Nail-fold capillaroscopy for the dermatologists

Nail fold is one of the most accessible sites for studying changes in the microcirculation in various microangiopathies. The characterization of changes in microvasculature can provide useful clues towards the diagnosis and prognosis of a disease. The diagnostic utility of nail fold capillaroscopy has improved and expanded over the past couple of decades. Beyond connective tissue diseases, it is now explored for its role in various systemic and dermatological diseases. Incorporation of nail-fold capillaroscopy in the diagnostic criteria of systemic sclerosis has generated interest among dermatologists. The current review is aimed at providing knowledge about nail-fold capillaroscopy to dermatologists. For the purpose of review, a PubMed search was done using the keywords “nail fold capillaries” and “nail fold capillaroscopy”. All the articles were retrieved and classified into reviews and clinical studies of various types. The final data were then analyzed and presented in a narrative fashion.

Air pollution and its association with respiratory dysfunction among healthy adolescents: a cross sectional study from South Western Punjab, India

Background: This study has been performed to compare the pulmonary functions of healthy adolescents studying in schools situated in highly polluted areas with those studying in schools of low polluted areas of south western Punjab.Methods: This study was conducted in various schools located at Faridkot and Bathinda city. These places had been identified by the Punjab Pollution Control Board (PPCB) as having low and high air pollution levels respectively. Study Population divided into two groups that is Group A: 300 children from schools situated in Bathinda city. Group B:' 301 children from schools situated in Faridkot city. Spiro Excel spirometer was used, and following parameters were obtained: FVC, FEV?, FEV?% (relation of FEV? to FVC), PEFR, FEF25-75%. Results: FVC was low in males and females in the high polluted group as compared in the low polluted group (p = 0.042; significant; males) (p = 0.039; significant; females). FEV? was low in males and females in high polluted group as compared in low polluted group (p = 0.003; significant; males) (p = 0.026; significant; females). In this study only, males showed a significant fall in mean percentage of FEF25-75%. PEFR was low in males in high polluted group as compared to that in low polluted group (p = 0.007; significant) while in females it was insignificant.Conclusions: It is concluded that in South Western Punjab, air pollution has detrimental effect on pulmonary functions (FVC, FEV?, FEV?%, FEF25-75% and PEFR) in healthy adolescents.

Screening thresholds for the corneal tomography in a myopic Pakistani population

Objective: To evaluate key corneal tomography parameters for screening refractive surgery patients in Pakistani population

Study Design: Cross-sectional, observation study

Place and Duration of Study: Armed Forces Institute of Ophthalmology AFIO, National University of Medical Sciences, Rawalpindi, Pakistan, from August 2013 to December 2016

Methodology: Myopic patients were evaluated by two separate observers on Allegro OculyzerII [Wavelight] for normal ocular examination. A total of 20 tomographic parameters, used for pre-refractive surgical evaluation, were included. Normality of data was evaluated using Kolmogorov-Smirnov test. Results for outliers were displayed as 2.5%, 5%, 95% and 97.5% percentiles

Results: The sample of 451 patients [895 eyes], comprised of 61% [n=277] females and 39% [n=174] males [39%]. The mean age was 26 +6.4 years [range of 18-62 years, M=F]. Normal mean anterior segment values included; flat simulated keratometry [K1] 42.9 +/-1.44 diopters [D], steep K2 43.9 +/-1.52 D, K mean 43.4 +/-1.43 D, K maximum 44.6 +/-1.56 D, astigmatism -0.96 +/-0.97 D, anterior chamber depth [ACD] 3.19 +/-0.28 mm, front elevation at the thinnest point 4.11 +/-2.44 um, and that at the back was 7.56 +/-4.52 um progression index [PI] maximum 1.14 +/-0.17, Ambrosio relational thickness maximum [ART max] 487.5 +/-89.0 and pachymetry at thinnest point 542.2 +/- 31.1 um

Conclusion: The study demonstrates key corneal tomography parameters, which can be useful for screening refractive surgery patients in Pakistani population

Transepithelial corneal crosslinking in treatment of progressive keratoconus: 12 months' clinical results

