Acute type A aortic dissection in patients with non-prior cardiac surgery vs. prior cardiac surgery: a systematic review and meta-analysis.

Background: Patients with prior cardiac surgery undergoing acute type A aortic dissection (ATAAD) are thought to have worse clinical outcomes as compared to the patients without prior cardiac surgery. Aim: To compare the safety and efficacy of ATAAD in patients with prior cardiac surgery. Methods: We systematically searched PubMed, Cochrane Library and Google Scholar from database inception until April 2024. We included nine studies which consisted of a population of 524 in the prior surgery group and 5,249 in the non-prior surgery group. Our primary outcome was mortality. Secondary outcomes included reoperation for bleeding, myocardial infarction, stroke, renal failure, sternal wound infection, cardiopulmonary bypass (CPB) time, cross-clamp time, hospital stay, and ICU stay. Results: Our pooled estimate shows a significantly lower rate of mortality in the non-prior cardiac surgery group compared to the prior cardiac surgery group (RR = 0.60, 95% CI = 0.48-0.74). Among the secondary outcomes, the rate of reoperation for bleeding was significantly lower in the non-prior cardiac surgery group (RR = 0.66, 95% CI = 0.50-0.88). Additionally, the non-prior cardiac surgery group had significantly shorter CPB time (MD = -31.06, 95% CI = -52.20 to -9.93) and cross-clamp time (MD = -21.95, 95% CI = -42.65 to -1.24). All other secondary outcomes were statistically insignificant. Conclusion: Patients with prior cardiac surgery have a higher mortality rate as compared to patients who have not undergone cardiac surgery previously. Patients with prior cardiac surgery have higher mortality and longer CPB and cross-clamp times. Tailored strategies are needed to improve outcomes in this high-risk group.

Investigating sex, race, and geographic disparities in bronchus and lung cancer mortality in the United States: a comprehensive longitudinal study (1999-2020) utilizing CDC WONDER data.

Background: Lung and bronchus cancer has become the leading cause of cancer-related mortality in the United States. Understanding the patterns of mortality is an absolute requirement. Methods: This study analyzed Lung and Bronchus cancer-associated mortality rates from 1999 to 2020 using death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER). Age-adjusted mortality rates (AAMRs), per 100 000 people, and annual percentage change (APCs) were also calculated. Results: 3 599 577 lung and bronchus cancer-related deaths occurred in patients aged younger than 1-85+ years between 1999 and 2020. Overall AAMRs declined from 59.1 in 1999 to 58.9 in 2001 (APC: -0.1364) then to 55.9 in 2005 (APC: -1.4388*) 50.5 by 2010 (APC: -2.0574*) 44.7 by 2014 (APC: -2.9497*) and 35.1 by 2020 (APC: -4.1040*). Men had higher AAMRs than women (overall AAMR men: 61.7 vs. women: 38.3). AAMRs were highest among non-Hispanic (NH) Black or African American (52.7) patients followed by NH White (51.8), NH American Indian or Alaska Native (38.6), NH Asian or Pacific Islander (24.7) and Hispanic or Latino race (20.2). AAMRs varied in region (overall AAMR; South: 52.4; Midwest: 52.3; Northeast: 46.3; West: 39.1). Non-metropolitan areas had a higher AAMR (55.9) as compared to metropolitan areas (46.7). The top 90th percentile states of Lung and Bronchus cancer AAMR were Arkansas, Kentucky, Mississippi, Tennessee, and West Virginia. Conclusion: An overall decreasing trend in AAMRs for lung and bronchus cancer was seen. Public health measures to regulate risk factors and precipitating events are needed.

Impact of non-alcoholic fatty liver disease on coronavirus disease 2019: A systematic review.

