Factors contributing to the mental wellbeing of Afghan migrants in Iran during the COVID-19 pandemic.

This study aims to explore the factors contributing mental health of Afghan migrants residing in Iran during the COVID-19 pandemic. With a deep understanding of the unique challenges encountered by migrants, especially during times of crisis, this research delves into the influential factors of experienced anxiety, social cohesion, and stress and their significant contribution to the development of depression among Afghan migrants. The study included a sample of 469 individuals from the Afghan migrant community, aged 15 to 80 years. Data collection took place from December to March 2022 in Iran. The study revealed that anxiety and the burden of the COVID-19 pandemic significantly influenced the occurrence of depression among Afghan migrants. Furthermore, the relationship between these factors and depression was mediated by the experience of stress. Conversely, higher levels of perceived social cohesion in the host country were linked to reduced stress and depression among the migrants. As Afghan migrants in Iran face a heightened risk of developing depression, the importance of social support and integration is underscored by the association between higher levels of perceived social cohesion in the host country and reduced levels of stress and depression. Recognizing the vulnerabilities of this population, it becomes evident that fostering social support networks and promoting integration can play a crucial role in mitigating the negative impact of migration-related stressors and enhancing mental wellbeing among this population.

Development and evaluation of a cream containing solid lipid nanoparticles loaded with Vitamin E.

Solid lipid nanoparticles (SLNs) have several potential applications in the topical drug delivery. The current project aimed to prepare and characterize SLNs loaded with vitamin E for topical administration and incorporating the prepared SLNs in a cream base. Further, the permeation of prepared SLNs was studied through a synthetic membrane and the release profiles were compared with vitamin E cream. The prepared SLNs were subjected to stability studies at two different temperatures. Hot homogenization followed by dilution technique was used for the preparation of SLNs. In this project, PDMS membrane was used to mimic the skin for permeation studies. From the results of this study, it can be concluded that prepared SLNs had enhanced the permeation of vitamin E as compared to vitamin E cream.

Terahertz photoconductive waveguide emitter with excitation by a tilted optical pulse front.

We explore the tilted-pulse-front excitation technique to control the superradiant emission of terahertz (THz) pulses from large-area photonconductive semiconductor switches. Two cases are studied. First, a photoconductive antenna emitting into free space, where the propagation direction of the optically generated THz beam is controlled by the choice of the tilt angle of the pump pulse front. Second, a THz waveguide structure with an integrated photoconductive window for the generation of THz radiation, where the injection of the THz radiation into a waveguide mode is optimized by the pulse front tilt. By providing long interaction lengths, such a waveguide-based optical-pump/THz-probe set-up may provide a new platform for the study of diverse short-lived optically induced excitations.

Unfolding the enigma of lamina cribrosa morphometry and its association with glaucoma.

Primary open angle glaucoma (POAG) is worldwide prevalent ailment, affecting millions, and leading irreversible cause of blindness. The treatment strategies revolve around one modifiable factor, elevated intraocular pressure (IOP), despite POAG presenting with normal IOP. Emphasis is put forth in recent past detecting structural elements of glaucoma; lamina cribrosa (LC) is found to be a promising prospect. Morphological alterations of LC are implicated as early sign before onset of glaucomatous optic neuropathy (GON). In this review, the authors explored scientific works from 1976 till 2018 through Google, Google Scholar, PubMed, HEC Digital Library, Springerlink, and PakMedinet in four months' time, extracted structural features of LC, its measurable attributes, fresh innovations employed for in-vivo visualization and clinical signs aiding in establishing diagnosis of glaucoma which will assist as a prophylactic measure against GON. No such work has ever been done in South-East Asia including our country. So LC opens a new horizon for research in Pakistan.

Change in corneal endothelial cell density after phacoemulsification in patients with type II diabetes mellitus.

