Foundation University Medical Journal

Outcomes of nasolacrimal intubation in children aged 1 to 8 years

2025-04-15T16:44:47+00:00

Abstract

Objective: To evaluate the outcomes of nasolacrimal duct (NLD) intubation in children aged 1-8 years having congenital nasolacrimal duct obstruction (CNLDO) and to compare success rates among different age groups.
Study design: Retrospective-Observational study.

Place and Duration of study: Al-Shifa Trust Eye Hospital, Rawalpindi. March-October 2023.

Patients and Methods: A total of 187 eyes from 162 pediatric patients aged 1–8 years who underwent NLD intubation were included. After exclusions, 156 eyes were analyzed. Patients were categorized into three age groups: Group A (1.1 to <3 years), Group B (3 to <5 years) and Group C (5 to 8 years). Success was defined by both subjective (resolution of tearing and discharge) and objective criteria (negative regurgitation test). Statistical analysis was performed using SPSS (Version 23.0) and intergroup comparisons were made using the Chi-square test.

Results: The overall success rate of NLD intubation was 68.59% with younger children demonstrating higher success rates. Group A had the highest success rate (83.67%) followed by Group B (64.86%) and Group C (58.93%), with a statistically significant difference (p = 0.0385). Complications occurred in 25 cases; tube extrusion (7 patients), cheese wiring of the puncta (5 patients), mucocoele, nasolacrimal fistula, and chronic dacryocystitis (1 patient each).

Conclusion: This study highlights that nasolacrimal intubation is more effective in younger children. The findings suggest that early intubation might prevent the need for multiple surgeries and reduce complications.

To determine the mean NLR(Neutrophil Lymphocyte Ratio) and Mean PLR(Platelet Lymphocyte Ratio) in Covid-19 patients

2025-05-27T04:39:04+00:00

ABSTRACT

Objective: To determine the mean NLR(neutrophil leucocyte ratio) and mean PLR(platelet lymphocyte ratio) in COVID- 19 patients.
Study design: Cross Observational Study.
Place and Duration of Study: The study was conducted in Medicine unit, Benazir Bhutto Hospital Rawalpindi during the period of May to November 2021.
Patients and Methods: A total of 95 patients those who were positive for corona virus by RT-PCR, 20 to 80 years of age, both genders were included. Patients with previous history of asthma, Chronic Obstructive Pulmonary disease, autoimmune disease, ischemic heart disease and chronic liver disease were excluded. The selected patients were given their written informed consent. NLR and PLR were calculated for all the patients on admission versus after 48 hrs. of admission. The data were collected and calculated by the principal researcher on a specially designed proforma.
Results: The study included total of 95 patients from 20-80 years with mean age of 46.73 ± 11.16 years. Fifty nine (62.11%) patients were 20-50 years old. Out of total, 39 (41.05%) were male and 56 (58.95%) were females. Mean leucocyte count was 8.05 ± 2.71 x 109/L. Mean leucocyte number was 5465 ± 1231 neutrophils/µL. Mean NLR was 5.15 ± 1.26 and mean PLR was 215.88 ± 38.14 in COVID-19 patients. Mean NLR was not significantly associated with changes over time in COVID-19 patients (p =0.21). Mean PLR was significantly associated with changes over time (p= 0.011), showing a statistically meaningful decrease from admission to 48 hours.
Conclusion: The study concluded that mean NLR and mean PLR was associated with COVID-19 patients. PLR decreased significantly, consistent with patient improvement. NLR showed a decreasing trend but not significantly, suggesting it may still reflect immune response but not sharply over 48 hours.

Prevalence of hepatitis B virus infection in pregnant females of rural areas of Karachi and identification of important risk factors

2025-05-27T08:43:27+00:00

Abstract

Objective: This study undertakes seroprevalence of Hepatitis B Virus(HBV) infection in pregnant females of rural areas and identifies important risk factors associated with hepatitis B virus.

