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Introduction: Dacryocystorhinostomy (DCR) is the mostpopular operation for treating nasolacrimal duct obstruction orchronic dacryostenosis. Study aimed to compare the successrate of external dacryocystorhino stomy with and withoutsilicone intubation.Material and Methods: A total 223 were operated fornasolacrimal duct obstruction, at district hospital level. 70patients were operated with silicon tube intubation and 153 patients operated without silicon tube. The patency of lacrimaldrainage system was evaluated with lacrimal syringing. Age, gender, laterality, and lacrimal irrigation in the thirdmonth visit were recorded. Surgical success was acceptedas the patency of the formed ostium with lacrimal syringing/irrigation. Data was analysed using the average, standarddeviation, variation coefficient, and the statistical significancewas determined using test. Results: Success rate was higher 94.24% in patients withsilicone tube intubation, and 86.92% in without silicon tubeintubation, with p-value (p>0.05).Conclusion: Our findings suggest that success rate was higherin dacryocystorhinostomy with silicone intubation, althoughresults were not statistically significant.
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Introduction: Large number of studies on the prevalence ofrefractive errors in various population groups have been done.Refractive errors, are by far the commonest cause of defectivevision in school children around the world. Undetected anduncorrected refractive errors are particularly a significantproblem in school children. With these rationales this studywas undertaken in schools of Kashmir with the objective toassess the magnitude of refractive errors.Material and Methods: This cross-sectional study wasconducted in schools of Kashmir valley from june 2016 tomay 2017. Sample size was calculated to be 1110. The 6 to16years children of selected schools of Kashmir valley whowere present on the day of the interview were interviewed andexamined. Snellen chart, pinhole, a trial box, a trial frame,self-illuminated vision box and streak Retinoscope were usedto detect refractive error. MS excel package and SPSS11.5software was use for analysis.Results: Out of 1110 cases (2220 eyes),856(77.12%) caseswere emmetropic, 56 (5.04%) cases had hyperopia of 0.25Dto 1.75D whereas only 4(0.36%) cases had a hyperopia ofequal to or greater than 2.0D. Myopia was the most commonobserved refractive error. 188(16.94%) cases had a myopiaof 0.25D to 1.75D and 6 (0.54%) cases had a myopia of2.0D to 3.75D.No case had myopia of equal to or greaterthan 4.0D(Table-V) Myopic astigmatism was seen in 22(1.98%) cases and hyperopic Astigmatismin 10(0.9%)cases.Conclusion: Refractive error was a significant cause of visualimpairment among school children and screening of schoolchildren plays a major role in detecting refractive errors.
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Introduction: Iodine deficiency disorders (IDD) has beenrecognized as a public health problem in India Enlargementof thyroid gland is the common manifestation of the IDDand goiter prevalence survey is used as diagnostic tool foridentifying areas of IDD. Failure to undertake early detectionand intervention measure results in secondary disablingconditions. Aim: In the present study we have estimated theprevalence of goiter in the age group of 6-12 years in districtBandipura of Jammu and Kashmir state, India and haveassessed type of salt consumed by the population.Material and Methods: This was a Cross-sectional studyconducted in Bandipura district of J and K state and the studywas conducted between July 2018 to October 2018. Samplingmethod was Gender stratified cluster sampling technique andthe sample size was based on a goiter prevalence of 30% and95% confidence interval. 30 clusters were selected and eachcluster included 90 children. Data was entered in Microsoftexcel and then analyzed using appropriate statistical software.Data was interpreted using percentages, means and SD.Results: The prevalence of grade 1 and grade 2 goitre inmales was 35.6% and 15.1% respectively whereas it was30.8% and 15.1% in females and the prevalence was morein males to the extent of 52.08% and in girls it was 49.23%.Goitre was found to be highest (51.7%) in subjects 12 yearsof age and lowest (40.6%) in subjects aged 7 years of age.There was a significantly higher goitre prevalence in childrenwho consumed crystalline/non-iodised salt than in childrenconsuming iodised salt. The TGR was 61.4% and 46.9% inchildren consuming non-iodised and iodised salt respectivelyConclusion: We conclude our study with the finding thatpopulation of Bandipura district in the north Kashmir isseverely iodine deficient. We recommended a major thrustin the implementation of NIDDCP in the said district withregular and continuous monitoring of iodine status.