Objective: The purpose of this study was to evaluate the safety and efficacy of transepithelial corneal collagen cross linking [TE-CXL] with modified riboflavin and accelerated UVA irradiance in thin corneas with pachymetry less than 400 microns at thinnest point, untreatable by epithelium off corneal collagen cross linking[CXL] in adult Pakistani population with progressive keratoconus

Methods: This quasi experimental study included twenty six eyes of 26 patients with progressive keratoconus who underwent accelerated transepithelial CXL in Armed forced institute of ophthalmology with 12 months follow up. Modified riboflavin, ParaCel [[riboflavin 0.25%, Benzalkonium chloride, EDTA, Trometamol, hydroxypropyl methylcellulose] and vibeX Xtra [riboflavin 0.25%] [Avedro, USA]] were applied to cornea in two stages. Uncorrected and Corrected Distant Visual Acuities [UDVA, CDVA], spherical equivalent [SE], astigmatism, pachymetry at thinnest point [Pachy thin], apex keratometry [Kmax], simulated and steep keratometry [Sim K, steep K] were measured at baseline and at 3, 6 and 12 months post operatively. The cornea was then exposed to accelerated UVA irradiance of 9mW/cm[2] for 10 min [total dose 30 mW/cm[2]]

Results: The mean age of the patient was 24.54 +/- 5.16 years. UDVA, CDVA, SE, astigmatism significantly improved at all postoperative test points [p=0.000, 0.004, 0.000, 0.004 respectively]. Kmax and pachy thin were significantly reduced over baseline at 1 year [p=0.000, 0.004 respectively]. Topographic indices Sim K and steep K did not show significant changes. No intra or post-operative complications were reported

Conclusion: Transepithelial accelerated CXL with modified riboflavin is a safe and effective procedure which halt disease progression in thin corneas with progressive keratoconus

To Determine Prevalence of Low Haemoglobin in Healthy Females and its Correlation with Diet, Weight and Body Mass Index.

Background: More than a quarter of the total world population is anemic and half of them have iron deficiency anemia. Many studies done have shown that iron fortified legume staples are important source of proteins and non- heme iron in children; all infants treated with oral iron and visited weekly to record iron intake, feeding, and health showed improvement in cognitive, motor, and social-emotional development hand washing with soap and hand finger nail clipping reduced prevalence of anemia.  So we designed this study to find out the cause of low hemoglobin in healthy females and its correlation with diet, weight and body mass index. Material and Methods: This open-label, prospective, observational study was conducted in 90 healthy volunteers belonging to nearby areas. The following parameters were observed and recorded: height, weight, body mass index (BMI) and hemoglobin estimation and questionnaire was given to the participants to record dietary intake. Results: All the volunteers completed the study were of an average age of 20.28±0.10 years and had average hemoglobin of 11.91 ± 0.11gm/dl and the average body mass index (BMI) was 21.73 ± 0.33 (kg/m2) respectively. It has been observed that haemoglobin has non-significant (p>0.05) correlation with age, weight, height and BMI. Majority of volunteers took more than three meals per day; eating food outside on one-two occasions per week and reported that their food was fried.  Most of the participants reported consuming small proportions of food with fruits and milk being essential component. Conclusion: To conclude our study found that the participants although were not anaemic they had haemoglobin on the lower side of normal values and there was no correlation between with age and BMI.

Comparison of higher order aberrations in patients with various refractive errors