BACKGROUND: Many studies have revealed a link between non-alcoholic fatty liver disease (NAFLD) and coronavirus disease 2019 (COVID-19), making understanding the relationship between these two conditions an absolute requirement. AIM: To provide a qualitative synthesis on the currently present data evaluating COVID-19 and NAFLD. METHODS: This systematic review was conducted in accordance with the guidelines provided by preferred reporting items for systematic reviews and meta-analyses and the questionnaire utilized the population, intervention, comparison, and outcome framework. The search strategy was run on three separate databases, PubMed/MEDLINE, Scopus, and Cochrane Central, which were systematically searched from inception until March 2024 to select all relevant studies. In addition, ClinicalTrials.gov, Medrxiv.org, and Google Scholar were searched to identify grey literature. RESULTS: After retrieval of 11 studies, a total of 39282 patients data were pooled. Mortality was found in 11.5% and 9.4% of people in NAFLD and non-NAFLD groups. In all, 23.2% of NAFLD patients and 22% of non-NAFLD admissions diagnosed with COVID-19 were admitted to the intensive care unit, with days of stay varying. Ventilatory support ranged from 5% to 40.5% in the NAFLD cohort and from 3.1% to 20% in the non-NAFLD cohort. The incidence of acute liver injury showed significance. Clinical improvement on days 7 and 14 between the two classifications was significant. Hospitalization stay ranged from 9.6 days to 18.8 days and 7.3 days to 16.4 days in the aforementioned cohorts respectively, with 73.3% and 76.3% of patients being discharged. Readmission rates varied. CONCLUSION: Clinical outcomes except mortality consistently showed a worsening trend in patients with NAFLD and concomitant COVID-19. Further research in conducting prospective longitudinal studies is essential for a more powerful conclusion.

Long-term outcomes of titanium-nitride-oxide coated stents and drug-eluting stents in acute coronary syndrome: A systematic review and meta-analysis.

BACKGROUND: In severe cases of coronary artery disease, percutaneous coronary intervention provide promising results. The stent used could be a drug-eluting stent (DES) or a titanium-nitride-oxide coated stent (TiNOS). AIM: To compare the 5-year effectiveness and safety of the two stent types. METHODS: The following systematic review and meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis guidelines, and PubMed/MEDLINE, Scopus, and Cochrane Central were searched from inception till August 2023. Primary outcomes were major adverse cardiac events (MACE), cardiac death, myocardial infarction (MI), cardiac death or MI, and ischemia-driven total lesion revascularization (ID-TLR). RESULTS: Four randomized controlled trials (RCT), which analyzed a sum total of 3045 patients with acute coronary syndrome (ACS) after a median follow-up time of 5 years were included. Though statistically insignificant, an increase in the ID-TLR was observed in patients receiving TiNOSs vs DESs. In addition, MI, cardiac death and MI, and definite stent thrombosis (DST) were significantly decreased in the TiNOS arm. Baseline analysis revealed no significant results with meta-regression presenting non-ST elevated MI (NSTEMI) as a statistically significant covariate in the outcome of MACE. CONCLUSION: TiNOS was found to be superior to DES in terms of MI, cardiac death or MI, and DST outcomes, however, the effect of the two stent types on ID-TLR and MACE was not significant. A greater number of studies are required to establish an accurate comparison of patient outcomes in TiNOS and DES.

Remimazolam versus propofol for sedation in gastrointestinal endoscopy and colonoscopy within elderly patients: a meta-analysis of randomized controlled trials.

PURPOSE: Propofol has become the sedative of choice for endoscopy and colonoscopy. However, it has shown associations with various adverse effects, specifically in the geriatric population. In contrast, remimazolam is a novel benzodiazepine, demonstrating a superior clinical safety profile. Hence, this systematic review and meta-analysis aims to clarify the efficacy and safety of remimazolam versus propofol in elderly patients (≥ 60 years) undergoing gastrointestinal endoscopic and colonoscopy procedures. METHODS: Electronic databases including PubMed, Cochrane Library, ScienceDirect, and Google Scholar were explored from inception till January 7, 2024. The Cochrane Risk of Bias Tool for Randomized Controlled Trials (RoB-2) was utilized to evaluate the quality of each included study reported in this meta-analysis. RESULTS: Seven randomized control trials were included, resulting in the pooling of 1,466 patients (remimazolam: 731 patients; propofol: 735 patients). Propofol demonstrated a significantly lower time to loss of consciousness (P < 0.00001, 4 studies, 784 patients) and a greater sedation success after first dose (P = 0.05, 5 studies, 1,271 patients). Remimazolam reported a significantly lower risk of bradycardia (P = 0.02, 5 studies, 1,323 patients), hypoxemia (P < 0.00001, 6 studies, 1,389 patients), and pain on injection site (P < 0.00001, 5 studies, 1,184 patients). No statistically significant differences in sedation time, number of supplemental doses, procedural parameters, and other adverse outcomes were reported. CONCLUSION: As per the results of our analyses, propofol demonstrated comparatively superior efficacy, however, remimazolam demonstrated comparatively superior safety. The debatable evidence generated from this meta-analysis may not currently be powerful enough to advocate for the use of remimazolam in elderly patients undergoing gastrointestinal procedures; hence, further comprehensive studies are necessary in order to arrive at a robust conclusion.

