Various Manifestations Of Trachoma In Internally Displaced Rural Population - A Free Eye Camp Based Survey.

BACKGROUND: The objective of the study is to observe frequency of various clinical manifestations of trachoma in rural population. This observational study was conducted at Khalifa Gul Nawaz Teaching Hospital (KGNTH), Bannu, Pakistan from April 2016 to Jan 2017. METHODS: Patients visiting for ocular complaints underwent initial screening that included demographic details and documentation of unaided as well as best corrected visual acuity (BCVA) which was followed by detailed slit lamp examination of anterior segment including eversion of upper lid for assessment of changes in upper tarsal conjunctivas by consultant ophthalmologist. A total of 648 patients who had clinical presentation of trachoma were included in the study. Patients who had other forms of conjunctivitis, trichiasis, entropion, corneal opacification and vascularization due to causes other than trachoma were excluded. Patients were categorized according to age in three groups (Group 1-3) and according to stages of trachoma in five groups (TF, TI, TS, TT and TO). RESULTS: Six hundred and forty-eight (648) were examined in this cross-sectional survey with a mean age of 14.3+14.2 years. Mean unaided visual acuity and BCVA of the patients was 0.12+.24 and 0.07+0.18 respectively. Groups-1 comprised of 86.7% of the patients and stage TF of trachoma was the most prevalent stage accounting for 70.06% of the patients. CONCLUSIONS: Trachoma is a serious community health problem with various clinical manifestations in different age groups. Awareness and educational programs are required to be conducted in schools and vocational training centres regarding its mode of transmission and control..

Necrotizing fasciitis following saphenofemoral junction ligation with long saphenous vein stripping: a case report.

INTRODUCTION: Necrotizing fasciitis is a rare condition with a mortality rate of around 34%. It can be mono- or polymicrobial in origin. Monomicrobial infections are usually due to group A streptococcus and their incidence is on the rise. They normally occur in healthy individuals with a history of trauma, surgery or intravenous drug use. Post-operative necrotizing fasciitis is rare but accounts for 9 to 28% of all necrotizing fasciitis. The incidence of wound infection following saphenofemoral junction ligation and vein stripping is said to be less than 3%, although this complication is probably under-reported. We describe a case of group A streptococcus necrotizing fasciitis following saphenofemoral junction ligation and vein stripping. CASE PRESENTATION: A 39-year-old woman presented three days following a left sided saphenofemoral junction ligation with long saphenous vein stripping at another institution. She had a three day history of fever, rigors and swelling of the left leg. She was pyrexial and shocked. She had a very tender, swollen left groin and thigh, with a small blister anteriorly and was in acute renal failure. She was prescribed intravenous penicillin and diagnosed with necrotizing fasciitis. She underwent extensive debridement of her left thigh and was commenced on clindamycin and imipenem. Post-operatively, she required ventilatory and inotropic support with continuous veno-venous haemofiltration. An examination 12 hours after surgery showed no requirement for further debridement. A group A streptococcus, sensitive to penicillin, was isolated from the debrided tissue. A vacuum assisted closure device was fitted to the clean thigh wound on day four and split-skin-grafting was performed on day eight. On day 13, a wound inspection revealed that more than 90% of the graft had taken. Antibiotics were stopped on day 20 and she was discharged on day 22. CONCLUSION: Necrotizing fasciitis is a very serious complication for a relatively minor, elective procedure. To the best of our knowledge, this is the first report in the English-language literature of this complication arising from a standard saphenofemoral junction ligation and vein stripping. It highlights the need to be circumspect when offering patients surgery for non-life-threatening conditions.