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Hashimoto Encephalopathy [HE] or Steroid-Responsive Encephalopathy associated with Autoimmune Thyroiditis [SREAT] is a rare autoimmune disease characterized by encephalopathy and elevated anti-thyroid antibodies in the absence of a central nervous system [CNS] infection, tumour or stroke. Clinical presentation of HE includes amnestic syndrome, seizures including status epilepticus, ataxia, myoclonus and psychiatric manifestations like depression, mania, psychosis and hallucinations. A good clinical response can be achieved with corticosteroid therapy so early diagnosis and treatment is very beneficial for patients. Here we report four patients with Hashimoto encephalopathy who had neuro-psychiatric manifestations of the disease and had detectable thyroid specific antibodies in the serum [thyroperoxidase antibody formerly known as antimicrosomal antibody]. All these patients showed an objectively significant response to methylprednisolone treatment
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Objective: To determine prevalence, clinical patterns and outcomes of neurological involvement in a cohort of primary sjogren's syndrome [PSS] patients presenting to a tertiary care hospital
Study Design: Observational retrospective cross-sectional case-control
study. Place and Duration of Study: This study was carried out at Neurology department of Pak Emirates Military Hospital, Rawalpindi, from May 2015 to Jun 2016
Patients and Methods: All patients fulfilling American College of Rheumatology [ACR] criteria of PSS and having neurological involvement, who were admitted in Neurology wards from May 2015 to June 2016, were included in the study. Demographic, clinical and seroimmunological data of the patients was documented
Results: A total of 26 patients with PSS had some degree of neurological involvement. Mean age was 40.50 years. [SD 14.803, min 22, max 78]. Fifteen patients were female and 11 were male. Sicca symptoms [ocular and oral dryness] were present in 38.5 Percent. Serological marker anti Ro and La were present in 76.9 Percent and 42.3 Percent respectively while both Ro and La were present in 34.6 Percent. Lip biopsy was diagnostic in 80.8 Percent and schirmer test was positive in 46.2 Percent. Refractory headache was present in 84.6 Percent. Seizures occurred in 34.6 Percent, which were focal in 23.1 Percent and generalized in 11.5 Percent. Trigeminal neuralgia was present in 26.9 Percent, multiple cranial nerve palsies in 15.4 Percent and recurrent facial nerve palsies in 11.5 Percent. Optic neuritis was seen in 19.2 Percent. Clinical presentation mimicking relapsing and remitting multiple sclerosis was seen in 30.8 Percent of patients among whom 61.5 Percent also met revised McDonald criteria for dissemination in space [DIS] on MRI and 23.1 Percent met criteria for dissemination in time. MRI brain showed cortical lesions in 42.3 Percent. Longitudinally extensive transverse myelitis involving cervical and upper thoracic cords was present in 26.9 Percent of patients
Conclusion: The diagnosis of neuro-sjogren's syndrome [NSS] can be difficult in the absence of sicca symptoms especially when neurological manifestations precede sicca symptoms by many years. This requires a high index of clinical suspicion and low threshold for investigations like lip biopsy and autoantibody profile for the diagnosis. This study highlights the need to revise the overemphasis of sicca symptoms in various current diagnostic criteria in order to improve early recognition and initiation of treatment
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Objective: To determine the efficacy and safety of electroconvulsive therapy [ECT] for the management of neuroleptic malignant syndrome [NMS] in adults. Study Design: Open label, unblinded series. Place and Duration of Study: This study was carried out at the Department of Neurology, Military Hospital Rawalpindi, from Jan 2015 to Dec 2015
Material and Methods: All the patients with the diagnosis of NMS during the study period were included in the study. Consective non-probability sampling technique was used. Patients were divided into two groups; uncomplicated and complicated cases of NMS
Results: A total of nineteen patients were included in this pilot study. Out of all, thirteen [68.4%] were males and six [31.6%] were females. Mean age of the patients was 35.05 [SD 13.362] years. The drug classes causing NMS were antipsychotic medicines in 73.7% of patients and antiemetics in 26.3% of patients. Mean electroconvulsive therapy [ECT] sessions given were 6.16 [SD 2.062]. Following treatment n=16 [84.2%] patients had complete recovery while n=3 [15.3%] patients died
