EVALUATION OF CHOROID THICKNESS CHANGES AFTER UNEVENTFUL PHACOEMULSIFICATION SURGERY USING SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY AT A TERTIARY CARE EYE HOSPITAL

Objective: To analyze the effects of uneventful phacoemulsification surgery on choroidal thickness using spectral domain optical coherence tomography. Study Design: Prospective comparative study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Jun 2018 to Jun 2019. Methodology: In this prospective study, 300 eyes of 300 patients undergoing phacoemulsification surgery were included. All patients underwent detailed ophthalmologic examination, including measurement with optical biometry, intraocular pressure and choroid thickness. The choroidal thickness was measured perpendicularly at the fovea using spectral domain optical coherence tomography preoperatively and 1 month postoperatively. Changes in intraocular pressure and choroid thickness after surgery were evaluated. Results: There was a statistically significant increase in the choroid thickness in early postoperative period (p-value <0.01). This increment was prominent in sub foveal regions. The intraocular pressure decreased significantly 1 month after surgery (p-value <0.01). The change in intraocular pressure was correlated with the choroid thickness change at sub foveal region. Conclusion: Uncomplicated phacoemulsification induces non-pathologic increase in sub-foveal choroid thickness probably due to the inflammatory insult of the surgery. Long-term follow-up of eyes having phacoemulsification surgery may provide further insight into the effects of cataract surgery on the choroid.

EVALUATION OF CHONDROPROTECTIVE EFFECTS OF HYALURONIC ACID IN A RAT MODEL OF OSTEOARTHRITIS

Objective: To evaluate the chondroprotective effects of hyaluronic acid in a rat model of osteoarthritis. Study Design: Laboratory based experimental study. Place and Duration of Study: Department of Pharmacology, Army Medical College, Rawalpindi, in alliance with National Institute of health, Islamabad and Department of Pathology, Army Medical College Rawalpindi, from Apr to Jun 2019. Methodology: Sixteen (16) rats of Sprague Dawley breed were procured in this study. Osteoarthritis was induced in right knee joint of rats by surgical resection of medial meniscus and anterior cruciate ligament. They were allocated into two (02) groups with eight (08) rats in both groups. Group-I was control group that was treated with 0.2 ml intra articular saline once weekly for four weeks. While group-II was treatment group that was intra particularly administered with 0.2ml hyaluronic acid once weekly for four weeks. One week after the last dosage, gait pattern of the animals was scored. Then animals were sacrificed and a part of proximal tibia was obtained for histopathologic analysis. Results: Mean gait score of control group and treatment group was 3.25 ± 0.707 and 1.00 ± 0.756 respectively with a statistically significant p-value of <0.001, while mean histopathological Modified Mankin score of control and treatment group was 11.5 ± 1.195 and 5.50 ± 1.195 respectively with a significant p-value of <0.001. Conclusion: Intra articular viscosupplementation of hyaluronic acid in rat model of osteoarthritis resulted in improved gait pattern and histopathology.

Salivary Diagnosis of COVID-19

Dear Editor, It is indeed an honour for us to contribute towards the ongoing research regarding the latest contagion, Coronavirus disease (COVID-19) as caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leading to global pandemic with variable clinical outcomes. COVID-19 positive individuals present with a variety of signs and symptoms as sore throat, cough, fever, dyspnoea, headache, myalgia, nausea, and vomiting whereas, some develop severe acute respiratory distress syndrome with a fatality rate of about 10%.1 Possible oral findings include xerostomia, hypogeusia, and chemosensory alterations. Common routes of transmission being person-to-person via direct sneeze, cough, and droplet inhalation or by contact through mucosa of eyes, nose and saliva.

A CASE REPORT OF JUVENILE FORM OF METACHROMATIC LEUKODYSTROPHY

Metachromatic Leukodystrophy is a lysosomal storage autosomal recessive disease characterized by arylsulphatase enzyme deficiency, with central and peripheral demyelination. We report a case of a 15-year-old girl with 6 months history of progressive muscular weakness, poor school performance, gradual memory loss and gait disturbance. Neurological examination was grossly normal, except mild muscle wastage in both upper and lower limbs and slight reduction of power globally in all limbs. Routine bloods including a lumbar puncture was normal and the diagnosis of metachromatic leukodystrophy was made on the findings of magnetic resonance imaging (MRI) brain.

