Corneal Astigmatism in Cataract.

OBJECTIVE: To measure preoperative corneal astigmatism in cataract patients. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Mughal Eye Hospital, Lahore, from 2018 to 2022. METHODOLOGY: The amount of preoperative corneal astigmatism was noted in cataract patients. Inclusion criteria included cataract patients above 16 years of age. Exclusion criteria included any preexisting corneal pathology (including corneal scar, corneal oedema, pterygium, etc.) and any previous ocular surgery, e.g. trabeculectomy, pterygium excision. SPSS version 25 was used for recording the data. RESULTS: Descriptive statistics were determined for demographic data and keratometry variables. Range of corneal astigmatism was zero to 5.75 dioptre with a mean of 1.05 dioptre (D) and standard deviation of 0.83. Corneal astigmatism of one or less than one diopter was recorded in 468 eyes (66.7%). Corneal astigmatism of 1.1 to 2 D was noted in 166 eyes (23.6%). Forty-nine eyes (7%) had corneal astigmatism of 2.1 to 3.0 D. Corneal astigmatism of 3.1 to 4.0 D, 4.1 to 5.0 D and 5.1 to 6 D was encountered in 11 (1.6%), 5 (0.7%) and 3 (0.4%) eyes respectively. CONCLUSION: A marked proportion of patients undergoing cataract operation have corneal astigmatism, so the phacoemulsification surgeon should consider difference of keratometry findings preoperatively. KEY WORDS: Corneal curvature, Corneal astigmatism, Phacoemulsification, Incision, Keratometry.

Heparin-induced Thrombocytopenia in Acute Coronary Syndrome.

Introduction Heparin-induced thrombocytopenia (HIT) is by far the most relevant pathological association of it encountered by clinicians. It is an immune-mediated phenomenon caused by antibodies directed against complexes of heparin molecules and platelet factor 4 (PF4). HIT is a considerable side effect in patients of acute coronary syndromes (ACS). Its prevalence and associated outcomes in ACS patients have not been studied sufficiently except for clinical trials. The objective of this study was to assess the frequency of HIT in patients presenting with ACS. Methods This was an observational study with 272 patients between 40 and 70 years of either gender presenting with ACS within 24 hours of the first appearance of symptoms. Blood samples for baseline platelet count were taken before heparin therapy. Then, patients were subsequently administered low molecular weight heparin 5000 units stat, followed by 12 units/kg/hr for 72 hours of intravenous infusion. Blood samples were repeated for platelet count on Day 5. Thrombocytopenia was defined as per the recommendation of American College of Cardiology as " ≥50% decline in platelets (below 150 x 109/L in most patients), which may occur immediately following heparin exposure (rapid presentation) or up to three weeks following exposure (delayed presentation)." Reports were assessed for the level of platelets. Data were entered and analyzed using SPSS version 22 (IBMCorp, Armonk, NY, US). Results The incidence of HIT was observed in 9.56% (n=26). In the HIT group, the mean platelet count on Day 5 was 109.81 ± 78.06 x 109/L. The incidence of HIT in ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) were equal but higher than that in unstable angina (UA) (p-value=0.01). The incidence of HIT was also significantly higher in the group that presented late to the hospital (after 12 hours of symptom onset) (p-value=0.001). Conclusion The risk of HIT is more prominent in patients with myocardial infarction and in those who have a duration of symptoms more than 12 hours at the time of hospital presentation. Cardiologists and specialists of internal medicine have to take precautions while administrating heparin therapy in these high-risk patients, to avoid any complications.

Lipid Profile of Patients with Acute Myocardial Infarction (AMI).

Introduction  Irrespective of underlying hyperlipidemia, the serum lipid profile witnesses a phasic fluctuation immediately after a major cardiovascular event. This study aims to evaluate the change in serum lipid profile in patients with acute myocardial infarction (AMI). Methods It was a prospective, cross-sectional study conducted in the department of cardiology, Shalamar Hospital, and Punjab Institute of Cardiology, from October until December 2018, focusing on patients admitted with ST-elevation myocardial infarction (STEMI). The patient's demographics and lipid profile (in mg/dl) within the first 24 hours and after 48 hours of the event were recorded. Results The mean serum total cholesterol (TC) levels decreased from 207.5 ± 30.5 to 192.4 ± 49.3 after 48 hours (p-value <0.0001). Mean serum triglyceride (TGs) levels increased from 153.8 ± 10.2 to 183.8 ± 14.8 (p-value <0.0001). Mean serum low density lipid-cholesterol (LDL-C) decreased from 149.0 ± 41.2 to 133.4 ± 54.0 (p-value = 0.0003). Mean serum high density lipid-cholesterol (HDL-C) decreased from 46.6 ± 9.9 to 40.7 ± 11.8 (p-value <0.0001). Conclusion Phasic fluctuations in serum lipid profile are observed after acute myocardial infarction (AMI). The trend that follows include reduced TC, LDL-C, and HDL-C, and increased TGs. Periodic lipid profile must be evaluated in all patients admitted for AMI to understand the changing trend, initiate lifestyle measures to reach target lipid levels, and predict the choice of lipid-lowering therapy.