Conclusion: In this small, open label, unblinded study ECT appears effective and safe in treating NMS in adults. Larger randomized studies will help to confirm data emerging from this preliminary study
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Objective: To determine the frequency of different causative bacteriological organisms and their antibiotic sensitivity from Endotracheal Aspirate [EA] of patients suffering from Ventilator Associated Pneumonia [VAP]. Study Design: Prospective cross sectional study. Place and Duration of Study: Intensive Care Unit [ICU], Combined Military Hospital [CMH] Lahore, from May 2013 to Nov 2013
Material and Methods: A total of 180 cases of VAP, fulfilling the ?nclusion criteria and admitted in the ICU, were included in the study using the non-probability consective sampling technique. A written informed consent was obtained from the family. All these patients underwent endotracheal aspirate for microscopy and culture. Antibiotic sensitivity was determined using standard antibiotics regimens
Results: Out of 180 patients, 165 [91.7%] were culture positive while 15 [8.3%] were culture negative. Gramnegativebacilli accounted for about 70% of all isolates. The most common organism isolated was Pseudomonas aeruginosa 25% [n=45] followed by MRSA 18.9% [n=34], Klebsiella 15.6% [n=28], Actinobacter spp 13.3% [n=24], E.coli 11.7% [n=21] and Citrobacter spp 4.4% [n=8]. Carbapenem was the most sensitive drug that was seen in our setup but still 43.9% of the isolates showed resistance against it and resistance was noted still higher with Actinobacter spp, where 83% isolates were resistant. Quinolones showed resistance in 100% of the isolates of Actinobacter, MRSA and Citrobacter. While more than 50% strains of Pseudomonas, E.coli and Klebsiella were also resistant to quinolones. Cephalosporins showed excellent sensitivity towards gram negative bacteria which included Citrobacter [100% sensitive] and E.coli [80% sensitive]. Polymxins showed more than 50% sensitivity to Pseudomonas aeruginosa, Actinobacter, E. coli and Klebsiella
Conclusion: VAP remains a very important hospital-acquired infection. The most prevalent etiological organism in our study was Pseudomonas aeruginosa and the most effective antibiotics were carbapenems
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A 33-year soldier, deployed at an altitude of 3,350 meters for two years, developed unilateral Central Retinal Vein Occlusion [CRVO] in the left eye. He had no risk factor for thrombosis and all thrombophilia screenings were negative. The patient was managed with intravitreal injections of anti-VEGF [Bevacizumab] every four weeks. He showed gradual improvement in the visual acuity over the next 3 months. Best corrected visual acuity [BCVA] after three months was 6/7.5; whereas, initially it was limited to hand movements only. This case illustrates that prolonged exposure to high altitude is a risk factor for CRVO, too. Frequent eye examination, including fundus, should be carried out among people living at such altitudes
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Objective: The purpose of this study was to determine the frequency of different diseases among Pakistani Hajj pilgrims attending the medical facilities of Pakistan Hajj Medical Mission during Hajj 2016 [1437 hijri]. Study Design: A descriptive cross sectional study. Place and Duration of Study: Pakistan Hajj Medical Mission hospitals and dispensaries at Makkah Mukkarrmah, Medina Munawwarah and Jeddah, from 10[th] Aug 2016 to 5[th] Oct 2016
Material and Methods: All Pakistani Hajj pilgrims reporting to various Pakistan Hajj Medical Mission Hospitals and dispensaries at Makkah, Medina and Jeddah were included in the study. A universal sample of all patients reporting to the Hajj medical mission [A total of 184,496 OPD visits] was used. The patient were initially assessed in Emergency Reception[ER] by medical officers and then referred to respective specialists if required. A specially designed proforma having information regarding name, age, disease and its duration was prepared and filled for each patient separately. A second hospital/dispensary visit of the Hajj pilgrim was considered separately on a new proforma. SPSS version 17 was used to analyze the data
