Management of Ischemic Stroke in a Tertiary Care Hospital in Khyber Pakhtunkhwa: Existing Status and Prospective Opportunities.

Background and objective Khyber Pakhtunkhwa is the third largest province of Pakistan by population and has a high incidence of ischemic stroke. We evaluated all patients who presented to the largest tertiary care facility in the province to learn about the current trends in the management of ischemic stroke and explore future opportunities in this regard.  Materials and methods This prospective observational research was carried out at the Lady Reading Hospital-Medical Teaching Institute (LRH-MTI), Peshawar, in the province of Khyber Pakhtunkhwa (KP). The hospital's ethics committee granted the required permissions for the research. Any patient with an ischemic stroke diagnosis, regardless of age, met the inclusion criteria if their diagnosis was confirmed by clinical assessment, imaging (such as CT or MRI), or both. The clinical parameters that were evaluated included the duration since the patient's reported onset of symptoms, the patient's first mode of transfer to the hospital (such as ambulance, private vehicle, or other means), and the date and time of admission to the hospital. A structured database containing the data was utilized, and IBM SPSS Statistics for Windows, Version 25 (released 2017; IBM Corp., Armonk, New York, United States) was used for statistical analysis. Results One hundred fifty-six stroke patients were diagnosed throughout the study period, with 76 of them having an ischemic stroke, accounting for 49% of all stroke cases. Approximately 43% (n = 33) of the patients were from Peshawar, with the remaining patients coming from adjacent districts. There was only a small percentage (19%, n = 15) of patients who were eligible for any thrombolytic therapy, and the majority (93%) were brought by private vehicles. There was a significant association between age and arrival in the emergency room (p = 0.003). Conclusion The study reveals subpar ischemic stroke management in Khyber Pakhtunkhwa, requiring coordinated efforts, modernization of treatment methods, and increased public awareness to improve patient outcomes.

Change in macular thickness after uncomplicated phacoemulsification surgery using optical coherence tomography in a tertiary care hospital.

Objectives: To determine the change in macular thickness after uncomplicated phacoemulsification surgery using optical coherence tomography in a tertiary care hospital. Methods: This study was conducted at Department of Ophthalmology Jinnah Postgraduate Medical Centre Karachi, for 6 months from 10th Dec 2019 to 10th June 2020. Sample size calculation of 52 eyes was done by using open epi software. Patients who fulfilled the inclusion criteria that is age ranging from 50 to 75 years, either gender with senile cataract having no preexisting ocular or systemic disease and those giving consent were included in this study. Patients with any comorbidity ocular trauma, having pre-existing ocular diseases such as active ocular infection, glaucoma, maculopathy or retinopathy were excluded from study. Patients with secondary cataract also excluded from study. After complete history, all patients underwent detailed ophthalmologic examination and Pre-surgery macular thickness recorded by using swept source OCT (DRI-OCT-2 Triton; Topcon). Surgery was performed and intraocular lens was implanted in all cases. Post procedure Macular thickness was measured using swept source OCT at 1st postoperative day, 1st month and 6th month after surgery. Results: The mean age of patients was 62.06 ± 5.1 years. Total of 52 eyes diagnosed with senile cataract were included in this study. There were 30 (57.7%) males and 22(42.3%) females. The mean preoperative central foveal thickness was 201.3±24.8µm. The postoperative central foveal thickness was 200.3±25.2µm (153-265µm) at day 1st of surgery, 224.1 ± 53.8 µm (151-458 µm) at 1st month and 212.4±28.3µm (167-255µm) 6th month after surgery. The mean preoperative BCVA was 0.70 ± 0.43 (0.1-1.7) logMAR. The postoperative mean BCVA was 0.26 ± 0.42 (0.00-3.10) logMAR at 1st day, 0.07± 0.10 (0.000.7) logMAR at 1st month and 0.05 ± 0.10 (0.00-0.3) logMAR at 6th month. Conclusion: In our study we found an increase in macular thickness but there was no loss of BCVA from changes of macular thickness after surgery and the mean BCVA increased progressively in postoperative period.

Interactive effects of FTO rs9939609 and obesogenic behavioral factors on adiposity-related anthropometric and metabolic phenotypes.