A comparative analysis of postoperative visual outcomes following cataract surgery with different brands of Monofocal Intraocular Lenses.

Objective: To compare visual outcomes after cataract surgery using three intraocular lenses (IOL) of different prices but similar properties. Methods: A comparative study with retrospective data of patients operated for phacoemulsification with monofocal IOL implants was carried out at Al-Ibrahim Eye Hospital (AIEH) from April 2021 to Feb 2022. Patients with diabetes, any preoperative ocular morbidity and unclear diagnosis were excluded from the study. Pre and post-operative best corrected visual acuity (BCVA) on 1st day, 7th day and 4-6 weeks were analyzed. IOLs were categorized on the basis of price into economical, standard and premium lenses. To minimize surgical bias, data was further stratified on the basis of surgical expertise. Results: Data of 3237 patients was analyzed. Economical lens (A) was implanted in 2647, standard (B) in 254 and premium (C) in 336 patients. On average BCVA (6/6 to 6/12) was achieved in 88.2% of patients. No significant difference was found at third follow up among BCVA of three IOls operated by senior surgeon, χ2(2) = 3.216, p = 0.20, with median (IQR) is 0.2(0.2) logMAR for Group-A, 0.1(0.2) logMAR for Group-B and 0.2(0.1) logMAR for Group-C. When results of the rest of the surgeons was considered, significant difference was found among BCVA at 3rd follow-up, χ2(2) = 6.661, p = 0.036, with median (IQR) is 0.3(0.2) logMAR for Group-A, 0.2(0.1) logMAR for Group-B and 0.2(0.3) logMAR for Group-C. Conclusion: When surgical factors mainly, surgeon bias is removed, all three types of monofocal IOL had similar visual outcomes.

Ocular Complications Associated With Diabetes And The Risk Of Sustainable Blindness; A Real World Analysis.

OBJECTIVE: To evaluate the frequencies of ocular comorbidities among patients with type II diabetes, and the association with multiple systemic factors. METHODS: The retrospective, cross-sectional study was conducted at the Al Ibrahim Eye Hospital, Karachi, and comprised diabetic eye clinic data from April 2014 to February 2022. Demographic, biochemical and ophthalmic findings of the patients were recorded. Ocular findings analysed were best-corrected visual acuity, lens status, corneal changes, optic disc assessment, intraocular pressure and signs of retinopathy and its grading. Data was analysed using SPSS 22. RESULTS: Of the 43,723 subjects, 22,677(51.86%) were males and 21,046(48.13%). The overall mean age was 54.14±10.68 years. There were 21,680(49.58%) patients with diabetes duration 5-10 years. Overall, 33,876(77.5%), had some ocular morbidity, while 9,847(22.5%) had no such complaints. The commonest morbidity was cataract12,607(28.8%), followed by refractive errors 8,508(19.5%), vision-threatening diabetic retinopathy 2,553(5.83%) and suspected glaucoma 1,211(2.76%). Vision 28 threatening diabetic retinopathy and suspected glaucoma represented sustained blindness risk 3,764(8.6%). Increasing levels of low-density lipoprotein were significantly associated with advanced diabetic eye disease and clinically significant macular oedema (p<0.05), while glycated haemoglobin >6.4 was associated significantly with diabetic retinopathy and suspected glaucoma (p<0.05). CONCLUSIONS: Diabetes caused some or the other ocular morbidity that needed intervention. Poor control of biochemical parameters was seen to increase frequency of ocular complications.

Unsteady blood flow of Carreau fluid in a porous saturated medium with stenosis under the influence of acceleration and magnetic fields: A comprehensive analysis.