Results: There were a total of 184,496 OPD [Out Patient Department] visits by Pakistani Hajj pilgrims during the study period. Age of the patients ranged from 20-96 years, 74.5% [n=137, 449] were male and 25.5% [n=47047] were female. Number of patients suffering from various diseases and their percentage in order of frequency was; respiratory diseases 29% [n=53187], musculoskeletal disorders 18% [n=33838], gastrointestinal diseases 15% [n=26696], Ear Nose and Throat [ENT] diseases 8% [n=14448], skin disorders 6% [n=10937], eye disease 3% [n=4530], mouth and dental diseases 3% [n=6101], wounds, fractures and burns 3% [n=6186], cardiovascular diseases 2% [n=4433], gynecological disorders 2% [n=4357], infectious disease 1% [n=1055], minor surgeries <1% [n=620], psychiatric disorders <1% [n=40] and other miscellaneous complaints 5% [n=9889]
Conclusion: Respiratory illness was the commonest disease among Pakistani Hajj Pilgrims while musculoskeletal and gastrointestinal complaints were also high. This study helps to identify the common diseases encountered during Hajj Medical Mission and may aid in the better preparedness of such missions in future
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Objective: To study the effect of adding body mass index and neck circumference to Epworth Sleepiness Scale [ESS] for diagnosing obstructive sleep apnea hypopnea syndrome in sleep clinics
Study Design: Cross sectional validation study
Place and Duration of Study: Department of Pulmonology, Military Hospital Rawalpindi from 1st July 2013 to 01 September 2014
Material and Methods: The ESS and ESS plus body mass index [BMI] and neck circumference [NC] data was evaluated for 150 patients hospitalized in our hospital for polysomnographic evaluation of obstructive sleep apnea. Overnight polysomnography [PSG] was done for all patients and was considered the gold standard for diagnosis of OSA. ESS Scoring, BMI and NC data was done using pre-designated questionnaire. All the data was analyzed using SPSS version 19
Results: Age ranged from 18-74 years with mean age of the study group 53 [ +/- 12.1 SD] years. Out of study population 87 [58%] were males and 63 [42%] females. In study population 80 [55.3%] patients had ESS >10. while 102 patients had ESS>10 with BMI > 35 kg/m2 and NC>40 cm. Using an AHI >/= 5 for OSA, 136 patients [90.6%] had OSA. Sensitivity of ESS > 10 for OSA was 55.15% but increased to 72.79% when BMI > 35 kg/m2 and NC > 40 cm was added to patients with ESS > 10. Similarly specificity and predictive values of study population for diagnosing OSA also increased after adding BMI and NC to ESS
Conclusions: In this study adding body mass index [BMI] and NC to ESS score significantly increased the sensitivity and specificity and positive predictive value for diagnosis of OSA
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Tunneled, cuffed central vein catheters [TCC] are an important mean of performing hemodialysis [HD].Infection is the commonest complication of these catheters. We describe a patient of chronic renal failure who suffered from Staphylococcus Aureus Bacteremia [SAB] due to the tunneled hemodialysis cathter. The bacteremia resulted in an isolated retrosternal abscess and multiple lung abscesses in this patient. The catheter was removed and patient was treated with broad spectrum antibiotics but he died despite optimal medical care. Although S. Aureus is a common cause of catheter related bacteremia but its manifestation as an isolated retrosternal abscess and multiple lung cavities due to tunneled hemodialysis catheter is a rare complication
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Objective: To assess the causes and awareness of smoking in general population
Study Design: Observational / descriptive study
Place and Duration of Study: This study was conducted at General Medicine OPD of PUMHS Hospital Nawabshah from 2015 up to January 2016
Materials and Methods: Two hundred patients were integrated in the study following receiving verbal well-versed consent. A self-administered questionnaire was filled and information was collected regarding reasons of smoking, and awareness regarding smoking that weather it is harmful, what is passive smoking etc
Results: When cases were interviewed regarding awareness of smoking than 121[60.5%] answered correctly that smoking is harmful for health while 79[39.5%] answered incorrectly. Passive smoking is risky for health, was answered correctly only by 76[38%] while 124[62%] persons did not knew that passive smoking very risky for health. Only 29[14.5%] cases answered correctly about smoking quitting centers in our country. 89[44.5%] peoples smoke to relieve occupational stress, 79[39.5%] participants smokes to relieve domestic stress, 67[33.5%] smoke for the digestive purpose, 111[55.5%] smokes when sitting with friends, 113[56.6%] smokes due to peer pressure and 78[39%] smokes due to habit from childhood and also their parents were smoker
