[en] The most common cause of morbidity and mortality in major surgical procedures are complication related to cardiovascular disease. Preoperative evaluation of patients with known or suspected heart disease is a major clinical challenge. Over the past 2 decades significant advancement has evolved in the assessment of cardiac risk prior to surgery. Early workers focused on the identification of surgical procedures that carried high risk. Later significant development was shifting the focus on identifying those patients who carried increased risk of cardiac complications during surgery. This has been made possible due to the advent of safe and sensitive cardiac testing and imaging modalities in particular dobutamine Echocardiography (Stress Echo) and Dobutamine/lipyrademole and thallium testing. Coronary Angiography relatively old and an invasive modality is indicated but has not shown to be cost effective given the low overall incidence of severe coronary artery disease (CAD). (author)

[en] Sor-Range coal was demineralized with HCl and the trace elements present in the acid extracts were determined by atomic absorption spectrophotometer. The effect of time of equilibration and that of the acid concentration was studied. It was found that increasing reaction time and concentration of hydrochloric acid, generally has increasing effect on the extraction of trace elements. Calcium and magnesium were found to be extracted in the higher amounts, while zinc and potassium has been extracted in the least amounts. The percent extraction of most of the trace elements with HCl solution show a considerable increase compared to that with water. (author)

[en] To evaluate key corneal tomography parameters for screening refractive surgery patients in Pakistani population. Study Design: Cross-sectional, observation study. Place and Duration of Study: Armed Forces Institute of Ophthalmology AFIO, National University of Medical Sciences, Rawalpindi, Pakistan, from August 2013 to December 2016. Methodology: Myopic patients were evaluated by two separate observers on Allegro OculyzerII (Wavelight) for normal ocular examination. A total of 20 tomographic parameters, used for pre-refractive surgical evaluation, were included. Normality of data was evaluated using Kolmogorov-Smirnov test. Results for outliers were displayed as 2.5%, 5%, 95% and 97.5% percentiles. Results: The sample of 451 patients (895 eyes), comprised of 61% (n=277) females and 39% (n=174) males (39%). The mean age was 26 +6.4 years (range of 18-62 years, M=F). Normal mean anterior segment values included; flat simulated keratometry (K1) 42.9 ±1.44 diopters (D), steep K2 43.9 ±1.52 D, K mean 43.4 ±1.43 D, K maximum 44.6 ±1.56 D, astigmatism -0.96 ±0.97 D, anterior chamber depth (ACD) 3.19 ±0.28 mm, front elevation at the thinnest point 4.11 ±2.44 um, and that at the back was 7.56 ±4.52 um progression index (PI) maximum 1.14 ±0.17, Ambrosio relational thickness maximum (ART max) 487.5 ±89.0 and pachymetry at thinnest point 542.2 ± 31.1 um. Conclusion: The study demonstrates key corneal tomography parameters, which can be useful for screening refractive surgery patients in Pakistani population. (author)

[en] Due to scarcity of local data regarding frequency of Renal Artery Stenosis (RAS), it is important to perform simultaneous renal arteriography in Patients undergoing coronary arterteriography for suspected coronary artery disease (CAD), in order to recognize all potential candidates for renal artery stenosis. It is cross sectional study. Three hundred patients, 157 male and 143 female with average age of 56+-8 Years and 55+-7 years respectively underwent simultaneous coronary and renal arteriography. Renal artery stenosis (RAS) was identified in 23.6% patients. Significant RAS (>50%) was present in 15% of patients. Hypertension, Dyslipidemia, smoking and diabetes mellitus were present in 88%, 80%, 50% and 49% respectively. Three vessel, two vessel and single vessel disease were seen in 58 %, 36% and 6% of patients. It is important to do simultaneous coronary and renal arteriography especially in patient having multiple risk factors and multi vessel coronary artery disease. (author)

[en] To evaluate the efficacy of primary and redo retinectomy in eyes with complex retinal detachment. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology Rawalpindi from Jan 2012 to June 2013. Patients and Methods: Fifty eight eyes (patients) underwent relaxing retinectomies for complex retinal detachment with proliferative vitreoretinopathy or intrinsic retinal shortening. Operative technique included pars plana vitrectomy, proliferative vitreoretinopathy management, use of intraoperative perfluorocarbon liquid, retinectomy, endolaser and intraocular temponade. The main outcome was anatomic success, defined as complete retinal reattachment at four months follow up. Eighteen eyes out of the same primary group underwent second retinectomy because of anatomical failure. Results: Mean age of study population was 53.78 ± 15.11 years, 56.9% of patients were male(s). Anatomic success rate after 1st retinectomy was achieved in 68.96% (40 eyes out of 58). In eighteen eyes that underwent 2nd retinectomy, anatomic success rate was 72.22% (13 eyes out of 18). Overall success rate was 91.3% (53 eyes out of 58) in our study. Conclusions: Relaxing retinectomies for retinal shortening can improve the anatomical success rate in patients with complex RD. (author)

