- 1.02cm are useful cut-off points for vaginal delivery in our population

Alpha-methyldopa hepatotoxicity in pregnancy

12-week pregnant, 33-year-old African American female, presented with jaundice and change in urine colour. Liver function tests revealed raised transamines and normal alkaline phosphatase. She was started on methyldopa 6 weeks prior to presentation. After initial negative investigations including viral and autoimmune hepatitis, she was given prednisone for methyldopa induced hepatitis. Two weeks later, repeat enzymes revealed normal values. Important clinical and management points related to methyldopa induced hepatotoxicity are discussed