Blood flow in stenosed arteries is a common cause of cardiovascular diseases, leading to serious health problems. The present study aims to investigate the unsteady Womersley blood flow in a stenosed, porous saturated artery under the influence of acceleration and magnetic fields. The study utilizes a Carreau constitutive equation to model blood rheology and employs the finite difference technique to compute the governing equations under the assumption of unsteady, unidirectional, and laminar flow. The importance of this study lies in its potential to provide a better understanding of the complex behavior of hemodynamic flow in the presence of external fields and porous media, which has significant implications for the control and management of cardiovascular diseases. In particular, the study analyses the impacts of non-dimensional parameters, such as magnetic field, channel permeability, acceleration field, Weissenberg number, and stenosis amplitude, on critical flow variables, such as velocity, resistivity, wall shear stress, and flow rate. Our calculations suggest that a magnetic field is an effective instrument for regulating hemodynamic flow because it increases resistance by up to 8.31% while decreasing flow by up to 8.44%. Channel permeability, on the other hand, improves blood velocity by up to 33.35% while eliminating resistance by up to 23.43%. Furthermore, greater acceleration fields decrease resistivity while increasing velocity, flow rate, and wall shear stress. Additionally, the severity of the stenosis and the Weissenberg number substantially affect flow factors. By raising the stenosis amplitude, resistivity rises, and other flow characteristics diminish, whereas modifying the Weissenberg number causes the reverse effect.

Rabies: Perils and Prevention, an Insight into Practices and Perception in Residents of Pakistan

Background: There is a sheer lack of knowledge in treating rabies in Pakistan. To decrease the number of victims every year, immunization and awareness programs are the basic necessities of Pakistani population. The aim of this study was to highlight the lack of learning strategies and how to overcome this problem, so as to eliminate rabies. Methods: This cross-sectional study was conducted on 692 respondents, aged 8-50 years, in Karachi city of Pakistan from January 2022 to June 2022. The study was based on demographic characteristics and basic knowledge of rabies, mode of transmission, clinical signs, and range of animal host species. Binary logistic regression analysis was performed to know the risk factor of rabies among different age groups, marital status, occupation, etc. Results: Results revealed that all the age groups were at risk of the wrong knowledge about rabies, odds = 1.182 and odds = 1.775 for 20-30 and 31-40 years of age, respectively; however, 31-40 years were at the high risk of showing odds=3.597 (95% C.I 1.621-7.983). The correlation of occupation was also checked with rabies knowledge. Only doctors (odds = 1.396) and students (odds = 1.955) showed their unawareness about rabies. Conclusion: This study highlights the grave situation that holds the country in the form of rabies. Through this study we aspire to raise awareness regarding the transmission, spread, and control of rabies

A Wearable-based Preventive Model To Promote Oral Health Through Personalized Notification.

Wearable technology has great potential to develop human-centric healthcare applications. It reshapes our lifestyle by providing information related to physical activities, sleep monitoring, or heartbeat rhythms. In this paper, we present an innovative model for oral healthcare, which is prevention-focused to notify individuals about cleaning teeth activity. It is based on a wrist-worn accelerometer device and has two components-first, a computationally lightweight feature extractor-secondly, a robust feed-forward neural network to recognize the cleaning teeth activity. The model performance is measured using standard performance metric F1 - score (i.e., 98%), which shows the applicability in a real-life scenario. The trained model can reside inside the smartwatch as a wrist-worn wearable. It would generate personalized notifications if s/he skipped the toothbrush activity. Furthermore, it notifies the users to change the toothbrush after three months, reducing the cognitive burden. Clinical Relevance-This work help the individuals to maintain their oral health using smartwatches as a wearable device.

Black mulberry (Morus nigra) fruit extract alleviated AD-Like symptoms induced by toxic Aß protein in transgenic Caenorhabditis elegans via insulin DAF-16 signaling pathway.

