Macular Thickness by Age and Gender in Healthy Eyes Using Spectral Domain Optical Coherence Tomography

PURPOSE: To determine normal macular thickness and its variation by age and gender in healthy eyes using spectral-domain optical coherence tomography (SD-OCT). METHODS: In this cross-sectional analysis, two hundred and twenty eyes of 220 healthy subjects underwent raster scanning using Topcon SD-OCT system, at the Department of Ophthalmology, Dow University of Health Sciences and Civil Hospital Karachi, Pakistan. Macular thickness from all 9 regions of the ETDRS map was documented for each subject. Variations in macular thickness measurements by age and gender were determined. RESULTS: The 220 subjects had a mean age of 45.3 years (16-80 years). Using the ETDRS map, foveal thickness for all subjects was measured to be 229±20.46 µm. Mean macular thickness for all subjects was 262.8±13.34 µm. Male gender was associated with greater foveal (p<0.0001) and mean macular (p<0.0001) thickness compared to females. There was no association of mean macular thickness (r(2) = 0.01; p>0.05) and foveal thickness (r(2) = 0.00004; p>0.05) with age. CONCLUSION: We have provided normative data for macular thickness using Topcon SD-OCT system. Our results are comparable to some and vary from other reports using the similar OCT system. Our results suggest that male gender is associated with greater macular thickness, while macular thickness has no association with age in healthy eyes. This is the first normative data for macular thickness from Pakistan; benchmark for diagnosing and monitoring macular pathologies. The values obtained in this study may be useful for comparison with other populations, other SD-OCT systems and future imaging technologies

Duhamel\u27s procedure for adult hirschsprung\u27s disease

An adult presented with chronic constipation and abdominal mass. Clinical features, abdominal radiographs and barium enema revealed features consistent with Hirschsprung\u27s disease. Full-thickness rectal biopsy was planned, but patient was lost to follow-up and presented 3 years later with intestinal obstruction. Exploratory laparotomy with resection of affected sigmoid colon and end colostomy were performed. Sequential rectal biopsies were obtained during the procedure to confirm the diagnosis. Later, Duhamel\u27s procedure with a diverting loop ileostomy was successfully performed. Ileostomy reversal was done thereafter. There was complete resolution of symptoms and dramatic improvement in bowel function

Incidence and outcome of small for gestational age fetuses: An experience from a secondary care hospital

The objective of the study was to determine the frequency and outcome of Small for Gestational Age (SGA) foetuses, and its association with the mode of delivery, foetal birthweight, maternal age and gestational age. It was a hospital-based descriptive study, conducted at Aga Khan Hospital for Women, Karachi, from January 2009 to December 2010. Mode of deliveries, foetal birthweight, maternal age and gestational age of SGA foetuses were recorded and analszed. Of a total of 6024 deliveries during the study period, 722(11.98%) had SGA foetuses. Maternal age in such cased ranged between 20-40 years in 588(81.44%), while 406(56.23%) of these deliveries were in between 34-37 weeks of gestation. Besides, 396(54.84%) cases were delivered vaginally. The incidence of SGA increased from 2009 to 2010 (13.13% vs 10.76%). The frequency of SGA foetuses tends to be significantly higher in Pakistan compared to the Western world. Prenatal care and better management can potentially avoid the occurrence of SGA deliveries, perinatal morbidity and mortality

Meckel Gruber Syndrome: Second trimester diagnosis of a case in a non-consanguineous marriage

Meckel-Gruber Syndrome (MKS) is a rare, autosomal recessive genetic disorder, incompatible with life. It is characterized by enlarged polycystic kidneys and post axial polydactyly. Foetal or neonatal death is caused by pulmonary hypoplasia. We report a case of a 35 year old woman who presented at 7 weeks of gestation of her sixth pregnancy. A transabdominal anomaly ultrasound performed for her current pregnancy at 18 weeks of gestation showed features consistent with MKS. The termination of pregnancy was declined and a live newborn female was delivered via an emergency caeserean section at 34 weeks of gestation due to previous history of lower segment caesarean section (LSCS) & leaking. Physical examination of the neonate confirmed the features of MKS. The neonate died within 4-5 hours of birth. This case represented a second trimester diagnosis of a recurrent case of MKS in a non-consanguineous marriage

Molecular confirmation of the causes of inherited visual impairment in Northern Pakistan