Numerous genetic variants have been linked to obesity predisposition, however, the interplay of genetic and behavioral factors is very crucial in determining the final phenotype. Therefore, this study examined the interactive effects of the FTO rs9939609 and various obesogenic behavioral factors on adiposity-related anthropometric and metabolic phenotypes in a sample of Pakistani population. A total of 612 participants encompassing 306 overweight/obese (cases) and an equal number (306) of age- and sex-matched normal-weight (controls) individuals were included in the study. Adiposity-related anthropometric parameters were collected by taking corresponding body measurements by following standard procedures. The metabolic parameters were assessed by performing corresponding biochemical assays. A standard questionnaire was devised for the collection of adiposity-related behavioral information. The FTO rs9939609 was genotyped by employing TaqMan allelic discrimination assay. The data was analyzed by using SPSS software. Interactive effects of the FTO rs9939609 and behavioral factors on obesity-related anthropometric and metabolic phenotypes were examined via linear regression by adjusting potential confounders and making correction for multiple comparisons. The results implied that the interaction between the FTO rs9939609 and low physical activity may significantly increase various adiposity-related anthropometric variables (p < 0.05). However, no such interactive effects were found on any adiposity-related metabolic variable. In conclusion, the interaction between the FTO rs9939609 and low physical activity may have a significant impact on obesity-related anthropometric traits in the Pakistani population.

Anti-diabetic Potential of Indigenous Medicinal Plants of Cholistan Desert, Pakistan: A Review.

Cholistan Desert is a sandy desert located in southern Punjab, Pakistan. The area is rich in more than 64 medicinal plants among 138 plant species. It is noteworthy that this remote desert lacks modern health care facilities and its inhabitants are dependent on locally-available plant species for the treatment of acute and chronic illnesses. Medicinal plants, traditionally have been ideal sources of remedies for the management of many non-communicable diseases; most modern prescriptions drugs have their origins from plants. Diabetes is increasing at an alarming rate in the past few decades. Whereas medicinal plants are used globally, the specific properties of only a few have been identifies scientifically. Similarly, little scientific evidence exists that confirms the efficacy of the medicinal plants of this region for diabetes management. Ethnobotanical studies show that locally-available medicinal plants do have anti-diabetic potential. We reviewed the medicinal properties of 36 of these plants. Several ingredients derived from these plants have chemical constituents that demonstrate anti-diabetic activity, thereby validating their importance for the management of diabetes.

Comparison of choroidal thickness in eyes of diabetic patients with eyes of healthy individuals using optical coherence tomography in a tertiary care hospital.

OBJECTIVES: To compare the choroidal thickness in eyes of diabetic patients with eyes of age matched controls using optical coherence tomography in a tertiary care hospital. METHODS: This Cross sectional study was conducted at the Department of Ophthalmology, Jinnah Postgraduate Medical Centre Karachi, for six months from13thJanuary 2020 to13thJuly 2020. The study group comprised of 44 patients with 88 eyes. Patients who fulfill the inclusion criteria that is age ranging from 35 to 80years, either gender, known case of diabetes mellitus and having any type of diabetic retinopathy (HbA1c >7), non-diabetic healthy individuals (HbA1c < 7) and those giving informed consent were included in the study. However, patients having active ocular infections, history of myocardial infarction, stroke, uveitis, any ocular surgery, lasers, intravitreal injections, poor fundus view and not giving consent were excluded. A pre-designed proforma was filled. A baseline ocular examination was performed and choroidal thickness was assessed from retinal pigment epithelium to choroid sclera junction in diabetic and healthy participants of the study group using high resolution Swept source OCT (DRI-OCT-2 Triton; Topcon). RESULTS: The average age of the patients was 39.41±15.95 years. According to our study mean central subfoveal choroidal thickness in diabetic eyes was 268.5 ± 66.22 (95% CI 240 - 297) and in non-diabetic healthy participants it was 339.3 ± 71.49 (95% CI 308 - 369) with a p-value of 0.001. However, average choroidal thickness was 261.8 ± 61.93 (95% CI 235 - 288) and 336.0 ± 74.35 (95% CI 304 - 367) in diabetic and non-diabetic healthy population with a p-value of 0.001. Choroidal thickness comparison between gender in diabetic and non-diabetic population also showed similar trend. CONCLUSION: In this study, mean central choroidal thickness as well as average choroidal thickness was significantly reduced in eyes having diabetic retinopathy as compared to participants with non-diabetic healthy eyes. These findings indicate that changes in choroid may be a probable route in the pathogenesis of diabetic retinopathy.