Study design:Cross-sectional study

Place and Duration of Study:The study was carried out at Baqai Medical University and Muhammadi Blood bank Karachi from January to December 2021.

Patients and Methods:A total of 385 samples were collected from pregnant females belonging to different areas of Karachi. Pregnant females of age 17- 45 years of rural areas were included while all non-pregnant females having comorbids were excluded. Samples were collected in EDTA tubes. Serum was extracted by centrifugation. Screening for hepatitis B was done by Electro Chemi Luminiscence Immunoassay (ECLIA) on cobas e 411 analyzer. Amplification and reporting of HBV was done using Real time PCR. Statistical analysis was done by using SPSS version 25.

Results:The prevalence of HBV is 10.4% in pregnant females. Important risk factors identified includes middle aged pregnant females (13.5%) having lack of education (42.2%) belonging to low socioeconomic status (14.5%) and most of them are housewives. The proportion of pregnant females found to be infectious who did give history of contact with diagnosed cases of hepatitis was 100% and 58.3% had positive history of transfusion. There was significant association of history of miscarriage and HBV (15.9%). History of previous C-section with hospital admissions were found significantly associated with HBV.

Conclusion:Our findings are depictive of an increasing trend and also highlight the important risk factors associated with spread of this virus in community. Lack of awareness among general population, reproductive age bracket, inappropriate screening of blood at rural health centers and malpractice of surgical procedures are some of the important risk factors pointed out in our study.

Comparison of the effects of levocarnitine versus normal saline in the treatment of intradialytic hypotension

2025-05-27T08:45:46+00:00

Abstract

Objective: To evaluate the outcome of levocarnitine versus normal saline in the treatment of intradialytic hypotension
Study Design: Pre-post quasi-experimental study
Place and Duration of Study: Oct 2024 to March, 2025 Armed Forces Institute of Urology (AFIU), Combined Military Hospital, Rawalpindi Pakistan .
Patients and Methods: Thirty five patients(experimental group:15 and control group:20) were included in the study over a period of 12 weeks. Outcomes, like Dialysis-related hypotension episodes, mean change in hemoglobin levels, fatigue, and cramps were measured. Data were analyzed using SPSS version 26.
Results: Both groups, had substantial decrease in Dialysis-related hypotension episodes, (p=0.05, for control: and experimental p=0.04). Experimental group found the elevation in Hb levels, (1.6g/dl, p=0.01). No changes were found in the serum creatinine and Echocardiographic outcomes.
Conclusion: L-carnitine supplementation reported to have significant changes in clinical outcomes, Dialysis-related hypotension, Hb levels, and quality of life in kidney Patients.

Comparison of surgery time in phacoemulsification with and without pre-op alprazolam

2024-12-20T17:41:05+00:00

Abstract

Objectives: To compare the effect of pre-operative administration of oral alprazolam on phacoemulsification time in patients undergoing cataract surgery.
Study Design: Case control Study
Place and Duration of Study: This was a prospective cohort study conducted at Fauji Foundation Hospital, Rawalpindi from August to September 2024.
Patients and Methods: A total number of 100 patients undergoing phacoemulsification with intraocular lens implantation were divided into 2 groups. One received oral alprazolam 1 mg, 1 hour prior to surgery, while the other was not given any medication. Time taken since start of phacoemulsification till the removal of the last piece of nucleus was noted. Results were compiled and the means of the two groups were compared using independent samples t-test.
Results: A total of 94 females and 06 males participated in the study. The mean age of the participants was 63.1 ± 7.51 years. There were no significant differences between the two groups in terms of age or gender distribution. In Group A (Alprazolam), the mean surgery time was 4.74 ± 2.09 minutes, whereas in Group B (Control), the mean surgery time was 7.84 ± 2.42 minutes. This difference was statistically significant, with a p-value of less than 0.01.
Conclusion: Preoperative administration of oral alprazolam significantly reduces phacoemulsification time in cataract surgery, likely due to reduction in patient anxiety and patient movement during the procedure and therefore enhances surgical outcomes.

Do we neglect patients?