Alzheimer's disease (AD) is one of the most severe neurodegenerative disorders. Recently, there is no effective treatment drug for AD. Morus nigra (M. nigra) is a black mulberry and widely distributed fruit in the Moraceae family with various undiscovered biological activities. The study aimed to investigate the potential anti-AD effect of M. nigra. Mulberry fruit extract (MF) was obtained from M. nigra and treated up to 1.00 mg/mL on transgenic AD Caenorhabditis elegans (C. elegans) models. MF inhibited Amyloid-ß (Aß)-induced paralysis symptoms by about 55.65 %, reduced Aß accumulation more than 50 % via immunoblotting, and suppressed over-sensitivity to exogenous serotonin in C. elegans. Furthermore, MF decreased the Aß oligomeric depositions in worm CL2006. MF activated the DAF-16 nuclear translocation and its downstream SOD-3 and GST-4. AD is a major age-related disorder. Therefore, MF treated for an aging test and proved to be expanded the lifespan of the worms up to 34.7 %. Besides, we have evaluated the MF in vivo antioxidative properties, where MF reduced reactive oxygen species (ROS) generations in C. elegans and remitted the activation of HSP-16.2 induced by the oxidative action of Juglone. Gene knockout and extended the lifespan of AD worms. However, RNA interference (RNAi) successfully silenced the daf-16 on the Aß phenotypic paralysis proved by MF effect. Our results indicate that MF alleviates AD-Like symptoms by activating the DAF-16 insulin signal pathway in C. elegans. Therefore, this MF study may provide new insights for mulberry application in safe AD treatment and clinical study.

Expression variation of OGG1 and HPRT gene and DNA damage in arsenic exposed industrial workers.

Arsenic exposure alters redox balance, induces DNA damage, and deregulates many genes. OGG1 gene involved in base repair mechanism, for excision of 8-oxoguanine (8-oxoG) from DNA formed as a result of accumulation of ROS in cell. HPRT gene encode transferase enzymes involved in purine recycling mechanism. The main focus of the study was to evaluate the expression variation in HPRT, OGG1 gene expression, and DNA damage of industrial workers. Blood samples of 300 occupational workers were collected from welding, brick kiln, furniture, pesticide, and paint industry (n = 60/industry) to evaluate the expression variation in HPRT, OGG1 gene expression, and DNA damage in blood cells by comet assay along with age and gender matched 300 control individuals. Blood arsenic content was higher (P<0.001) in an industrial group compared to the control. OGG1 and HPRT expression were (P<0.05) downregulated in exposed workers compared to controls. Spearman correlation analysis showed a significant positive correlation between HPRT vs OGG1 (P< 0.0001) in exposed workers compared to controls. Altered expression of both genes was observed between workers with <25years and >25years of age as well as between workers with <10years and >10year exposure. Reduced expression (P<0.05) of both genes and a high extent of DNA damage was evident in exposed smokers compared to respective non-smokers. DNA fragmentation was higher (P<0.05) in the furniture, welding and brick kiln group compared to control, and other industries. The present study suggests that altered expression of OGG1 and HPRT gene induce oxidative stress, showed a negative impact on the recycling of purines leading to DNA damage which increase the vulnerability of workers to carcinogenicity.

Effect of lip thickness and competency on soft-tissue changes.

INTRODUCTION: Improvement in facial esthetics is a major reason for seeking orthodontic treatment. Soft tissues responsible for esthetics show a variable response to the movement of underlying teeth during orthodontics. METHODS: The purpose of this cross-sectional study was to analyze the response of soft tissues and compare it among groups presenting with different lip thickness and competence. It was carried out on 37 patients with Class I and Class II Division 1 malocclusion who had undergone extractions of maxillary first premolars and had completed their orthodontic treatment. Data were obtained by corresponding lateral cephalometric radiographs taken before and at the end of orthodontic treatment. Association was analyzed with a Pearson correlation test. Differences among groups exhibiting varying competency and lip thickness were tested with an independent sample t test. A P value of ≤0.05 was considered statistically significant. RESULTS: Pearson correlation revealed significant associations among incisor tip retraction with lip base retraction (r = 0.68), lip base thinning (r = 0.41) and vermilion retraction (UV) (r = 0.73). Regression analysis showed a moderate increase in lip length (AB) and thickness at vermilion, which were 0.11 mm and 0.15 mm for each mm of incisor retraction at the tip, whereas stronger effects were observed for UV (0.38 mm) and lip base retraction (0.55 mm). There was significantly more lip base thinning (P = 0.03) and UV (P = 0.04) in the incompetent group compared with the competent group. The AB increased significantly in the sample with thicker lips (P = 0.01). Pearson correlation coefficient showed a strong association of lip retraction at the base and vermilion with the incisor movement at the cervical area, for competent and incompetent lips, and thicker and thinner lips. CONCLUSIONS: Lip retraction at vermilion and lip base thinning was significantly more in patients with incompetent lips, whereas the AB increased significantly more in the group with thicker lips.

Walthard cyst of spermatic cord in the right inguinal hernia.