OBJECTIVE: To compare the mean change in Corneal Endothelial cell Density (CED), from baseline (pre-operative value), two months after phacoemulsification cataract surgery between type II diabetic patients and non-diabetic patients. METHODS: This prospective stratified controlled study was conducted at PNS Shifa Hospital, Karachi. 80 eyes of 72 type II diabetic patients and 80 eyes of 77 non diabetic controls, having Nuclear Opalescence (NO) grades 2 and 3 on slit lamp examination underwent phacoemulsification surgery. CED was measured in cells/mm2, of concerned eye of each subject preoperatively and 2 months post operatively using specular microscope. The difference in mean CED change between the two groups after surgery was analyzed. RESULTS: Mean age of study population was 61.41± 6.76 years. Out of study population, 92 (57.5%) were males and 68 (42.5%) were females. There was a statistically significant difference between both groups in terms of mean post-operative CED, mean change in CED and mean frequency change in CED (p <0.05). There was no statistically significant difference between both groups in age, gender, laterality of eyes and mean pre-operative CED, (p >0.05). Difference of pre-operative CED from post-operative CED in each group was statistically significant. CONCLUSION: There is a significant difference between diabetic population and normal population in terms of corneal endothelial loss after uneventful phacoemulsification cataract surgery.

Comparison of retinal nerve fiber layer thickness between normal population and patients with diabetes mellitus using optical coherence tomography.

OBJECTIVE: To compare the difference in peripapillary Retinal Nerve Fibre Layer (RNFL) thickness between normal population and Type-II diabetic patients without diabetic retinopathy using Spectral Domain Optical Coherence Tomography (SD OCT). METHODS: This cross sectional study was carried out at PNS Shifa Naval Hospital, from May 2017 to November 2017. Out of 200 eyes, 100 eyes were of normal individuals and 100 eyes were of Type-II diabetic patients without diabetic retinopathy. Both groups were age and gender matched. Average RNFL thickness, along with RNFL of each quadrant of individuals was noted using SD OCT, and compared between two groups. RESULTS: Mean age of study population was 44.63 ± 4.30 years. Mean axial length was 23.46 ± 0.59 mm. Mean peripapillary RNFL thickness was 126.98 ± 10.07 µm in Group-A (normal individuals), and 120.77 ± 5.41 µm in Group-B (Type-II diabetics). Difference in mean RNFL thickness, as well as RNFL thicknesses of each quadrant was statistically significant between both groups (p-value < 0.001). CONCLUSION: Diabetic patients have thin RNFL as compared to normal individuals, and must be taken in account while making diagnosis of any disease based on thinning of RNFL.

System dynamics of active and passive postural changes: Insights from principal dynamic modes analysis of baroreflex loop.

The baroreflex being a key modulator of cardiovascular control ensures adequate blood pressure regulation under orthostatic stress which otherwise may cause severe hypotension. Contrary to conventional baroreflex sensitivity indices derived across a-priori traditional frequency bands, the present study is aimed at proposing new indices for the assessment of baroreflex drive which follows active (supine to stand-up) and passive (supine to head-up tilt) postural changes. To achieve this, a novel system identification approach of principal dynamic modes (PDM) was utilized to extract data-adaptive frequency components of closed-loop interactions between beat-to-beat interval and systolic blood pressure recorded from 10 healthy humans. We observed that the gain of low-pass global PDM of cardiac arm (:feedback reflex loop, mediated by pressure sensors to adjust heart rate in response to arterial blood pressure), and 0.2 Hz global PDM of mechanical arm (:feed-forward pathways, originating changes in arterial blood pressure in response to heart rate variations) may function as potential markers to distinguish active and passive orthostatic tests in healthy subjects.

Comparison of Clinical Characteristics of Rhegmatogenous Retinal Detachment in Pseudophakic and Phakic Eyes.

