Pattern of biopsy-proven kidney diseases: experience of a teaching hospital in Bahawalpur, Pakistan.

This descriptive observational study was conducted at the Department of Nephrology, Bahawal Victoria Hospital, Bahawalpur, Pakistan, from January 2012 to April 2018, to study the pattern of biopsy-proven kidney diseases in that region as a part to establish a national renal biopsy registry. All adult patients who underwent renal biopsy at the Bahawal Victoria Hospital, Bahawalpur, Pakistan, from January 2012 to April 2018, were included in the study. All the biopsies were evaluated by light microscopy and immunofluorescence. All the patients underwent urine dipstick, microscopic examination, and quantification of proteinuria. Hepatitis B surface antigen, anti-hepatitis C virus, human immunodeficiency virus, and serology (antinuclear antibody, anti-ds DNA, and C3 and C4) were checked in all the patients. There were a total of 195 patients, with a mean age of 30.5 ± 12.8 years. Females were comparatively younger than males (P = 0.0154). Primary glomerulonephritis (GN) accounted for 77% (155) of all the patients, whereas secondary GN contributed 15.8%. Focal and segmental glomerulosclerosis (FSGS) was the most common diagnosis (28.2%) followed by membranous nephropathy (MN) (18.9%). Lupus nephritis was the third-most common pathology, and it predominated among females (P= 0.0026). Out of the eight diabetic patients, one each had FSGS and crescentic GN. In conclusion, primary glomerular diseases were the predominant biopsy-proven kidney diseases, and FSGS and MN were the most common glomerular diseases. This pattern in South Punjab closely resembles that in southern and northern parts of the country.

The Spectrum of Beta-thalassemia Mutations in Couples Referred for Chorionic Villus Sampling at Bahawal Victoria Hospital, Bahawalpur.

Introduction The prevalence of beta-thalassemia mutations is different in various castes, regions, and ethnic groups. By knowing this prevalence, we can conduct a targeted screening of only the high-risk population and only for the specific mutations that are prevalent in each group. Objective The purpose of this study was to determine the regional, caste-wise, and ethnic spectrum of beta-thalassemia mutations in couples referred for a prenatal diagnosis. Methods A cross-sectional analytical study was conducted at the thalassemia unit, Bahawal Victoria Hospital, Bahawalpur, from October 1, 2015, to May 15, 2018. After obtaining informed consent, chorionic villus sampling (CVS) was performed in 144 women having a gestational age of 12 to 16 weeks. We took blood samples of the couples. A chromosomal analysis for 13 mutations was done at Punjab Thalassaemia Prevention Programme (PTPP), Lahore. The researchers filled a questionnaire with all the details of couples like ethnicity, caste, and region. Results The most common mutation was Fr 8-9(+G), accounting for 29.8%, followed by IVS 1-5(G-C), which was 28.9%. We did not find three mutations in any chromosome. Fr 8-9 (+G) was the most common mutation among Punjabis and Pakhtoons. IVS 1-5 (G-C) was the most common mutation among Saraikis and Urdu-speaking people. In Rajputs, Arains, Jatts, and Pathans, Fr 8-9 (+G) was the most common mutation. IVS 1-5 (G-C) was the most common mutation among Sheikhs, Balochs, Syeds, and Miscellaneous. IVS 1-5 (G-C) was the most common mutation in the Bahawalpur division and Ghotki (Sindh) while Fr 8-9 (+G) was the most common mutation in the Multan division. The p-value of all the results was <0.001. Conclusion There is an ethnic, caste-wise, and regional distribution of mutations. We can conduct a targeted screening of the population and provide counseling about chorionic villus sampling by using this local data.

Central Corneal Thickness and its Relationship to Intra-Ocular and Epidmiological Determinants.

OBJECTIVE: To measure central corneal thickness in Pakistani population and determine its relationship to intra-ocular pressure, age, gender and ethnicity. STUDY DESIGN: Cross-sectional observation study. PLACE AND DURATION OF STUDY: Pakistan Institute of Medical Sciences, Islamabad, Pakistan, between December 2013 and February 2015. METHODOLOGY: The right eyes of 1000 cases (496 males and 504 females) were recruited for this study. Inclusion criteria were Pashtun or Punjabi ethnicity, intra-ocular pressure < 22 mmHg, gonioscopically open angles, cup-disk-ratio < 0.5, and age matched normal visual fields. Cases with prior ocular surgery, contact lens use, corneal pathologies, myopia or hypermetropia > ±3.0 diopters, astigmatism of > ±1.0 diopters were excluded. Central corneal thickness was measured using a TopCon non-contact specular microscope. Intra-ocular pressure was measured using Goldmann applanation tonometer. Frequency distribution, test of significance, and regression analysis was carried out using Statistical Package for Social Sciences version 20.0. RESULTS: Mean age was 47.31 ±11.78 years. Ethnic composition was 51.6% (n=516) Pashtun and 48.4% (n=484) Punjabi. The mean central corneal thickness was 503.96 (±12.47) µm, while the mean intra-ocular pressure was 15.61 (±2.68) mmHg. Regression analysis showed a significant association between central corneal thickness and intra-ocular pressure (p=0.00) and age (p=0.00). A±100 µchange in central corneal thickness was associated with change in IOPof ±3.30 mmHg, whereas central corneal thickness decreased by 0.12 µm per year. No significant association could be established between central corneal thickness and ethnicity (p=0.19). CONCLUSION: Central corneal thickness of the studied races was comparable to non-Caucasians which affects intra-ocular pressure measurements, and decreases with increasing age. No relationship was observed between central corneal thickness and ethnicity or gender.