2025-04-23T15:57:26+00:00

When a patient walks into a consultant's room, he/she has a specific symptom/set of symptoms to tell the physician, based on which the story kicks off; differentials are considered, certain tests are ordered, and a treatment/management plan is devised. In due course of time, the whole scenario becomes monotonous, mechanical, and robotic. Something gets forgotten in this process- the patient himself, as an entity, a living being, an individual possessing a body, mind, emotions, fears, and anxieties. The human mind is so complex, layer upon layer that a mere one to two minutes fails to make evident what is going on within him.

A rare case of systemic lupus erythematosus in a male patient associated with antiphospholipid syndrome, presenting with severe autoimmune hemolytic anemia

2025-05-05T17:55:31+00:00

Abstract
This case report describes an unusual case of Systemic Lupus Erythematosus (SLE) in a male patient associated with antiphospholipid syndrome who presented with recurrent episodes of jaundice secondary to severe autoimmune hemolytic anemia. SLE is rare in males and very few cases have been reported so far. Our patient was a middle-aged gentleman diagnosed case of SLE, presented with fatigue, generalized weakness and shortness of breath. He also had multiple episodes of jaundice. Diagnostic workup confirmed autoimmune hemolytic anemia, that was refractory to steroid therapy and Azathioprine, but responded to IV methylprednisolone and Mycophenolate. The antibodies for antiphospholipid syndrome were also positive. Although lupus and antiphospholipid syndromes are rare in males, these entities should be considered especially among those with unexplained anemia and hemolysis.

High myopia of -26D in a 3 year old child: A rare case presentation

2025-05-19T08:30:17+00:00

Abstract
High myopia in early childhood is rare and often associated with genetic, ocular, or systemic abnormalities. This case report describes a 3-year-old girl diagnosed with high axial myopia (-24.00 DS) and an axial length exceeding 33 mm, highlighting the importance of early detection and comprehensive management. A 3-year-old female presented with squinting and difficulty seeing distant objects. Cycloplegic refraction revealed -24.00 DS in both eyes, with no nystagmus or strabismus. Examination under anesthesia confirmed -26.00 DS on retinoscopy. Ocular examination was remarkable for severe chorioretinal atrophy and pale optic discs (0.5 CDR). Axial length measurements were 33.23 mm (right eye) and 33.15 mm (left eye). A diagnosis of high axial myopia was made, and myopia management was initiated with spectacle correction, soft contact lenses, and low-dose atropine therapy (0.01%). Systemic evaluation ruled out syndromic associations, and the patient was placed on close follow-up for progression monitoring and amblyopia management.
This case represents one of the highest reported myopic refractive errors in early childhood. It highlights the importance of early detection, individualized myopia management, and long-term monitoring to reduce the risk of progressive vision loss and complications. Advances in myopia control offer promising avenues for improving visual outcomes in highly myopic children.

Managing emergency non-cardiac surgery in a pediatric patient with most severe cyanotic heart disease: A case study

2025-05-27T08:48:02+00:00

Abstract
Anesthesia for congenital heart disease patients undergoing noncardiac emergency surgery presents significant challenges due to complex anatomical and physiological abnormalities, requiring tailored interventions to maintain hemodynamic stability. Anesthetists need to be knowledgeable not only about the normal series cardiac circulation but also the parallel (or balanced) and single-ventricle circulations. Providing anesthesia to pediatric patients with congenital heart anomalies during procedures unrelated to the heart involves a range of specialized considerations and remains a complex aspect of perioperative care. Multiple factors contribute to the complexity of anesthetic management in children with congenital heart disease, such as the patient's age, nature and extent of the cardiac abnormality, hemodynamic compensation, surgical urgency, and any coexisting health issues. This case discusses the anesthetic management of an 8-year-old boy with congenital heart disease and severe pulmonary hypertension undergoing emergency laparotomy. It addresses perioperative challenges and provides an overview of pediatric pulmonary hypertension physiology, risk stratification, and intraoperative considerations.