Pneumatic Retinopexy: An Experience of 12 Years at a Tertiary Care Hospital.

Purpose The purpose of this study is to retrospectively analyze single-operation success (SOS) rates of pneumatic retinopexy (PR) for the treatment of rhegmatogenous retinal detachment (RRD) and to identify the predictors of treatment outcomes. Methods Sixty-one eyes of 61 patients who underwent PR for RRD during a period of 12 years were included in this study. Patient demographics along with pre-treatment clinical characteristics were recorded. Treatment outcomes in terms of best-corrected visual acuity (BCVA) and anatomical characteristics were reported including any post-operative complications. Visual outcomes were compared according to pre-treatment characteristics and between groups of the eyes achieving SOS and those requiring additional surgery. Results SOS was achieved in 37 (61%) eyes. Twenty-four (39%) eyes required one (36%) or two (3%) additional procedures. There was no significant association between pre-treatment characteristics and treatment failure. SOS eyes had significantly better visual outcomes (P=0.002), and so did those with macula-on status (P=0.003). New/missed breaks (9.8%) and proliferative vitreoretinopathy (PVR) (4.9%) were the most common causes of failure. Conclusions We found PR to be a beneficial technique for the treatment of RRD in this cohort. PR remains the least invasive treatment modality, and as a cost-effective technique, it is especially useful in low/middle-income countries such as Pakistan.

Effects of inoculation of corn silage with Saccharomyces cerevisiae on silage fermentation characteristics, nutrient digestibility, mycoflora and aflatoxin production.

In the present study, fresh whole corn plants along with half milk kernels line were treated with live and hydrolysed yeast with different concentrations before ensiling and kept in airtight bags and then into mini silos in order to achieve anaerobic conditions for proper fermentation. The buckets were opened after different time intervals to characterise the material, quick acidification, dry matter recovery, and aerobic stability of silage respectively. Moreover, mycoflora and aflatoxin contamination were also analysed. The overall result reported that the silage quality was improved by the application of live and hydrolysed yeast. The best result was reported by the application of live yeast (T2: 10 g/kg) which significantly improved the fermentative, proximate, and digestibility parameters and reduced the mycoflora and aflatoxin contamination. Our results present promising new options for the use of natural compounds that may help to improve silage quality and reduce aflatoxin contamination.

Epidemiology, risk factors, and pathogenesis associated with a superbug: A comprehensive literature review on hepatitis C virus infection.

Viral hepatitis is a major public health concern. It is associated with life threatening conditions including liver cirrhosis and hepatocellular carcinoma. Hepatitis C virus infects around 71 million people annually, resultantly 700,000 deaths worldwide. Extrahepatic associated chronic hepatitis C virus accounts for one fourth of total healthcare load. This review included a total of 150 studies that revealed almost 19 million people are infected with hepatitis C virus and 240,000 new cases are being reported each year. This trend is continually rising in developing countries like Pakistan where intravenous drug abuse, street barbers, unsafe blood transfusions, use of unsterilized surgical instruments and recycled syringes plays a major role in virus transmission. Almost 123-180 million people are found to be hepatitis C virus infected or carrier that accounts for 2%-3% of world's population. The general symptoms of hepatitis C virus infection include fatigue, jaundice, dark urine, anorexia, fever malaise, nausea and constipation varying on severity and chronicity of infection. More than 90% of hepatitis C virus infected patients are treated with direct-acting antiviral agents that prevent progression of liver disease, decreasing the elevation of hepatocellular carcinoma. Standardizing the healthcare techniques, minimizing the street practices, and screening for viral hepatitis on mass levels for early diagnosis and prompt treatment may help in decreasing the burden on already fragmented healthcare system. However, more advanced studies on larger populations focusing on mode of transmission and treatment protocols are warranted to understand and minimize the overall infection and death stigma among masses.

Comparison between the values of intra-ocular pressure measured by Goldmann applanation tonometer and Air-Puff non-contact tonometer and their relationship with central corneal thickness.

Glaucoma is a sight threatening disorder in which measuring intra-ocular pressure (IOP) with accuracy plays a fundamental role. This study aimed to compare the IOP values air-puff of non-contact tonometer(APT) and Goldmann applanation tonometer (GAT) along with their relationship to central corneal thickness (CCT), in various IOP groups. Three hundred and eleven patients were enrolled using convenience sampling in this cross-sectional, prospective study. IOP was measured with Keeler 3000 APT and GAT along with CCT using TOMEY EM-4000. Data was analysed using Bland-Altman, Spearman's and intra-class correlation analysis of APT, GAT and CCT on SPSS 24.0. The median IOP by APT and GAT was 14 mmHg (range:37) and 12 mmHg (range:16) whereas the median CCT was 534µ (range: 44), respectively. At low (<10 mmHg) and normal IOP (10-20 mmHg) both the instruments showed similar results but GAT was found to be more accurate (p£0.001) at higher IOP (21-30 mmHg). However, at moderate and higher groups of IOP, APT revealed overestimation of IOP compared to GAT. CCT also plays a significant role.

Spectral Domain - Optical Coherence Tomography findings in Triple-A Syndrome - A case series from Pakistan.

Triple A Syndrome is an autosomal recessive entity involving multiple systems usually characterized by adrenal insufficiency, alacrimia and achalasia. The disease features include variable degrees of neurological and neuro-ophthalmic manifestations. Protein ALADIN encoded by the AAAS gene is found to be defective in Triple A Syndrome. Here we discuss a case series of five patients diagnosed as Triple A Syndrome. Clinically there was variable degree of optic atrophy in all the cases, which was further confirmed with spectral domain Optical Coherence Tomography The aim of this study was to publish the OCT based ONFL graphs of these unique cases, so that being an ophthalmologist we can take a multidisciplinary approach and decisions accordingly.