OBJECTIVE: To compare the clinical profile, systemic risk factors, and characteristics of rhegmatogenous retinal detachment (RRD) in pseudophakic and phakic eyes. STUDY DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: Armed Forces Institute of Ophthalmology, Rawalpindi from August 2013 to August 2015. METHODOLOGY: A total of 164 eyes (96 pseudophakic patients and 68 phakic patients) with RRD were analyzed. Demographic data and associated known risk factors of study population were acquired. Retinal examination was done by single experienced retinal surgeon using indirect ophthalmoscopy for type of retinal break, location and number of retinal breaks, status of macula, morphological extent of RRD and retinal degenerations. All the findings were endorsed on a pre-devised proforma. RESULTS: Mean age of patients in pseudophakic and phakic groups was 61.18 ±10.39 and 59.27 ±9.57 years, respectively. Frequency of male patients in pseudophakic and phakic groups was 74% and 57.4%, respectively. Mean axial length in pseudophakic and phakic groups was 23.13 ±2.18 mm and 21.9 ±2.01 mm, respectively. Difference in axial length and gender distribution between two groups was statistically significant (p < 0.05). Difference in frequency of patients with history of hypertension and myopia between two groups was statistically significant (p < 0.05). Characteristics of RRD (type, location and number of retinal breaks, macula status, and extent of RRD) between groups were not statistically significant. CONCLUSION: RRD is more common in pseudophakic patients with male gender, increased axial length, myopia, and hypertension.

Age related changes in corneal morphological characteristics of healthy Pakistani eyes.

PURPOSE: To determine the age related changes in corneal morphological characteristics in normal healthy adult Pakistani population. METHODS: Four hundred and sixty-four eyes of 232 healthy volunteers with ages between 10 and 80 years of either gender were included. Corneal endothelial cell density (CED), morphology and central corneal thickness (CCT) were evaluated in each subject with non-contact specular microscope (SP-3000 P, Topcon Corporation, Japan) and average of three readings per eye was used for final analysis. All the findings including demographic data, and corneal parameters were endorsed on a pre-devised proforma. RESULTS: Mean age of study population was 39.52 ± 18.09 years with 123 (53%) males and 109 (47%) females. Mean CED of study population was 2722.67 ± 349.67 cells/mm2, while mean CCT was 505.72 ± 32.82 µm. Corneal morphological parameters among various age groups showed statistically significant difference in all parameters (p < 0.01). Correlation statistics revealed that CED (r = -0.497, p < 0.01), CCT (r = -0.216, p < 0.01) and hexagonality (r = -0.397, p < 0.01) decreased significantly with increasing age, while average cell size (r = 0.492, p < 0.01) and CV of size (r = 0.454, p < 0.01) increased with age. CONCLUSION: This study showed that CED in Pakistani eyes was less than that reported in Chinese eyes, higher than Portuguese, Iranian and Indian eyes and comparable to the values in Turkish, Nigerian and Thai eyes.

Efficacy and safety of optic nerve sheath fenestration in patients with raised intracranial pressure.

OBJECTIVE: To evaluate the efficacy and safety of Optic Nerve Sheath Fenestration (ONSF) in patients with raised intracranial pressure (ICP). METHODS: This Quasi Experimental Study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi from July 2013 to July 2015. Thirty one eyes of 18 patients who underwent ONSF for raised ICP were followed up for one year to ascertain efficacy and safety of ONSF procedure. RESULTS: Thirteen (72.22%) patients underwent ONSF bilaterally, while five (27.78%) underwent unilateral ONSF. Best corrected visual acuity (BCVA) improved in 24 (77.4%), remained stable in four (12.9%) and deteriorated in three (9.7%) patients. Papilledema improved in 27 (87.1%) while remained stable in four (12.9%) according to Frisénscale of Papilledema. Change in BCVA and papilledema from pre-operative values was statistically significant (p<0.001). There was significant negative correlation (r= -0.434, p=.017) between duration of symptoms before presentation and improvement in BCVA. Common complications were a tonic pupil, subconjunctival haemorrhage, chemosis, weakness of recti and diplopia. CONCLUSION: ONSF is an effective procedure with statistically significant improvement in BCVA and reduction in severity of papilledema.

Factors affecting the visual outcome in acute central serous chorioretinopathy.