To compare the mean root mean square [RMS] of total higher order aberrations [HOAs], coma and spherical aberrations in individuals with myopia, hypermetropia and myopic astigmatism. This prospective analytical study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from Jan 2014 to Dec 2014. Two hundred eyes of 121 patients with age ranging from 18-40 years were included in the study. Patients were divided into 4 group namely Low myopia, High myopia, Astigmatism and Hypermetropia on the basis of refractive error. Included were the patients who had refractive error more than +/- 0.5D and best corrected visual acuity [BCVA] of 0.00 or better. Patients who had history of surgery and / or eye disease were excluded from the study. Visual acuity [VA], Spherical equivalent [SE] of refractive error, RMS value of total HOAs, coma and spherical aberrations were evaluated. HOAs were measured with aberrometer [Wavelight analyzer version 1073] at 6 mm pupil size. Age of the patients ranged from 18 years to 40 years with mean age of 29.10 +/- 10.6 years. Seventy one [35.5%] were males and 129 [64.5%] were female. Mean RMS value of HOAs, coma and spherical aberrations was calculated in all four groups. RMS of total HOAs and spherical aberrations in hypermetropia was 0.96 +/- 0.96 and 0.30 +/- 0.42 respectively and it was higher than other three groups. In overall comparison the mean RMS of total HOAs and spherical aberrations was significantly increased in hypermetropia group and there was a statistically significant negative correlation of SE of hypermetropia with RMS of total HOAs and spherical aberration

Effect of wavefront optimized LASIK on higher order aberrations in myopic patients

To determine mean change induced in root mean square value of higher order aberrations in myopic patients undergoing wavefront optimized laser assisted in situ keratomileusis. This quasi experimental study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from Jan 2014 to Dec 2014. Sixty eyes of 35 myopic patients were included in the study. All patients underwent wavefront optimized [WFO] laser assisted in situ keratomileusis [LASIK] using femtosecond laser [FM 200Wavelight technologies] and excimer laser [Ew SOOWavelight technologies]. Higher order aberrations [HOAs] were measured with aberrometer [Wavelight allegro analyzer version 1073] during preoperative assessment and one month after surgery. All 35 patients ranged from 20 to 32 years with a mean age of 24 +/- 3.41 years. Refractive error ranged from -1.00 to -9.50 DS with a mean spherical equivalent [SE] of -3.73 +/- 1.95 before surgery and - 0.36 +/- 1.50DS one month after LASIK. Uncorrected visual acuity [UCVA] was improved to 0.00 or better in all 60 eyes. An increase of 1.56 fold was observed in RMS of total HOAs. Among the HOAs, a statistically significant positive correlation was observed between spherical aberrations [4[th] order aberration] and preoperative spherical equivalent. In spite of excellent improvement in refractive error, significant amount of higher order aberrations were induced after WFO LASIK

Comparison of rapid and conventional corneal collagen cross linking in patients having Keratoconus

To compare the effect of rapid and conventional methods of corneal collagen cross linking [CXL] on visual acuity [VA] and corneal parameters in Keratoconus. Randomized control trial. Armed Forces Institute of Ophthalmology, Feb 2012 to Apr 2013. Thirty patients, fifteen in each group, were randomized by non probability consecutive sampling to rapid or conventional CXL group. Pre and post operative [6 months] best corrected visual acuity [BCVA], anterior and posterior keratometric [K] values and pachymetry were recorded. Intra and inter group comparison of all these parameters were statistically analyzed. All thrty patients showed either stabilization or improvement in BCVA. Both groups showed comparable results in terms of improvement BCVA [p = 0.682], reduction in the corneal thickness at thinnest point [p = 0.062], anterior flat and steep K [p = 0.633, p = 0.443 respectively] and posterior flat and steep K values [p = 0.130, p = 0.068] at six months duration. Conventional and rapid methods of CXL are comparable in terms of their effect on VA and corneal parameters

Justification for hysterectomies and frequency of histopathological lesions of hysterectomy at a teaching hospital in Peshawar, Pakistan