Optic Disc Melanocytoma; A Rare Entity.

A young male presented with complaints of disturbance of vision and floaters for the past five years with best corrected visual acuity of 6/6 in both eyes. Ophthalmic examination of the anterior segment was normal in both eyes. There was a relative afferent papillary defect in the right eye. Fundoscopic examination of the left eye showed a raised, 3-disc diameter (DD) dark brown lesion arising from the optic disc. Ophthalmic investigations were performed including fundus photos, A-scan, B-scan, Auto-fluorescence, OCT, and FFA. Findings were consistent with those of optic disc melanocytoma. The patient is now kept on close three-monthly follow-up. To the best of our knowledge, there are no published reports from Pakistan so far.

Biocomposite of sodium-alginate with acidified clay for wastewater treatment: Kinetic, equilibrium and thermodynamic studies.

Clay-based composites were prepared, characterized, and applied for the elimination of Blue FBN (BFBN) and Rose FRN (RFRN) dyes. The Fourier transform infrared spectroscopy (FTIR), scanning electron microscope (SEM), Thermogravimetric (TGA) and X-ray diffraction analyses were performed to check the interaction of dye molecule with adsorbents. The analysis showed a successful interaction between adsorbent and dyes ions. The experimental data was best fitted with Freundlich isotherm for both dyes (BFBN and RFRN). The findings revealed that at 80 min the adsorption grasped equilibrium in the case of both dyes and succeeded the pseudo-second-order kinetics model. Furthermore, the enthalpy (ΔH°), Gibbs free energy (ΔG°) and entropy (ΔS°) changes suggested that adsorption was exothermic, physical and spontaneous in nature. The maximum adsorption capacities were determined as 76.39% for BFBN and 59.85% for RFRN dye at pH 2.0 and 30 °C. Composites found to be stable at higher temperature and regenerated using MgSO4 eluting agent. The textile effluent colour was removed up to 50.35 and 54.95% using raw and modified clay, respectively. The modified clay showed promising efficiency for adsorption of synthetic BFBN and RFRN dyes from aqueous solution, which could be a viable option for the treatment of industrial wastewater and textile effluents.

Yield and Safety Profile of Ultrasound Guided Fine Needle Aspiration Cytology (FNAC) of Lymph Nodes.

OBJECTIVE: To determine the re-biopsy rate, positive yield and safety profile of ultrasound guided fine needle aspiration cytology (FNAC) in cervical lymph nodes in terms of its complications and repeat procedures. STUDY DESIGN: An analytical study. PLACE AND DURATION OF STUDY: Department of Vascular and Interventional Radiology, Dow University Hospital, Dow University of Health Sciences, Karachi, from June to December 2013. METHODOLOGY: Eighty neck swellings, which were found to be lymph nodes on ultrasound, underwent ultrasound guided FNAC, from outpatients. Lymph nodes which were included in the study were those that were not easily palpable, located near major blood vessels, where patient refused of direct palpation and wanted image guided FNAC, those directly sent by physician for image guided FNAC and where blind biopsy remained inconclusive. Patients who refused on explanation or did not give consent were excluded. Complications and repeat biopsy were noted. RESULTS: This study consisted of 80 cases, of which 51 cases (63.75%) were female and 29 cases (36.25%) were male. Repeat biopsy was required in 1 case (1.6%). There were no procedure-related complications. Atotal of 44 cases (55%) revealed evidence suggesting or confirming the existence of tuberculosis. Rest of the others showed other benign lesions, reactive lymphadenopathy and malignancy. CONCLUSION: Ultrasound guided FNAC is a safe procedure with low re-biopsy rate that aids diagnosis. The predominant cause of cervical lymphadenopathy in this study was tuberculous lymphadenitis.

Gender and stress perception based differences in BMI, hormonal response and appetite in adult Pakistani population.

OBJECTIVE: To evaluate and compare the gender based variations in stress perception induced changes in leptin, cortisol and serotonin (5-HT) trends, appetite and Body Mass Index (BMI). STUDY DESIGN: An analytical comparative study. PLACE AND DURATION OF STUDY: Neurochemistry Laboratory, University of Karachi, from January to August 2013. METHODOLOGY: Appetite, BMI and serum leptin, cortisol, and 5-HT were measured in 100 men and women of aged 30-60 years, working in teaching institutes of Karachi, to evaluate gender based, stress perception induced variations. The samples were identified by stratified random technique. The chemical variables were estimated through ELISA. RESULTS were analysed using one-way ANOVA and multivariate general linear model using SPSS version 17. RESULTS: Mean stress perception, BMI and serum leptin levels were significantly more in women (p<0.05). Serum cortisol and 5-HT were found significantly reduced in women (p<0.05). BMI, serum cortisol and leptin were found to be increased with increasing level of stress perception (p<0.05). VAS for hunger and desire to eat as the measure of appetite was significantly higher in men (p<0.05). CONCLUSION: Stress perception attenuates the positive effect of cortisol and negative effects of leptin and 5-HT on appetite through changes in their circulatory levels. Women perceive more stress and exhibit significantly attenuated changes in hormonal levels and appetite which may be the contributing factor towards obesity. Increased BMI in women despite decreased appetite merits more studies.

Mediastinal enteric cyst.

A 20-year-old female presented with complaints of right-sided chest pain, cough, fever and shortness of breath for the preceding one-and-a-half year. Air entry was decreased over the middle and lower chest. Computed tomography scan of the chest revealed a cystic lesion with thick margins present in the right hemi-thorax. The cyst was excised by posterolateral thoracotomy. Histopathology revealed it to be mediastinal enteric cyst with intestinal and pancreatic tissue.