Impact of Topical Nepafenac on Macular Thickness after Phacoemulsification with Intraocular Lens Implantation in Patients without Diabetic Retinopathy

PURPOSE:  To study the effect of post-operative Non-Steroidal Anti-inflammatory (NSAID) eye drops on macular thickness in patients without diabetic retinopathy measured by Optical Coherence Tomography (OCT) STUDY DESIGN: Quasi experimental study PLACE & DURATION OF STUDY:  removed for blind review METHODOLOGY: Diabetic patients without retinopathy who required cataract surgery for visual rehabilitation were included in study. They were than divided into two groups. Group A included patients who received routine steroid+antibiotic post-operative drops while Group B comprised of patients who received nepafenac (0.1%) eye drops eight hourly in addition to routine post-operative eye drops. All patients underwent standard phacoemulsification and intraocular lens implantation followed by use of NSAID eye drops for a month. OCT measurements were done pre-operatively, 7 and 28 days post operatively. RESULTS: Comparison of central macular thickness between groups was significant at (Pre & 7 day post op) and insignificant at (7th day & 28th day post op) and (Pre & 28th day post op) i.e. 0.043, 0.834 and 0.084 respectively. However, difference of mean central macular thickness was significant at all follow-up periods i.e.0.003, 0.006, and 0.000 CONCLUSION: Post-operative NSAID in diabetic patients without retinopathy leads to a significant decrease in macular thickness as compared to controls after cataract surgery. KEY WORDS: Phacoemulsification, Optical Coherence Tomography, Non-steroidal Anti-Inflammatory Agent

Load Management in Electric Utilities: a Literature Survey

Much has been written about load management in electric utilities over the past decade. A number of ideas regarding the importance and the significant attributes of an effective load management program have been presented by various experts. This paper presents an overview and synthesis of these ideas in one cohesive unit. Load management addresses the need to improve plant utilization by making customer demand more complementary over time to the available capacity. The first part of this paper explains the importance and the objectives of load management. The second part describes the technological approach used to influence the consumers' pattern of electrical energy consumption through direct load control of appliances, thermal energy storage at the customer's site, and rate incentives to reduce the peak. The third part explores the behavioral solutions to the peaking problem and the marketing implications for utilities. A general marketing plan is then presented which can provide a starting point for utility marketing efforts and can be tailored to the specific needs of a particular utility and its service area.Business Administratio

Frequency of Endometriosis among Women Undergoing Diagnostic Laparoscopy in Cases of Sub-Fertility

Objectives: To determine the frequency of endometriosis among women undergoing diagnostic laparoscopy in cases of sub-fertility. Material and methods: A total of 169 women having primary infertility were included in this cross-sectional study which was done from January 2016 to June 2017 at Department of Obstetrics and Gynecology, Nishtar Hospital, Multan. Complete history was taken for age, duration of infertility, duration of marriage, sexual history, history of intake of contraceptive drugs, past medical/surgical history and if patients had taken any previous treatment for fertility issues. General physical as well as systemic examination were performed by a trained doctor along with pelvic examination. Baseline investigations like ESR, FSH, LH, serum prolactin levels were done. These study cases will undergo pelvic ultrasound and laparoscopy was performed in proliferative stages of menstrual cycle. Data was analyzed by using SPSS Version 20. Results: Mean age of our study cases was noted to be 28.92 ± 4.55 years (with minimum age was 22 years while maximum age was 38 years). Family history of infertility was noted in 33 (19.5%) of our study cases. Mean duration of marriage in our study cases was noted to be 4.33 ± 1.03 years. Mean BMI of our study cases was 22.21 ± 3.01 kg/m2 (with minimum BMI was 18 kg/m2 while maximum BMI was 32 kg/m2). Our study results have shown that obesity was present in 36 (21.3%) of our study cases. In our study, endometriosis was seen in 27 (16 %) of our study cases. Stage 1 endometriosis was seen in 4 (2.4%), stage 2 endometriosis in 6 (3.6%), stage 3 endometriosis in 8 (4.7%) and stage 4 endometriosis in 9 (5.3%) of our study cases. Conclusion: Frequency of endometriosis was high in our study. Our study results indicate that it is a common gynecological problem which usually found in patients of young and reproductive age. Laparoscopy is a minimally invasive procedure which requires minimum time of hospitalization and minor post-operative discomfort in diagnosis of endometriosis. Laparoscopic procedures in women with infertility should be employed earlier as they are relatively less invasive, convenient and more accurate tool for diagnosis. There is a dire need to bring about awareness among infertile women to consult infertility clinics at proper time. It emphasizes the need to recognize the outcomes of laparoscopic procedures for management and diagnostic purposes. Keywords: Primary infertility, endometriosis, laparoscop

