Determining the National Cataract Surgical Rate in Pakistan.

PURPOSE: Cataract surgical rate (CSR) (cataract surgeries performed per million population) is an eye health indicator that helps assess the state of eye care services. A survey in 2002 revealed a CSR of 2254. The current survey aimed to establish a new and sustainable development goal compliant baseline for the volume of cataract surgery performed by different service providers in Pakistan at district, provincial, and national levels. METHODS: The survey was commissioned by the National Committee for Eye Health under the Ministry of National Health Services, Regulations and Coordination. The methodology used for the survey included identification and mapping of all service providers by district and category and data collection from all districts in the country. RESULTS: There were more cataract surgeries performed in women than men with a male-to-female ratio of 0.95. About 98.9% of all cataract surgeries were performed with intraocular lenses, while 63.9% were performed by phacoemulsification. About 17.7% of cataract surgical services were provided in the government sector (including Forces), while nongovernmental organizations and the private sector contributed to 82.3%. Pakistan achieved a national CSR of 5307 which is almost double the CSR determined in 2002. CONCLUSION: In order to achieve a CSR of 7500+ by 2030, there is a need for at least 1,840,000 cataract surgeries to be performed annually. If there is no change in the current annual cataract surgical output, the CSR will drop to 4628 by 2030.

Atrioventricular septal defect and tetralogy of Fallot - A single tertiary center experience: A retrospective review.

BACKGROUND: Complete atrioventricular septal defect (CAVSD) in association with tetralogy of Fallot is a rare and complex disease that makes its repair more difficult than repair of either lesion alone. We reviewed retrospectively our experience in managing this lesion. PATIENTS AND METHODS: Between February 2006 and May 2017, 16 patients who underwent repair of CAVSD/tetralogy of Fallot (TOF) were reviewed retrospectively. Fifteen patients had trisomy 21. Five patients underwent primary repair while eleven patients went for staged repair in the form of right ventricular outflow tract (RVOT) stenting (n = 9) or systemic to pulmonary (S-P) surgical shunt (n = 2). RVOT stenting has replaced surgical shunt since 2012 in our center. Early presentation with cyanosis was the main determinant factor for staged versus primary repair. RESULTS: The median age at first palliation was 46 days (range 15-99 days). The median age at total repair for both groups was 6 months (range 3-18 months); the median age for the palliated patients was 6.5 months (range 5-18 months) while the median age for primary repaired patients was 5 months (range 3-11 months). The median weight at final repair was 6.9 kg (3.7-8.2 kg). The pulmonary valve was preserved in five patients (31%), four of them had no prior palliation. Chylothorax occurred in 50% of the patients. One late mortality occurred after final repair due to sepsis. CONCLUSION: CAVSD/TOF can be repaired with low mortality and morbidity. The use of RVOT stent has replaced the surgical (S-P) shunt with acceptable results in our center.

Statin therapy is associated with superior clinical outcomes after endovascular treatment of critical limb ischemia.

OBJECTIVE: The aim of this study was to determine if statin therapy improves clinical outcomes after endovascular intervention in patients with critical limb ischemia (CLI). METHODS: A retrospective review of all patients undergoing endovascular treatment for CLI was performed. Two groups were created according to whether they were receiving statin therapy at the time of intervention. Demographics, lesion morphology, overall mortality, primary and secondary patency, and limb salvage were compared between these groups. Analysis was performed using multivariate regression and Kaplan-Meier analysis. RESULTS: Between 2004 and 2009, 646 patients, 319 receiving statin therapy and 327 without, underwent an endovascular intervention for CLI. The statin group had significantly higher rates of diabetes mellitus, coronary artery disease, congestive heart failure, previous myocardial infarction, and coronary artery bypass grafting (P < .05). The two groups had similar lesion length, location, lesion type, TransAtlantic Inter-Society Consensus (TASC) classification, and primary procedure. At 24 months, the statin-treated group had higher rates of primary patency (43% vs 33%; P = .007), secondary patency (66% vs 51%; P = .001), limb salvage (83% vs 62%; P = .001), and overall survival (77% vs 62%; P = .038). Statin therapy was also independently associated with improved limb salvage by multivariate regression analysis (hazard ratio, 2.55; P < .001). CONCLUSIONS: Patients who were receiving statin therapy when they underwent interventions to treat CLI had significantly improved overall survival, primary and secondary patency, and limb salvage rates. Our findings suggest that statins should be part of the periprocedural treatment regimen and support further investigation into the beneficial effects of statins in patients undergoing endovascular treatment of CLI.

Listeria meningitis complicating infliximab treatment for Crohn's disease.

Infliximab, a monoclonal antibody directed against tumour necrosis factor-alpha, is an effective therapy for Crohn's disease. Though uncommon, serious opportunistic infections, including reactivation of tuberculosis, have occurred in patients after infliximab administration.Meningitis caused by Listeria monocytogenes developed in a 37-year-old man six days after the second infusion of infliximab. The patient, who also was treated with azathioprine and corticosteroids, had an uneventful recovery after a course of antibiotics. Several other recent reports have implicated infliximab therapy in the development of severe Listeria infections, particularly meningitis and sepsis. With the increasing use of tumour necrosis factor-alpha-neutralizing agents, clinicians should be aware of the risk of opportunistic infections caused by L monocytogenes in patients with Crohn's disease following infliximab treatment.