OBJECTIVE: To determine the visual outcome in patients with acute Central serous chorioretinopathy (CSCR) and to analyze the association of clinical, angiographic and tomographic factors with final visual outcome in Pakistani population. METHODS: This study was conducted at AFIO Rawalpindi and PNS Shifa Naval hospital Karachi from November 2011 to August 2016. Fifty five eyes of 53 patients with acute CSCR were included. All patients underwent a detailed ophthalmic examination including SD OCT imaging at baseline, One month and three month and FFA was performed at baseline. Primary outcome measures were measurement of initial and final BCVA and CFT. SPSS 13.0 was used for the analysis of data. RESULTS: Mean age of study population was 36.66 ± 6.24 years. On OCT mean CFT at baseline was 467.49 ± 144.80 µm in affected eye, whereas mean CFT measurements at final follow up was 244.67 ± 32.99 µm (p <0.01). Presenting mean log MAR BCVA was 0.47 ± 0.25 and final mean log MAR BCVA was 0.18 ± 0.14 (p <0.01). Baseline BCVA showed statistically significant association with final BCVA (p=0.03). CONCLUSION: Presenting VA of 6/12 or better is associated with favorable visual outcome in patients with acute CSCR.

Comparison of corneal morphological characteristics between diabetic and non diabetic population.

OBJECTIVE: To compare corneal morphological parameters between diabetics and age matched non-diabetic control subjects and to evaluate the correlation of these parameters in relation to duration of diabetes mellitus (DM), glycemic status and severity of diabetic retinopathy.(DR). METHODS: This cross sectional comparative study was conducted at the Department of Ophthalmology, PNS Shifa Karachi from February 2016 to January 2017. Patients with ages between 10 to 80 years of either gender who were diagnosed to have DM were recruited in the study. Control group comprised of age matched healthy volunteers who did not have DM. Corneal morphological parameters (CED, Average cell size, CV of cell size and hexagonality) was evaluated in each subject with non-contact specular microscope and findings were endorsed on a pre devised proforma. RESULTS: Data of 298 eyes (149 diabetic patients and 149 healthy controls) was evaluated. Mean corneal endothelial cell density (CED) of diabetic population was 2494.47 ± 394.10 cells/mm2, while mean CED of control group was 2574.46 ± 279.97 cells/mm2 [p = 0.04]. Between group differences in mean average cell size, CV of cell size and hexagonality was statistically not significant. Analysis of corneal endothelial parameters among subgroups of patients with no DR, with NPDR and PDR did not show statistically significant difference. Moreover, patients with diabetes of more than 10 years duration had significantly lower CED (p <0.01) and larger average cell size (p= 0.03). Duration of DM was significantly correlated with type of DR, HbA1c level, CED, polymegethism and hexagonality. CONCLUSION: Mean corneal endothelial cell density (CED) was found to be significantly lower in diabetic population as compared to healthy controls.

Frequency of Systemic Risk Factors in Central Serous Chorioretinopathy.

OBJECTIVE: To determine the frequency of various systemic risk factors associated with acute central serous chorioretinopathy (CSCR) in our setup. STUDY DESIGN: Descriptive case series. PLACE AND DURATION OF STUDY: Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi, from July 2011 to June 2014. METHODOLOGY: All consecutive patients with acute CSCR who presented in the outpatient department during the study period were recruited. Clinical findings were endorsed on a pre-devised proforma with special emphasis on inquiring about known systemic risk factors for CSCR in detail from each patient. Patients were managed conservatively with control of modifiable risk factors and topical 0.1% Nepafenac eye drops. Analysis of data was done using SPSS version 13.0. RESULTS: Forty-four eyes of 42 patients were eligible for final analysis. The mean age of study population was 37.38 ±6.31 years with 38 (90.47%) male patients. Elevated serum cortisol and serum testosterone levels were found in 3 and 2 patients, respectively. Known systemic risk factors for CSCR were present in 36 (85.71%) patients with emotional stress/psychiatric disorder 15 (35.71%), Type Apersonality 11 (26.19%), smoking 10 (19.04%), hypertension 5 (11.90%), and acid peptic disease 4 (9.52%) were the most frequently found risk factors. CONCLUSION: Emotional stress/psychiatric illness, hypertension, acid peptic disease and use of exogenous steroids and other medicines are the established risk factors for CSCR that can be modified/withdrawn to reduce the morbidity related to CSCR.

Functional and anatomical outcome in closed globe combat ocular injuries.

