How close are we? An audit of biometry of a tertiary care hospital in Karachi.

OBJECTIVE: To evaluate the accuracy of biometry in the post-op phase of cataract surgery. METHODS: This study was conducted at Liaquat National Hospital, Karachi, from June 2015 to July 2016, and comprised the audit of patients who underwent cataract surgery during the period. Keratometry was done on Haag-Strait manual keratometer and A-scan was done by applanation contact method on SonoMed machine. Theoretic-T formula was used to calculate desired intraocular lens power for all kinds of axial lengths. A single surgeon operated upon the same Alcon Constellation phacoemulsification machine. Postoperative follow-up was done by monitoring auto refraction and visual acuity on days 1, 7, 30 and 90. SPSS 21 was used for data analysis.. RESULTS: Of 244 patients, 121(49.60%) were males and 123(50.40%) were females. There were 123(50.40%) right eyes and 121(49.60%) left eyes. Overall, 132(54.10%) achieved postoperative refraction within ±0.5 D of target and 193(79.10%) within ±1 D of target. Age, gender and laterality had no significant effect on outcomes (p>0.05 each). CONCLUSIONS: Postoperative refraction corresponded quite closely with global recommendations.

Analysis of association between type of amblyopia and gender at a tertiary care hospital in Karachi.

OBJECTIVE: To analyse the frequency of different types of amblyopia and its association with gender. METHODS: The cross-sectional study was conducted from March 2014 to October 2014 at the Department of Ophthalmology of a tertiary care hospital inKarachi. The patients were classified into different types of amblyopia like anisometropic, strabismic, sensory deprivation and meridional amblyopia. Stratification was done according to age, gender and type of amblyopia by using SPSS version 21. RESULTS: Out of 130 patients, 71 were male and 59 were female. The amblyopia rate determined was anisometropic 69.23%, strabismic amblyopia 21.51% and others 9.23%. The mean age of subjects was 18.02±9 years. Type of amblyopia was independent of gender, and anisometropic amblyopia was the most common type of amblyopia found in both genders. CONCLUSIONS: This study found no significant association between gender and types of amblyopia and anisometropic amblyopia was the most common type of amblyopia in the data collected.

A Randomized Controlled Trial of Blood Pressure Reduction Based on Disease Control Priorities 3 in Pakistan to Manage and Control Hypertension.

INTRODUCTION: According to American Heart Association standards, hypertension is classified into three stages based on blood pressure measurements: essential hypertension, stage 1 hypertension, and stage 2 hypertension. The global target is to reduce the prevalence of high blood pressure by 25% by the year 2025. Worldwide, the prevalence of high blood pressure among men and women aged 18 and above reported to be 24% and 20%, respectively. AIM: The aim of this study was to overall reduce high blood pressure of hypertensive patients to the recommended level of 140/90 mm of Hg through implementing a non-pharmacological and multi-component intervention based on Disease Control Priorities (3rd edition). METHODS: A randomized controlled trial in which a multi-component intervention for lowering high blood pressure was tested. This was pilot-tested for its acceptance, appropriateness, and relevance, explored through an earlier formative research and desk review conducted from the available evidence. A total of 240 study participants were enrolled after obtaining informed consent. Ethical approval was obtained from the Institutional Review Board of Health Services Academy and the trial was registered in clinicaltrials.gov number NCT04336631. SPSS software version 21 was used to enter and analyze the data. RESULTS: High blood pressure of hypertensive patients in a hospital setting during 03 months yielded -23.9 mm Hg of systolic blood pressure reduction (95% confidence interval, p ≤ 0.005). A significant reduction was observed in intervention group after delivering the intervention. Compared to patients in the usual care group, improved health outcomes were achieved for diet control, reducing salt intake and increased physical exercise. In the intervention group, the mean blood pressure among male hypertensive patients was 145/90 mm Hg and in female hypertensive patients, the mean blood pressure was recorded as 140/100 mm Hg. CONCLUSION: High blood pressure was significantly reduced in hypertensive patients who adhered to a low salt diet, weight loss measures, and increased physical activity.

Hyperventilatory capacity--a predictor of altitude sickness.

BACKGROUND: The aim of the study was to document link between hyperventilatory capacity and risk for developing acute mountain sickness (AMS). METHODS: This study was carried out at Karakorum Mountain ranges (Northern areas of Pakistan) from March till July 2004. 54 healthy male subjects were enrolled in this study. Arterial oxygen saturation (SpO2) of the subjects was measured by the pulse oximeter at rest and after 1 minute of voluntary hyperventilation at an altitude of 2833 meters. Symptoms of acute mountain sickness (AMS) were recorded on a questionnaire by using the Lake Louise consensus scoring system 24 hours after ascent to high altitude. RESULTS: Mean pre hyperventilation oxygen saturation (SpO2) was 94.07 + 0.26% whereas SpO2 after 01 minute of hyperventilation was 98.61 + 0.14% that was significantly increased (p<0.001). The mean increase in percent oxygen saturation of hemoglobin after one minute of hyperventilation (hyperventilatory capacity) for the study group was 4.61 +/- 0.24 % while the mean symptom score was 2.06 +/- 0.26. It was noted that 19 (35.2%) subjects did not develop AMS whereas 34(63.0%) subjects had mild AMS and only one subject developed moderate AMS. There was no case of severe AMS. The data reveals significant (P<0.01) association between hyperventilatory capacity and development of the symptoms of AMS (r = -0.664). It is evident that individuals with greater hyperventilatory capacity manifest less number of symptoms of mountain sickness. CONCLUSION: It is concluded that post hyperventilation increase in oxygen saturation at lower altitude may help to predict the susceptibility of subjects to develop high altitude sickness.

Necrolytic acral erythema: successful treatment with topical tacrolimus ointment.

Necrolytic acral erythema is a relatively recently described psoriasis-like skin eruption seen in people infected with hepatitis C virus. Hepatitis C virus infection is endemic in many parts of the world with a steady increase of incidence in Pakistan. Recognition of this disorder is crucial to an early treatment of the underlying liver disease. Herein, we report the first case of necrolytic acral erythema from Asia and also describe good therapeutic response to topical tacrolimus ointment.