There are isolated case reports of Walthard cells in paratesticular structures although these benign epithelial cells are commonly found in relation to fallopian tubes. This is a second case report of cystic Walthard rest presented in an elderly man in right inguinal hernia.

AI-Driven Aeronautical Ad Hoc Networks for 6G Wireless: Challenges, Opportunities, and the Road Ahead.

Aeronautical ad hoc network (AANET) has been considered a promising candidate to complete the vision of "Internet in the sky" by supporting high-speed broadband connections on airplanes for 6G networks. However, the specific characteristics of AANET restrict the applicability of conventional topology and routing management algorithms. Here, these conventional methodologies reduce the packet delivery success of AANET with higher transfer delay. At that point, the artificial intelligence (AI)-driven solutions have been adapted to AANET to provide intelligent frameworks and architectures to cope with the high complexity. The AI-driven AANET can provide intelligent topology formation, sustainability, and routing management decisions in an automated fashion by considering its specific characteristics during the learning operations. More clearly, AI-driven AANETs support intelligent management architectures, overcoming conventional methodologies' drawbacks. Although AI-based management approaches are widely used in terrestrial networks, there is a lack of a comprehensive study that supports AI-driven solutions for AANETs. To this end, this article explores the possible utilization of primary AI methodologies on the road to AI-driven AANET. Specifically, the article addresses unsupervised, supervised, and reinforcement learning as primary AI methodologies to enable intelligent AANET topology formation, sustainability, and routing management. Here, we identify the challenges and opportunities of these primary AI methodologies during the execution of AANET management. Furthermore, we discuss the critical issue of security in AANET before providing open issues.

Synthesis of Biogenic Silver Nanocatalyst and their Antibacterial and Organic Pollutants Reduction Ability.

Plant-mediated nanoparticles are gaining popularity due to biologically active secondary metabolites that aid in green synthesis. This study describes a simple, environmentally friendly, dependable, and cost-effective production of silver nanoparticles utilizing Cucumis sativus and Aloe vera aqueous leaf extracts. The aqueous leaf extracts of Cucumis sativus and Aloe vera, which worked as a reducing and capping agent, were used to biosynthesize silver nanoparticles (AgNPs). The formation of surface plasmon resonance peaks at 403 and 405 nm corresponds to the formation of colloidal Ag nanoparticles. Similarly, the Bragg reflection peaks in X-ray diffraction patterns observed at 2θ values of 38.01°, 43.98°, 64.24°, and 77.12° representing the planes of [111], [200], [220], and [311] correspond to the face-centered cubic crystal structure of silver nanoparticles. Fourier transform infrared spectroscopy confirms that bioactive chemicals are responsible for the capping of biogenic silver nanoparticles. The size, structure, and morphology of AgNPs with diameters ranging from 8 to 15 nm were examined using transmission electron microscopy. Water contamination by azo dyes and nitrophenols is becoming a more significant threat every day. The catalytic breakdown of organic azo dye methyl orange (MO) and the conversion of para-nitrophenol (PNP) into para-aminophenol using sodium borohydride was evaluated using the prepared biogenic nanoparticles. Our nanoparticles showed excellent reduction ability against PNP and MO with rate constants of 1.51 × 10-3 and 6.03 × 10-4s-1, respectively. The antibacterial activity of the nanomaterials was also tested against four bacteria: Staphylococcus aureus, Klebsiella pneumoniae, Enterobacter, and Streptococcus pneumoniae. These biogenic AgNPs displayed effective catalytic and antibacterial characteristics by reducing MO and PNP and decreasing bacterial growth.

Reasons for refusing orthognathic surgery by orthodontic patients: A cross-sectional survey.

Objective: To find out the most common reasons for refusing orthognathic surgery and to compare the responses along gender lines and in terms of open-ended and closed-ended approaches. METHODS: The cross-sectional retrospective study was conducted from August to December 2020 at the Orthodontics Department of Bahria University Medical and Dental College, Karachi, Pakistan, and comprised of patients who were planned for but refused orthognathic surgical treatment between January 2018 and July 2020. Data was collected through telephone-based interviews to record reasons of avoiding orthognathic surgery. The data-collection tool had both open-ended and closed-ended questions. Data was analysed using SPSS 23. RESULTS: Of the 60 patients, 42(70%) were females and 18(30%) were males with a mean age range of 23.25±2.19years. Overall, 19(31.7%) patients avoided surgery due to additional expense, while post-operative pain was cited as a reason by 35(58.3%) patients. Males were 9 times more concerned about their dental alignment compared to females (p=0.005). Fear of tooth injury (p<0.0001) and intra-operation and post-operation bleeding (p<0.0001) were found twice in males than females. Conclusion: The most common reasons for refusal to have orthognathic surgery were increased cost and post-operative pain. Males were more concerned about dental alignment and had higher fear of post-surgical tooth injury and intra- and post-operative bleeding compared to the females.