Families with inherited visual impairment were identified and examined from January 2000 to December 2005 and given a clinical diagnosis. Known genes and loci were screened for mutations or linkage at Institute of Ophthalmology and Neurosciences, University of Leeds, in order to provide molecular confirmation. Inherited retinal disease was the most common cause of inherited visual impairment in 38 of 57 families (66.6%) with Leber\u27s congenital amaurosis, rod-cone dystrophy and cone-rod dystrophy being the most common diagnoses in 22, 8 and 3 families respectively. Anterior segment dysgenesis was diagnosed in 8 families (14%). Mutations in known genes or linkage to known loci were identified in 23 of 57 families (40%). All families had molecular confirmation of autosomal recessive inheritance or a pedigree consistent with this mode of inheritance, with evidence of first-cousin marriage. Knowledge of carrier status and genetic counseling may allow families to make an informed decision regarding marriage, and thus begin to plan a way of reducing the incidence of inherited visual impairment

Sero-negative celiac disease with dermatitis herpetiformes: a case report

Introduction:We report a case of sero-negative celiac disease in Pakistan. Case Presentation: A 20-year-old female presented with papulovesicular rash for 15 years, diarrhea for 8 years, spasms of hands and twitching of face for 4-5 months. She had mild anemia, low vitamin-D3 and serum calcium. On exclusion of other causes of malabsorption, anti-tissue transglutaminase antibodies (immunoglobulin-A & immunoglobulin-G), anti-endomysial antibodies, total immunoglobulin-A levels and skin biopsy were performed, which were normal. Intestinal biopsy revealed subtotal villous atrophy. Patient was prescribed gluten-free diet, to which she responded with alleviation of symptoms. Conclusions: Negative serology should not rule out celiac disease, intestinal biopsy should be performed if there is strong clinical suspicion

Range for normal body temperature in the general population of Pakistan.

OBJECTIVES: To determine the range for normal body temperature in the general population of Pakistan and to determine if any age, sex and ambient temperature related variations exist in body temperature. Moreover, to compare how much axillary temperature differs from oral temperature measurements. METHODS: Oral as well as left and right axillary temperature recordings were made using an ordinary mercury-in-glass thermometer in 200 healthy individuals accompanying patients at various clinics at the Sindh Institute of Urology and Transplantation (SIUT) between mid-May to mid-June 2006. Data analysis was done using Epi Info version 3.3. RESULTS: The range for Normal Oral Temperatures fell between 97 degrees F to 99.8 degrees F (mean 98.4 degrees F). There were no significant age related (p=0.68) and ambient temperature related variations (p=0.51) in body temperature, but women had slightly higher normal temperatures than men (mean 98.5 degrees F vs. 98.3 degrees F; p=0.01). A wide variation existed in the difference between oral and axillary temperatures, with axillary temperatures ranging up to 2.6 degrees F lower or up to 1.1 degrees F higher than the oral temperatures (mean difference = 0.85 degrees F). The correlation between oral and axillary temperatures increased at higher oral temperatures (p=0.009). CONCLUSION: There is a range for Normal Body Temperature and any temperature above 98.6 degrees F/37 degrees C is not necessarily pathological. Women appear to have higher body temperatures. As there is no uniform oral equivalent of axillary temperature, the latter should be interpreted with caution

Effect of Intravitreous Anti–Vascular Endothelial Growth Factor Therapy on Choroidal Thickness in Neovascular Age-Related Macular Degeneration Using Spectral-Domain Optical Coherence Tomography

A critical method of monitoring patients with neovascular age-related macular degeneration (AMD) being treated with anti–vascular endothelial growth factor (anti-VEGF) is optical coherence tomography (OCT), which uses low-coherence interferometry of light to examine the retina in vivo on a micrometer scale.National Institutes of Health (U.S.) (Grant R01-EY11289-25)National Institutes of Health (U.S.) (Grant R01-EY13178-10)National Institutes of Health (U.S.) (Grant R01-EY013516-07)National Institutes of Health (U.S.) (Grant R01-EY019029-02)United States. Air Force Office of Scientific Research (Grant FA9550-10-1-0551)United States. Air Force Office of Scientific Research (Grant FA9550-10-1-0063)Massachusetts Lions Club

Range for Normal Body Temperature in Hemodialysis Patients and Its Comparison with That of Healthy Individuals

