Outcome of 2000 Cases of Phacoemulsification

Phacoemulsification cases performed at Fauji Foundation Hospital, Rawalpindi. Methods: This study was conducted in the Department of Ophthalmology, Fauji FoundationHospital, Rawalpindi, from October 2004 to March 2007. It comprised 2000 cases of phacoemulsification with intraocular lens (IOL) implantation which wereperformed at Fauji Foundation Hospital in two and a half years. Variables analysed included patient’s age and sex, pre-existing conditions limiting final visualacuity (VA), and type of anesthesia used. Outcome measures included intra operative and postoperative complications and final visual acuity. Results: Of the 2000 cases, there were 72% female and 28% male patients. 62% of patients were given periocular whereas 38% were operated in topical anesthesia. 15.35% of patients suffered intra operative complications. Intra operative complications were: radial tear in 5% cases, posterior capsular (PC) rent without vitreous loss in 3.45% and PC rent with vitreous loss in 4.85% of patients, iris damage in 0.83%, zonular dehiscence in 0.6% of cases, and nuclear fragment drop in 0.3% of patients. Of total patients, 91% of patients kept their appointment for 8 weeks follow up. Postoperatively corrected visual acuity after elimination of factors reducing best corrected visual acuity (BCVA) was 6/9 or better in 89% of cases. Postoperative complications were seen in 20.83% of patients, which included mild to moderate striate keratitis in 11.98%, mild to moderate anterior uveitis in 4.01%, raised intra ocular pressure (IOP) in 0.73%, wound leakage in 0.3%, ophthalmoplegia in 0.05% and endophthalmitis in 0.10% of cases. Posterior capsularopacification (PCO) was seen in 3.65% of patients in 8 weeks of followup. Post operative astigmatism was from 0 – 4.5 D. Conclusion: Phacoemulsification is much safer, predictable, relatively atraumatic procedure and it provides early rehabilitation. It is associated with more patient as well as surgeon satisfaction

Frequency of occurrence of urinary tract infection in double j stented versus non-stented renal transplant recipients

Prophylactic ureteric stenting in renal transplant recipients prevents major surgical complications such as ureteric leak and obstruction on the one hand while, on the other hand, it is associated with complications like urinary tract infections (UTI), hematuria, stent migration, stent encrustation and forgotten stents. UTI is documented to be most common complication associated with double J (DJ) stent. In this retrospective observational study involving 157 patients, we compared the frequency of occurrence of UTI in DJ-stented versus non-stented renal transplant recipients. The study patients had undergone renal transplantation, with or without DJ-stenting, between January 2007 and June 2012. The mean age of the study subjects was 34.01 ± 14.63 years. The patients were followed-up for one year post-transplantation with regular evaluation, including detailed assessment, complete blood picture, renal function tests, routine urine examination and cultures. Data were collected through chart and electronic record review. Of a total of 157 patients, 61 (38.85%) developed UTI, including 30 of 74 stented patients (40.54%) and 31 of 83 non-stented renal transplant recipients (37.34%). Relative risk was calculated to be 1.08. The mean serum creatinine at the end of one year was 1.47 mg/dL in DJ-stented patients and 1.36 mg/dL in nonstented patients. Our study suggests that there is no significant difference in the frequency of UTI between DJ-stented and non-stented renal transplant recipients

Comparison of Peribulbar Vs Topical Anaesthesia for Phacoemulsification

Background: To compare the efficacy of topicalanaesthesia with peribulbar anaesthesia inphacoemulsification.Method: This comparative analytical study wasconducted in the Department of Ophthalmology, FaujiFoundation Hospital, Rawalpindi, from February 2006 toJanuary 2007. A total of 200 patients who underwentphacoemulsification with intraocular lens (IOL)implantation were included in this study. Patients wererandomly assigned to peribulbar group (group 1, n=100)who received 4-5 ml of local anaesthetic (equal quantitiesof 2% xylocaine and 0.5% bupivacaine) in peribulbarregion and topical group (group 2, n=100) using 0.5%proparacaine in conjunctival sac every 5 minutes for halfan hour before surgery. Patients refusing informedconsent, having communication problem and nystagmuswere excluded from the study. All surgeries wereperformed by the same surgeon.Results: The difference between two groups regardinganalgesia was found to be statistically insignificant.Periocular group provided significant akinesia.Conclusion: Topical anaesthesia is an effectivealternative to peribulbar anaesthesia forphacoemulsification reducing the risks associated withperibulbar injection

Common variants at 8q24 confer susceptibility to urothelial bladder cancer in the Pakistani population

Item does not contain fulltext9 p

Increased expression levels of Syntaxin 1A and Synaptobrevin 2/Vesicle-Associated Membrane Protein-2 are associated with the progression of bladder cancer

Abstract Gene expression is tightly regulated in time and space through a multitude of factors consisting of signaling molecules. Soluble N-ethylmaleimide-sensitive-factor attachment protein receptors (SNARE) are membrane proteins responsible for the intercellular trafficking of signals through endocytosis and exocytosis of vesicles. Altered expression of SNARE proteins in cellular communication is the major hallmark of cancer phenotypes as indicated in recent studies. SNAREs play an important role in maintaining cell growth and epithelial membrane permeability of the bladder and are not only involved in cancer progression but also metastatic cell invasion through SNARE-mediated trafficking. Synaptobrevin2/Vesicle associated membrane protein-2 (v-SNARE) and Syntaxin (t-SNARE) form a vesicular docking complex during endocytosis. Some earlier studies have shown a critical role of SNARE in colon, lungs, and breast cancer progression and metastasis. In this study, we analyzed the relative expression of the STX1A and VAMP2 (SYB2) for their possible association in the progression and metastasis of bladder cancer. The profiling of the genes showed a significant increase in STX1A and VAMP2 expression (p < 0.001) in high-grade tumor cells compared to normal and low-grade tumors. These findings suggest that elevated expression of STX1A and VAMP2 might have caused the abnormal progression and invasion of cancer cells leading to the transformation of cells into high-grade tumor in bladder cancer

Novel and recurrent LDLR gene mutations in Pakistani hypercholesterolemia patients

Item does not contain fulltextThe majority of patients with the autosomal dominant disorder familial hypercholesterolemia (FH) carry novel mutations in the low density lipoprotein receptor (LDLR) that is involved in cholesterol regulation. In different populations the spectrum of mutations identified is quite different and to date there have been only a few reports of the spectrum of mutations in FH patients from Pakistan. In order to identify the causative LDLR variants the gene was sequenced in a Pakistani FH family, while high resolution melting analysis followed by sequencing was performed in a panel of 27 unrelated sporadic hypercholesterolemia patients. In the family a novel missense variant (c.1916T > G, p.(V639G)) in exon 13 of LDLR was identified in the proband. The segregation of the identified nucleotide change in the family and carrier status screening in a group of 100 healthy subjects was done using restriction fragment length polymorphism analysis. All affected members of the FH family carried the variant and none of the non-affected members nor any of the healthy subjects. In one of the sporadic cases, two sequence changes were detected in exon 9, one of these was a recurrent missense variant (c.1211C > T; p.T404I), while the other was a novel substitution mutation (c.1214 A > C; N405T). In order to define the allelic status of this double heterozygous individual, PCR amplified fragments were cloned and sequenced, which identified that both changes occurred on the same allele. In silico tools (PolyPhen and SIFT) were used to predict the effect of the variants on the protein structure, which predicted both of these variants to have deleterious effect. These findings support the view that there will be a novel spectrum of mutations causing FH in patients with hypercholesterolaemia from Pakistan