To determine the justification for hysterectomies and the frequencies of histopathological lesions and complications in hystrectomised patients. As a part of a quality assurance process at the Mercy Teaching Hospital, hysterectomies performed between 1[st] January, 2010 and 1[st] Jan 2012 were retrospectively analyzed for presenting complaints, surgical indication, histologic findings, and postoperative complications. The hysterectomy was considered justified if the preoperative diagnosis was verified by the pathology report or if significant alternate pathology was present. A total of 123 hysterectomies were performed during this period. Eleven [8.9%] patients' results could not be traced. The other 91.1% had some pathology found. Histologic findings reconfirmed the clinical diagnoses. The hysterectomies were considered justified if p=0.000. Hysterectomy was performed abdominally in 88[71.5%] patients, vaginally in 35 patients [28.4%]. The most common indication for hysterectomy was fibroid related menorrhagia n=40[32.5%], followed by third degree uterovaginal prolapse n=30[24.4%], and dysfunctional uterine bleeding 29[23.6%] patients. Fever was the most common 7[5.7%] post operative complication followed by urinary tract infection 5[4.9%] The incidence of postoperative fever was greater following abdominal surgery, while urinary tract infection was greater following vaginal hysterectomy [P=0.370]. Almost 91.1% of all hysterectomies in this study were justified. Clinical diagnoses were related to presenting complaints [p=0.000] and were confirmed by histopathogic findings [p=0.000]. Most of the hysterectomies were carried out abdominally in part because fewer patients presented with prolapse

Trend of fertility potentials with increasing age in Pakistani males

The objective being to examine the magnitude and the shape of the relationships between age and semen volume, sperm concentration and sperm motility by keeping the other factors affecting fertility directly constant among patients undergoing infertility evaluation at National Institute of Health, Islamabad, Pakistan. This experimental study with non-probability sampling was conducted in Reproductive Physiology/Health, Public Health Laboratories Division, National Institute of Health, Islamabad during 2006-2009. A total 350 patients [21-50 years] were divided age wise into three groups [21-30, 31-40 and 41-50 years] to compare alteration in sperm count and motility. Semen profile was evaluated according to WHO reference value for normal semen characteristics. The result of Sperm concentration showed a non significant [p>0.05] decreasing trend with increasing age that was 0.047million/ml for every year where as sperm motility declined significantly with increasing age at p>0.05. Age-related decreases in semen qualities particularly decline in sperm motility revealed that men may become progressively less fertile as they age. However, unlike women, there appears to be no evidence of an age threshold for men

Prevalence of hyperprolactinemia in different age groups of women with fertility problems

Hormonal disturbance is one of the major causes of infertility and higher prolactin concentration, causes ovulatory dysfunction and infertility in women. Aim of our study was the evaluation of disordered prolactin concentration for fertility related complaints in female patients and prevalence of hyperprolactinemia in various age groups. The study was carried out in Reproductive Physiology/Health, PHLD NIH [National Institute of Health, Islamabad]. 246 women complaining fertility problems were included in study. Subjects were divided into two major groups ranging from 13-50 years [n=165] in Normal and 13-40 years [n=81] in Hyperprolactinemic group where Normal group had reference value of 1.9-25.9 ng/ml and Hyperprolactinemic group was having prolactin level >25.9 ng/ml. They were further sub-divided into age groups, four groups in Normal category and three groups in Hyperprolactinemic category. 66% women in all had serum concentration of prolactin in normal limits [1.9-25.9 ng/ml] whereas 33% women had elevated prolactin level. The mean serum concentration of prolactin Hyperprolactinemic groups [in each age group] varied significantly from Normal groups [P<0.01]. Decrease in prolactin level was seen in advancing age

Reasons for the problems faced by patients in Goverment Hospital: results of survey in a a goverment Hospitals in Karachi, Pakistan

To assess the reasons for the problems faced by patients in the government hospitals to make an emphasis on higher authorities for identification of problems and implementation of effective measures. A questionnaire-based doctor's survey was conducted at Jinnah Postgraduate Medical Centre [JPMC]. The survey included 10 doctors each from 5 wards of JPMC. Informed consent was taken from study participants and ethical considerations were fulfilled. All the doctors were asked questions related to the problems created by hospital management, due to the irresponsibility and concerns of the doctors and also due to the patients themselves. The responses were evaluated separately. A total of 50 doctors participated. out of which, 19 were males and 31 females. Out of all the reasons listed, 84% doctors favored the reason of inadequate salary to doctors and paramedical staff by government while other two reasons favored by 80% doctors were lack of facilities and security for doctors and illiteracy and poverty of patients. This hospital based study showed that the causes were related mainly to hospital management, doctors' attitude and responsibility and also to patients' illiteracy and poverty. This calls for adequate measures by higher authorities to rectify the situation