Efficacy of Oral Progesterone in Preterm Births at a Tertiary Care Hospital

Objectives: To determine the efficacy of oral progesterone in prevention of preterm labor at a tertiary care hospital. Material and methods: All women (345) with previous history of preterm delivery, aged less than 45 years of age having their gestational ages 15 – 20 weeks were included from January 2015 to June 2016 at Department of Gynecology and Obstetrics, Nishtar Hospital Multan. These study cases were given 400 mg oral progesterone every day till delivery and were followed till delivery to record prevention of preterm birth (efficacy; birth of a baby with more than 37 weeks gestational age assessed on LMP treated with oral progesterone). Data were analyzed by using SPSS Version 20. Results: Mean age of our study cases was 30.12 ± 4. 83 years. Mean parity of our study cases was 4.52 ± 1.19. Mean gravidity of our study cases was 5.66 ± 1.18. Mean gestational age of our study cases was 37.51 ± 1.34 weeks at the time of delivery. Mean body mass index of our study cases was 23.39 ± 2.87 kg/m2. Our study results have indicated that obesity was present in 83 (24.1%) study cases. Of these 345 study cases, 180 (52.2%) belonged to urban areas, 328 (95.1%) had singleton pregnancy and previous no. of preterm births ranging from 1 – 2 was noted in 240 (69.57%).  Treatment with oral progesterone prevented preterm labor in 231 (67%) of the study cases. Conclusion: Our study results support the use of oral progesterone as use of oral progesterone was successful in preventing preterm labor in our study. Its use was found to be safe and reliable, hence can be given to the women with previous history of preterm birth without any adverse side effect. The prevention of preterm birth was significantly associated with age, parity, gravidity, no. of previous preterm births, order of pregnancy and residential status. Keywords: Oral Progesterone, Prevention, Preterm birth

Bioavailable constituents/metabolites of pomegranate (Punica granatum L) preferentially inhibit COX2 activity ex vivo and IL-1beta-induced PGE2 production in human chondrocytes in vitro

Several recent studies have documented that supplementation with pomegranate fruit extract inhibits inflammatory symptoms in vivo. However, the molecular basis of the observed effects has not been fully revealed. Although previous studies have documented the inhibition of nitric oxide and cyclooxygenase (COX) activity in vitro by plant and fruit extracts added directly into the culture medium but whether concentrations of bioactive compounds sufficient enough to exert such inhibitory effects in vivo can be achieved through oral consumption has not been reported. In the present study we determined the effect of rabbit plasma obtained after ingestion of a polyphenol rich extract of pomegranate fruit (PFE) on COX enzyme activity ex vivo and the IL-1β-induced production of NO and PGE2 in chondrocytes in vitro. Plasma samples collected before and 2 hr after supplementation with PFE were tested. Plasma samples collected after oral ingestion of PFE were found to inhibit the IL-1β-induced PGE2 and NO production in chondrocytes. These same plasma samples also inhibited both COX-1 and COX-2 enzyme activity ex vivo but the effect was more pronounced on the enzyme activity of COX-2 enzyme. Taken together these results provide additional evidence of the bioavailability and bioactivity of compounds present in pomegranate fruit after oral ingestion. Furthermore, these studies suggest that PFE-derived bioavailable compounds may exert an anti-inflammatory effect by inhibiting the inflammatory cytokine-induced production of PGE2 and NO in vivo

Therapeutic Targets and Signaling Pathways for Diagnosis of Myeloma

Multiple myeloma (MM) is a malignancy of plasma cells that not only shows different clinical behavior but also depicts heterogeneous groups at molecular level. The prognosis of the disease has been dramatically changed with the arrival of new drugs in the past few years. In this context of better therapeutic agents, there are important challenges for accurate evaluation of patients by better prognostic and predictive tools. Transcriptomic studies have largely added to decipher MM heterogeneity, dividing MM patients into different subgroups according to prognosis. Micro-arrays and more recently RNA sequencing have helped in evaluating coding and non-coding genes, mutations, unique transcriptome convertors and different splicing events giving new information concerning biology, outcome and treatment options. Initial data from gene expression profiling studies have also pointed out genes that predict prognosis, i.e., CSK1-B, and can deliver pharmacogenomics and biologic vision into the pathophysiology, targeted treatment, and future direction. Importantly, we suggest that all prospective studies and clinical trials now accept genetic testing and risk stratification of MM patients. In this review, we discuss the part and effect of gene expression profiling in myeloma