COMPLICATIONS OF INTRA ABDOMINAL DRAINS: A SINGLE CENTER EXPERIENCE

Objective: To compare frequency of intra-abdominal complications in drainage and non-drainage group among patents who underwent intra-abdominal surgeries. Study Design: Comparative prospective study. Place and Duration of Study: Department of Surgery, Pakistan Ordinance Factory, Wah Cantt, from Mar 2018 to Jul 2018. Methodology: There were 32 patients, 16 in each group. Patients were selected through the process of consecutive sampling. Patients were randomly divided into two groups (random number table method); group A patients underwent intra-abdominal drain while group B was non-drainage group. Patients were followed up for 7 days and observed for complications. Results: Total 32 patients were included in the study. There were 14 (43.8%) males and 18 (56.3%) females. Mean age of patients was 43.2 ± 9.5 years. Drain group showed significantly low anastomosis leakage (p=0.02), wound infection (p=0.05), mortality (p=0.04), pulmonary complications (p=0.05) and bleeding (p=0.03) as compared to the non-drain group. Conclusion: Intra-abdominal drains are associated with several complications. Anastomosis leakage is the most common complication following pulmonary complications and bleeding. However, drains help in early detection of complications and timely management of such complications leads to better outcome of a surgical procedure.

SEMEN ANALYSIS; CORNER STONE IN EVALUATING INFERTILITY

Objective: To study the patterns and distribution of various abnormal semen parameters in infertile males. Study Design: Cross sectional study. Place and Duration of Study: Department of Pathology, Combined Military Hospital, Karachi, from Nov 2019 to Oct 2020. Methodology: The study included 364 patients who presented with primary and secondary infertility. Consecutive convenient sampling was done. Semen analysis was performed using World Health Organization latest guidelines. Samples were categorized as normospermia, azoospermia, oligospermia, asthenozoospermia and necrospermia. Results: The study comprised of 364 samples of infertile males. Normal sperm count was observed in 317 (87%) males, azoospermia in 28 (7.6%) and oligospermia in 19 (5.2%) males. Low ejaculated volume and higher non-motile sperms were noted in oligospermia samples in comparison with normospermia samples. Asthenozoospermia was observed in 102 (28%) and oligoasthenospermia was noted in 15 (4.1%) samples. Conclusion: Good quality semen analysis is a corner stone to diagnose the cause of male infertility.Sperm concentration and motility are the important markers of normal male reproductive system and are related to each other.

PATTERNS OF MYOINVASION IN ENDOMETRIOID ADENOCARCINOMA OF ENDOMETRIUM

Objective: To assess the patterns of myoinvasion of endometrial endometrioid adenocarcinoma, their frequencies in our hospital and to correlate these patterns with survival. Study Design: Retrospective observational study. Place and Duration of Study: Department of Pathology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, from Aug 2019 to Apr 2020. Methodology: All cases of endometrial endometrioid adenocarcinoma between 2015 and 2017 were retrieved from the archives, independently reviewed by two researchers, all key reporting parameters recorded in addition to the pattern of myoinvasion as per their operational definitions described by Cole and Quick. The follow-up of 3-5 years was obtained from archives and through telephonic contact for outside hospital patients. Disease free survival and relapse-associated mortality were represented through Kaplan-Meier curves. Results: Eighty cases of myoinvasive endometrial endometrioid adenocarcinoma were reviewed. We found that infiltrating irregular gland pattern was the most frequent in all the age groups. Thirty-five (43.75%) cases showed this type of invasion, followed by broad front pattern 23 (28.75%), Microcystic Elongated and Fragmented (MELF) pattern 15 (18.75%) and adenomyotic pattern 6 (7.5%). One case showed a combination of the last two patterns, whereas adenoma malignum pattern was not seen. Follow-up of these patients showed 8 (10%) patients with relapse related mortality including 5 (62.5%) infiltrating irregular glands, 2 (25%) adenomyosis-like and 1 (12.5%) broad front pattern of myoinvasion. Seventy-two (90%) patients had recurrence free survival. Conclusion: Frequency of infiltrating irregular pattern of myoinvasion in endometrial endometrioid adenocarcinoma is high and associated with recurrence related mortality. Recognition....................