Corneal Collagen Cross Linking (CXL) in treatment of Pseudophakic Bullous Keratopathy.

OBJECTIVE: To determine mean change in visual acuity, central corneal thickness and symptoms in patients with pseudophakic bullous keratopathy after treatment with corneal collagen crosslinking. METHODS: This quasi experimental study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from April 2015 to Nov 2015. A total of 24 eyes of 24 patients were included in the study. Visual symptoms were graded in five grades (Grade 1-5), Grade-1 being very mild with decreased vision only while patients with all five symptoms (decreased vision, foreign body sensations, pain, watering and photophobia) were graded as Grade-5. Corneal collagen cross linking using topical isotonic riboflavin followed by UVA radiations (3mW/cm(2) for 10 minutes) was performed in all the patients. Visual acuity (VA), visual symptoms and central corneal thickness (CCT) were recorded before and 04 weeks after the treatment. RESULTS: A total of 24 eyes of 24 patients (18 male and 6 females) underwent surgery. Age of the patients ranged from 55 to 75 years with mean age 65.83 + 3.89 years. Mean visual acuity was 2.09 + 0.23 before treatment while after treatment it was 2.13 + 0.22. Mean CCT as measured by optical pachymetry (Galilae G6) was 753.96 + 55.16 and 641+ 29.25 before and after surgery respectively. Improvement of clinical symptoms was seen in all the patients. CONCLUSION: Corneal collagen cross linking is a temporary but effective symptomatic treatment of pseudophakic bullous keratopathy.

Peri-procedural outcome of saphenous vein graft intervention.

BACKGROUND: Patients who develop recurrent myocardial ischemia after coronary artery bypass graft (CABG) surgery are often referred for percutaneous coronary intervention. The objective of this study was to evaluate the clinical characteristics and peri-procedural outcomes in patients with prior CABG referred for percutaneous coronary intervention (PCI) over a 3 year period. METHODS: Data were collected on patients who underwent coronary interventional procedures following CABG surgery. We evaluated angiographic procedural success and immediate outcome among patients who had undergone such procedures from Nov 2006 to Oct 2009 (n = 113). RESULTS: Patients in the 2006-2009 cohort had mean age 58.2 years, more patients were male (109 vs 4) and were more likely to have hypertension (57.5%), hyperlipidaemia (72.6%) and family history of ischemic heart disease (IHD) (65.5%), but less likely to have smoking (42.5%). Acute closure of stent leading to procedural failure was seen in 1 (0.9%) patient, sub-acute thrombosis of stent was seen in 1 (0.9%) patient, dissection or perforation of target vessel was seen in 3 (2.7%) and 1 (0.9%) patients respectively. Slow flow phenomenon was seen in 13 (11.5%) and post-procedural cardiac enzymes were raised in 6 (5.3%) patients. CONCLUSION: Success rates of saphenous vein graft (SVG) intervention and survival rate have improved with time as a result of improvements in technique and greater use of stents, filter devices and adjunctive medications.

Fetal acrania - prenatal sonographic diagnosis and imaging features of aborted fetal brain.

We report a 35 year old female patient referred to our ultrasound department to rule out congenital anomalies. The fetus was found to have a completely formed brain, base of the skull and facial structures but lacking a cranium. The fetus was therapeutically aborted. We correlated our antenatal sonographic findings with gross pathological features and CT Scan of the fetal head. Despite an extensive search, CT features of aborted fetal brain and base of skull were not found in the literature.

Metabolic syndrome in patients with ischemic heart disease.

OBJECTIVE: To determine the frequency of metabolic syndrome in patients with Ischemic Heart Disease (IHD). STUDY DESIGN: Cross-sectional, descriptive study. PLACE AND DURATION OF STUDY: Cardiology Department of Punjab Institute of Cardiology, Lahore, from June 2006 to June 2007. METHODOLOGY: A total of 100 subjects with ischemic heart disease, fulfilling the inclusion criteria, were enrolled in the study. Demographic data (age and gender) and the 5 component conditions of the metabolic syndrome were noted. Subjects were physically assessed for the abdominal obesity, based on waist circumference. Fasting blood samples for glucose and lipid profile in first 24 hours after acute coronary insult were drawn and tested in central laboratory. Variables were processed for descriptive statistics. RESULTS: In this study population, 68% were male and 32% were female with mean age of 52 +/-13.6 years in men and 56 +/- 12.5 years in women. Frequency of metabolic syndrome was 32% in men and 28% in women. It increased with age. The highest rate of metabolic syndrome was in men diagnosed as STEMI (odds ratio: 3.39, 95% CI=1.36-8.41). CONCLUSION: Frequency of metabolic syndrome was high among the patients with IHD. It supports the potential for preventive efforts in persons with high-risk of IHD.