OBJECTIVE: To analyse the pattern, visual and anatomical outcome of closed globe combat-related ocular injuries sustained by troops. METHODS: This retrospective study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan, and comprised patients with ocular injuries from January 2010 to June 2014. Record of each patient was evaluated and demography, mode and type of injury, initial and final visual acuity, associated globe injuries, concomitant non-ocular injuries, type of surgical procedures and complications were endorsed on a pre-devised proforma. Statistical analysis was done using SPSS 13. RESULTS: Overall, 49 eyes of 44 male participants were analysed. The overall mean age was 27.59±6.89 years. The most common mode of injury was improvised explosive device blast responsible for 22(50%) casualties. Ocular contusion was the most frequent closed-globe injury occurring in 35(71.42%) eyes. Most frequent ocular findings in all injured eyes were vitreous haemorrhage 16(32.65%), cataract 12(24.48%), retinal detachment 8(16.32%) and commotio retinae 8(16.32%). A total of 48(97.96%) intra-ocular/adnexal surgeries were performed with pars plana vitrectomy 17(34.69%), cataract surgery 16(32.65%), intraocular lens implantation 8(16.32%), and adnexal surgery 5(10.20%) being the most frequently performed procedures. Overall visual improvement at the final follow-up was statistically significant in all injured eyes irrespective of mode of treatment (p =0.001). CONCLUSIONS: The functional and anatomical outcome was better in closed-globe combat ocular injuries compared to open-globe injuries.

Comparison of serum lipid profile in Type-2 Diabetics with and without retinopathy in Pakistani population.

OBJECTIVE: To compare serum cholesterol, TG, HDL-C and LDL-C concentrations between type-2 Diabetes mellitus (DM) patients with retinopathy and without retinopathy and to study association between various modifiable risk factors of Diabetic retinopathy (DR). METHODS: The study included 300 patients with type 2 DM; 140 of them were without DR (Group-I) and 160 were with DR (Group-II). Serum total cholesterol, LDL-C, HDL-C, and TG levels were determined. SPSS 17.0 for windows was used for statistical analysis. RESULTS: Overall, mean age of study population was 48.86 ± 5.62 years. Subjects with DR were older (P < 0.018), had higher fasting plasma glucose (P < 0.01) and higher HbA1c (P <0.01) concentrations compared with those without DR. Analysis of serum cholesterol, LDL-C, HDL-C and TG among subgroups of patients with no DR, with NPDR and PDR showed statistically significant difference (p <0.01). There was strong positive correlation of severity of DR with BSF, HbA1c, serum LDL-C, total cholesterol and TG. CONCLUSION: The serum cholesterol, TG, HDL-C and LDL-C concentrations were found to be significantly deranged in patients with DR as compared to those without DR.

Predictive Value Of Ocular Trauma Score In Open Globe Combat Eye Injuries.

BACKGROUND: Prediction of final visual outcome in ocular injuries is of paramount importance and various prognostic models have been proposed to predict final visual outcome. The objective of this study was to validate the predictive value of ocular trauma score (OTS) in patients with combat related open globe injuries and to evaluate the factors affecting the final visual outcome. METHODS: Data of 93 patients admitted in AFIO Rawalpindi between Jan 2010 to June 2014 with combat related open globe ocular injuries was analysed. Initial and final best corrected visual acuity (BCVA) was categorized as No Light Perception (NLP), Light Perception (LP) to Hand Movement (HM), 1/200-19/200, 20/200-20/50, and ≥20/40. OTS was calculated for each eye by assigning numerical raw points to six variables and then scores were stratified into five OTS categories. RESULTS: Mean age of study population was 28.77±8.37 years. Presenting visual acuity was <20/200 (6/60) in 103 (96.23%) eyes. However, final BCVA of ≥20/40 (6/12) was achieved in 18 (16.82%) eyes, while 72 (67.28%) eyes had final BCVA of <20/200 (6/60). Final visual outcome in our study were similar to those in OTS study, except for NLP in category 1 (81% vs. 74%) and ≥20/40 in category 3 (30% vs. 41%). The OTS model predicted visual survival (LP or better) with a sensitivity of 94.80% and predicted no vision (NLP) with a specificity of 100%. CONCLUSIONS: OTS is a reliable tool for assessment of ocular injuries and predicting final visual outcome at the outset.