COMPARISON OF LOCAL METHYLCOBALAMINE INJECTION VERSUS LOCAL BUPIVACAINE INJECTION FOR THE TREATMENT OF ACUTE HERPETIC NEURALGIA

Objective: To compare the reduction in mean pain score with local Methylcobalamin injection versus local Bupivacaine injection in patients with acute herpetic neuralgia. Study Design: Quasi experimental study. Place and Duration of Study: Dermatology Outpatient Department, Pak Emirates Military Hospital, Rawalpindi, from Jun to Dec 2019. Methodology: Total 100 patients, having pain score more than 3, fulfilling the selection criteria were divided into two groups. Group A was treated with daily subcutaneous injection Bupivacaine, whereas Group B was treated with daily subcutaneous injection Methycobalamin at the site of neuralgia. Patients were followed up for 4 weeks. The pain score was noted. All the data was entered and analyzed on SPSS version 21. Results: In this study mean age of patients in group A was 43.82 ± 15.76 years and in group B was 44.76 ± 16.92 years. The mean visual analogue pain score at 4th week in the group A patients was 1.14 ± 0.32 and in group B was 1.90 ± 0.97. Statistically significant difference was found in group A (local Bupivacaine) with visual analogue score (VAS) at 4th week (pvalue=0.002). Conclusion: The local Bupivacaine injection showed significant reduction in mean pain score than local Methylcobalamin injection in patients with acute herpetic neuralgia.

EXPLORING THE KNOWLEDGE AND PRACTICES OF AUSTRALIAN MEDICAL STUDENTS REGARDING INFECTION PREVENTION AND CONTROL IN HOSPITALS: A PILOT STUDY

Objective: To assess the knowledge and practice of medical students regarding standard precautions in an Australian undergraduate medical programme. Study Design: Cross sectional study. Place and Duration of Study: University of New South Wales, Australia, duration of study was six-years. Methodology: Fifty medical students who were involved in clinical practice, were invited to complete a comprehensive questionnaire on standard precautions. Results: The majority of participants agreed that hand hygiene was the most important factor in infection control. Only 32 (16%) knew to use a full personal protective equipment for Ebola. Regarding sharps disposal, 46 (92%) students always disposed used needles in the recommended bin, 27 (54%) indicated they sometimes recapped used needle while 25 (20%) sometimes bent used needles. Conclusion: This study showed that there is a gap between knowledge and practice of medical students regarding hand hygiene and other infection control measures. There is a need for standardized and regular student training in the use of standard precautions in infection prevention and control.

THE IDEAL PROFILE (INCREASE IN B-LINES/DELTA B-LINES) ON LUNG ULTRASOUND FOR DIAGNOSING WEANING INDUCED PULMONARY EDEMA IN VENTILATED PATIENTS

Objective: To ascertain the ideal number of B-lines on lung ultrasound for the diagnosis of weaning induced pulmonary edema in ventilated patients. Study Design: Prospective observational study. Place and Duration of Study: Department of Medicine, Shifa International Hospital, Islamabad, from Jan to Aug 2020. Methodology: All the patients over the age of 18 years who were on mechanical ventilation in a medical intensive care unit were included in the study. The patients were given spontaneous breathing trials as a protocol for weaning from mechanical ventilation. Lung ultrasound was performed on 4 points of anterior chest wall before and after spontaneous breathing trials. Before and after spontaneous breathing trials counting of B lines was done on ultrasound of lung and comparison of increase in B lines (Delta-B-lines) was done with reference diagnosis of weaning induced pulmonary edema diagnosed by intensivist who was blinded to the results of lung ultrasound. Results: The study included 42 patients including 23 (54.8%) men and 19 (45.2%) women. 14 cases failed spontaneous breathing trials. Seven cases (16.7%) had weaning induced pulmonary edema. Delta-B-lines ≥6 diagnosed weaning induced pulmonary edema with 100% accuracy. Out of the remaining seven patients with weaning failure but without weaning induced pulmonary edema, 6 (28.6%) had Delta-B-lines ≥6. The ultrasound lung technique had a 100% sensitivity profile to detect weaning induced pulmonary edema and a specificity of 77.78%. Conclusion: The study indicates that Delta-B-lines ≥6 diagnosed the weaning induced pulmonary edema with the best accuracy.