Convergence of technologies: the print, web and multimedia united to deliver an integrated basic medical sciences course in a resource limited setting.

This mixed methodology study was conducted at Shifa College of Medicine to see if study guide, module website and multimedia compact disk can be used to deliver an integrated basic sciences course while introducing the concepts of evidence based medicine and how it translates in students' performance. The study guide focused on the management of learning, activities and provision of information. The website was used to introduce evidence based medicine while the multimedia disc provided pictures, videos and animations for organs of special senses. Feedback questionnaire and end of module result were used to evaluate the module and its learning tools. The students agreed that the study guide, module website and multimedia compact disc facilitated their learning experience.

Management of anisometropic abmlyopia in adults.

Amblyopia is characterised by decrease in vision in one or both eyes as a result of processing defect in the visual pathways of the brain. It is considered an irreversible process if detected in the adult age group. This study was conducted from July 1 to December 31, 2010, at Shifa Foundation Community Health Centre, Islamabad, to determine if anisometropic amblyopia detected in adults can be reversed. A total of 15 adults, 11 (73.33%) males and 4 (26.66%) females, were managed for anisometropic amblyopia. All the patients were prescribed full cycloplegic correction in the anisometropic eye simultaneously with part-time occlusion therapy. Success was defined as visual acuity of 6/18 or better at the end of the therapy. All patients were required to complete a structured questionnaire regarding their experiences with the therapy. Reversal of amblyopia was observed in 11 (73.33%) patients who felt more confident about performing tasks for which they had earlier considered themselves unsuitable. Poor compliance was responsible for not producing the desired outcome in 4 (26.66%) patients. Anisometropic amblyopia in adults is reversible with dedicated efforts on behalf of both the ophthalmologist and the patient.

Analysis of retinal nerve fibre layer changes in anisometropic amblyopia by Heidelberg retina tomograph.

OBJECTIVE: To identify if anisometropic amblyopia is associated with changes in optic disk morphology. METHODS: The study comprised a total of 80 eyes recruited from Shifa Foundation Community Health Centre and the Pakistan Institute of Medical Sciences, Islamabad between May and October 2012. Anisometropic amblyopia was the only cause of disability (visual acuity > or = 6/12) in amblyopic eyes whereas normal eyes had a best corrected visual acuity of 6/6 and no morbidities. Patients with other causes of amblyopia, co-morbid ocular diseases, and in whom a good-quality image could not be obtained were excluded. Mean retinal nerve fiber layer thickness was analysed using Heidelberg retina tomograph. Analysis of frequency distribution, probability and regression were run on the data collected during the study using SPSS version 15.0. RESULTS: The mean age of the patients was 23.85 +/- 5.85 years. The retinal nerve fibre layer thickness ranged between 0.09 mm and 0.35 mm (mean: 0.23 mm +/- 0.07) in amblyopic eyes, and between 0.18 mm and 0.36 mm (mean: 0.25 mm +/- 0.05) in normal eyes. The difference was not statistically significant (p = 0.087). No association was found between the retinal nerve fiber layer thickness or the age and refractive error of patients. CONCLUSION: The optic disk does not appear to be the site of morphological changes in amblyopia.

Lingual tuberculosis.

Tuberculosis is a common disease in developing countries like Pakistan. Although it can involve almost any region of the body, some presentations are still very rare. This is a case report of a 36 years old male with tuberculous lesion on the tongue presenting as a lump. Patient also had disseminated disease. There are very few cases reported of this rare presentation across the globe.

Health related quality of life in pregnant women: a comparison between urban and rural populations.

OBJECTIVE: To study mental and physical health of pregnant women and compare the differences between those residing in urban and rural settings. METHODS: A Cross-Sectional Survey was conducted on pregnant women (n=179) in urban and rural areas of Islamabad in January 2009. SF-12, a validated instrument for mental and physical health assessment was used and translated into Urdu. Responses were decoded as per SF-12 analysis protocol. Independent sample t-test was done to compare the quantitative variables. The level of statistical significance was p<0.05. The survey was filled either by the participant or the research team and was anonymous. All the researchers were trained in the interview technique in order to make sure that each question carried the same meaning during the actual survey. This was done to standardize the survey methodology. RESULTS: A total of 179 survey forms were collected, 83 and 96 from both rural and urban areas respectively. Role Limitations because of Physical Problems (p=0.020), General Health Perceptions (p=0.001) and Role Limitations because of Emotional Problems (p=0.023) had statistically significantly lower scores in rural women as compared to urban women. CONCLUSION: Self-perceived mental and physical health was better in urban pregnant women than in rural women.