Validity of Hand Held Fundus Camera by Optometrist using Slit lamp 90D bio microscopy as a reference standard for screening of Diabetes Retinopathy.

OBJECTIVE: To find out the validity of hand-held fundus camera by optometrist using slit lamp 90D biomicroscopy as reference standard for screening of diabetes retinopathy. METHODS: The observational cross-sectional study was conducted at the diabetic clinic of Al-Ibrahim Eye Hospital, Karachi, from August 2020 to May 2021, and comprised diabetics of either gender aged >16 years visiting the outpatient department. Un-dilated fundus photograph of both eyes were taken with non-mydriatic fundus camera. Pupils were then mid-dilated with one drop of tropicamide 1% before capturing retinal images by handheld fundus camera by another optometrist. Both the optometrists identified and recorded the presence and absence of diabetic retinopathy. Subsequently, a retinal specialist examined the fundus with slit lamp 90 D biomicroscopy. Data was analysed using SPSS 23. RESULTS: Of the 500 subjects, 291(58.2%) were males and 209(41.8%) were females. The overall mean age was 54.49±9.16 years (range: 16-83 years). Of the 1000 eyes, fundus was not readable in 130(13%) by hand-held fundus camera, 296(29.6%) eyes by non-mydriatic fundus camera and 76(7.6%) eyes by slit lamp. Sensitivity and specificity of hand-held fundus camera compared to non-mydriatic fundus camera was 89.86% and 80.36%, respectively. In comparison with slit lamp, the sensitivity was 91.71% and specificity was 71.10%. Kappa statistic for diabetic retinopathy detection by hand-held fundus camera versus non-mydriatic fundus camera was 0.705, indicating substantial agreement. Kappa statistic for diabetic retinopathy detection with hand-held fundus camera with semi-dilated pupil was found to be a valid screening tool in the hand of optometrist for preliminary screening of diabetic retinopathy. CONCLUSIONS: Handheld fundus camera with semi-dilated pupil was found to be a valid screening tool in the hand of optometrist for preliminary screening of diabetic retinopathy.

Visual outcomes of cataract surgery: An observational study of ten years from a tertiary eye care hospital in Pakistan.

OBJECTIVES: To observe and analyze the visual outcomes of cataract surgery of ten years at a tertiary eye care hospital, Karachi. METHODS: An observational study with retrospective data search was conducted in Al Ibrahim Eye Hospital (AIEH), Karachi. Data of all adults (above 16 years) who underwent cataract surgery from 2010-2019 was retrieved from HIMS. Presence of opacity in the lens was labelled as cataract. Surgery was advised when patient's BCVA was found to be ≤ 6/18. Visual assessments of the patients were done on day 01, one week and six weeks postoperatively. Postoperatively, 6/6 - 6/12 was considered as good, 6/18 as mild visual impairment, < 6/18 to 6/60 as moderate visual impairment and < 6/60 as severe visual impairment. RESULTS: A total of 1,027,840 patients visited AIEH with different eye diseases. Among 1027840 individuals, cataract was identified in 88443 (8.6%). Surgery was advised to 58371 and performed in 38616. Records of operated cases (38616) were retrieved. Mean age of patients was 54.96±14.22 years. There were 20578 (53.29%) males and 18038 (46.71%) females who underwent surgery . At the end of sixth week, 3561 (18.4%), patients were found to have "good vision", 12242 (63.43%) had mild visual impairment, 2676 (13.86%) had moderate visual impairment and 822 (4.26%) had severe visual impairment. Corneal Complications was the commonest cause (33.56%) at sixth week. CONCLUSIONS: The institution achieved WHO recommended criteria of "good visual outcome" (6/6 to 6/18) of 81.83% which is near to recommended ≥ 90% and severe visual impairment of 4.26%.