Background/Aims: Patients with chronic kidney disease undergoing hemodialysis have an altered homeostasis leading to altered body temperatures. We aimed to determine the range for normal body temperature in hemodialysis Patients and compared it to healthy individuals. Also, we determined how much axillary temperatures differed from oral temperatures in both groups and whether axillary temperature is affected by the presence of an arteriovenous fistula (AVF) in hemodialysis Patients. Methods: Oral and axillary (left & right) temperatures were recorded using an ordinary mercury-in-glass thermometer in 400 subjects (200 hemodialysis Patients, 200 healthy individuals) at the Sindh Institute of Urology and Transplantation from mid-May to mid-June 2006. Comparisons were made between the temperatures of both groups. Results: Mean oral temperature in hemodialysis Patients was higher than in healthy individuals [98.7 degrees F (37 degrees C) vs. 98.4 degrees F (36.8 degrees C), p \u3c 0.001], as was the mean average axillary temperature [97.7 degrees F (36.5 degrees C) vs. 97.5 degrees F (36.3 degrees C), p = 0.02] and mean left axillary temperature [97.9 degrees F (36.6 degrees C) vs. 97.6 degrees F (36.4 degrees C), p \u3c 0.001]. The fistula arm had higher axillary temperature in 77 (44%) hemodialysis Patients. The difference between oral and axillary temperatures varied widely, making it impossible to obtain an accurate correction factor in both groups. Conclusion: Hemodialysis Patients have higher normal body temperatures than healthy individuals. Axillary temperatures require cautious interpretation. In hemodialysis Patients, the non-fistula arm should be preferred for recording axillary temperatures, as the presence of AVF may cause discrepancies in temperature measurements

En Face Enhanced-Depth Swept-Source Optical Coherence Tomography Features of Chronic Central Serous Chorioretinopathy

Objective To characterize en face features of the retinal pigment epithelium (RPE) and choroid in eyes with chronic central serous chorioretinopathy (CSCR) using a high-speed, enhanced-depth swept-source optical coherence tomography (SS-OCT) prototype. Design Consecutive patients with chronic CSCR were prospectively examined with SS-OCT. Participants Fifteen eyes of 13 patients. Methods Three-dimensional 6×6 mm macular cube raster scans were obtained with SS-OCT operating at 1050 nm wavelength and 100 000 A-lines/sec with 6 μm axial resolution. Segmentation of the RPE generated a reference surface; en face SS-OCT images of the RPE and choroid were extracted at varying depths every 3.5 μm (1 pixel). Abnormal features were characterized by systematic analysis of multimodal fundus imaging, including color photographs, fundus autofluorescence, fluorescein angiography, and indocyanine-green angiography (ICGA). Main Outcome Measures En face SS-OCT morphology of the RPE and individual choroidal layers. Results En face SS-OCT imaging at the RPE level revealed absence of signal corresponding to RPE detachment or RPE loss in 15 of 15 (100%) eyes. En face SS-OCT imaging at the choriocapillaris level showed focally enlarged vessels in 8 of 15 eyes (53%). At the level of Sattler's layer, en face SS-OCT documented focal choroidal dilation in 8 of 15 eyes (53%) and diffuse choroidal dilation in 7 of 15 eyes (47%). At the level of Haller's layer, these same features were observed in 3 of 15 eyes (20%) and 12 of 15 eyes (80%), respectively. In all affected eyes, these choroidal vascular abnormalities were seen just below areas of RPE abnormalities. In 2 eyes with secondary choroidal neovascularization (CNV), distinct en face SS-OCT features corresponded to the neovascular lesions. Conclusions High-speed, enhanced-depth SS-OCT at 1050 nm wavelength enables the visualization of pathologic features of the RPE and choroid in eyes with chronic CSCR not usually appreciated with standard spectral domain (SD) OCT. En face SS-OCT imaging seems to be a useful tool in the identification of CNV without the use of angiography. This in vivo documentation of the RPE and choroidal vasculature at variable depths may help elucidate the pathophysiology of disease and can contribute to the diagnosis and management of chronic CSCR.National Institutes of Health (U.S.) (R01-EY011289-27)National Institutes of Health (U.S.) (R01-EY013178-12)National Institutes of Health (U.S.) (R01-EY018184-05)National Institutes of Health (U.S.) (R44EY022864-01)National Institutes of Health (U.S.) (GR01-CA075289-16)National Institutes of Health (U.S.) (R01-NS057476-05)National Institutes of Health (U.S.) (R44-EY022864-01)United States. Air Force Office of Scientific Research (FA9550-10-1-0551)United States. Air Force Office of Scientific Research (FA9550-10-1-0063)Research to Prevent Blindness, Inc. (United States)Massachusetts Lions ClubGerman Science Foundation (DFG-GSC80-SAOT