Conclusion: This study showed that peoples had low level of consciousness regarding injurious consequences of smoking. Common reasons were seen peer pressure, reduce stress and digestive purpose
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Objective: To compare short term mortality in non-diabetic ischemic stroke patients with or without stress hyperglycemia
Study Design: Cohort study
Place and Duration of Study: This study was carried out at Neurology Department of Military Hospital, Rawalpindi from Jan 2010 to Jul 2012 for a total duration of six months
Material and Methods: Non-diabetic ischemic stroke patients were included in the study and they were divided in two groups. Each group had 75 patients. Group 'I' [Normoglycemic or control group] had normal blood glucose level while group 'II' [Hyperglycaemic or cohort] had hyperglycaemia on presentation or over next 72 hours. Prognosis in terms of patient either being dead or alive was determined within or at 4 weeks of admission in both groups. Data were entered and analysed using Statistical Package for Social Sciences SPSS version 10. Descriptive statistics were calculated for both qualitative and quantitative variables. For comparison of short term mortality in hyperglycaemic and normoglycemic stroke patients, chi-square test was applied. p-value <0.05 was considered statistically significant
Results: Short term mortality was higher in cohort [hyperglycemic] group as compared to control [normoglycemic] group [34.7% vs. 14.7%]. Relative risk was 2.36. The groups had a statistically significant difference in the short term mortality within four weeks with a Chi-Square 'p' value of 0.004 [p=0.004]
Conclusion: Short term mortality in non-diabetic ischemic stroke patients with stress hyperglycemia is higher than those patients who do not have stress hyperglycemia
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Diabetic myonecrosis is a rare and underdiagnosed complication of long-standing, uncontrolled diabetes. It usually occurs in patients with long-standing diabetes in the presence of microvascular complications. Thigh muscles are more commonly affected and the usual presentation is thigh swelling with or without pain, systemic features being rare. Magnetic resonance imaging is the gold standard for diagnosis. Most patients recover spontaneously with bed rest, adequate analgesia and good glycemic control. We present a case of recurrent myonecrosis of adductor muscles of the thigh in a patient with long standing type 2 diabetes mellitus who recovered with conservative management
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To search for the websites available on the World-Wide-Web that contain resources for scientific medical writing iciuding medical writing advices, online biomedical journals, refrence and citation guidelines and biostatistics webpages. Yahoo, Google scholar and Scirus search engines were used by entering the search terms [medical writing resources], [biostatistics] and [citation guideslines] during the June 2008 to December 2008. Many websites were found containing instructions to authors in health sciences [http:/www.icmje.org/ .http:/mulford.meduohio.edu/ instr/, http:/amwadvc.org/, http:/www.councilscience-editors.org/, http:/www.medweb.emory.edu/, http:/www.writers write.com/medical/, http:/gateway.nlm.nih.gov/, http:/www.au thoraid.info/ http:/www.equator-network.org/.], resources for online biomedical journals[www.pakmedinet.com, FreeMedical Journals.com, PubMedECntal.com, findarticle.com] biostatistics information [http:/interstat.statjournals.net, www.bmj.com/statbk/ http:/statpages.org/, www.quantitativeskills.com/sisa] and reference guidelines [[www.apastyle.org, http:/library.duke.edu/research/citing/, http:/www.library.ualberta.ca/guides/citation/index.cfm, http:/www.osu.edu/,]. With the recent advancements in online availability of biomedical resources, internet may help a lot in putting up a research work into an article form and getting it published
Subject(s)
Internet , Search Engine , BiostatisticsABSTRACT
Horner syndrome is characterized by ptosis ,miosis and anhidrosis. We describe a case of Horner Syndrome as a possible but rare complication of internal jugular vein catheterization
Subject(s)
Humans , Male , Catheterization/adverse effects , Jugular Veins , Catheters , Blepharoptosis , Miosis , Hypohidrosis , Renal DialysisABSTRACT
This case report describes the occurrence of intraventricular haemorrhage in a teenage boy, who was later found to have neurofibromatosis-1, cerebral vascular disease and pectus excavatum