[en] The paper is focused on the influence of some inorganic modifiers on the thermal stability of the clay-inorganic intercalates. The inorganic modifiers used were NaOH and KOH. Solvent intercalation procedure was used. Clay was modified at 150, 500 and 750 degree C, separately with NaOH and KOH. TGDTA study was performed to evaluate the thermal stability of the resultant intercalates. Intercalation with NaOH and KOH performed at 150 degree C showed significant mass loss. Intercalation with NaOH performed at 500 and 750 degree C, separately showed less mass loss compared to the ones prepared at 150 degree C and hence exhibited thermal stability. In case of intercalation performed with KOH at 500 and 750 degree C separately, the mass loss was comparable to the original pre-baked clay. (author)

[en] To analyze the effect of use of VERION image guided system on surgically induced astigmatism (SIA) in patients undergoing cataract surgery Study Design: Randomized controlled trial. Place and Duration of Study: The study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from Aug 2016 to Dec 2016. Material and Methods: Sixty eyes undergoing cataract surgery with already existing corneal astigmatism of at least 0.5 diopter (D) were included in the study. Cases with already existing ocular pathology or any per operative complication were excluded. Non-probability (purposive) sampling technique was used. Patients were randomly grouped into two groups 1 and 2. Group-1 underwent normal conventional phacoemulsification with no specific predetermined incision site. Group-2 underwent keratometric assessment using VERION image guided system and data was transferred to operating microscope. Steep and flat meridian were displayed on screen and incision were made on steep axis. Pre and 2 week post op keratometric readings were noted on a workup performa for both the groups and compared. All the surgeries were done by the same surgeon. Statistical program for social sciences (SPSS) version 23.0 was used for statistical analysis. Results: Sixty eyes (29 male, 31 female) with mean age of 57.65 ± 7.41 years were studied. Group-1 included 30 eyes with mean age of 56.73 ± 9.16 years. Group-2 also included 30 eyes with mean age of 58.56 ± 5.10 years. Mean pre op astigmatism was 0.93 ± 0.45D and 0.88 ± 0.47 D in group 1 and 2 respectively. Mean post op astigmatism was 0.95 ± 0.43 and 0.50 ± 0.39 in group 1 and 2 respectively Mean SIA in group-1 was 0.54 ± 0.43. Diopters while that in group 2 was 0.55 ± 0.36 diopters. Mean residual astigmatism -0.016 ± 0.43 and 0.37 ± 0.24 D in groups 1 and 2 respectively showing a 42% reduction in astigmatism in group 2 as compared with 1.7% increase in group 1. Conclusion: There is no significant difference between the SIA between two groups however there was a significantly less residual astigmatism in VERION group (group 2). Verion assisted incision along the steep axis is helpful in achieving a better refractive outcome in patients undergoing cataract surgery. (author)

[en] While doing the study on Aspirin Awareness and Usage (AAUS) in cases of Acute Coronary Syndrome (ACS), AAUS study Group designed the protocol to include the profile of patients presenting with symptoms of ACS and in the light of that also reviewed the available data in South Asian population. A prospective study was carried out in 17 coronary care units (CCUs) in all 4 provinces of Pakistan. Patients included were males and females of all age groups presenting with chest pain, diagnosed to have Coronary Artery Disease (CAD) and categorized into Unstable Angina (USA), STEMI or NSTEMI, based on clinical, ECG and enzymatic criteria. The risk factors, family history, dietary history, time to reach ER after the onset of symptoms, management of ACS in CCU and outcome of treatment were recorded. A total of 1,527 patients presented to the Emergency Room (ER) with chest pain but around 1400 patients were evaluable. The majority (68%) were males. The mean age of all patients was 52.2+-10.7 years. 28.3% patients were <45 years. Average time to presentation at ER was 13.2+-6.2 hours. 92.7% patients presented with chest pain. More than half the patients had hypertension (55.2%) and or smoking (52%) as the risk factors while 37.2 % had diabetes and 18.2% had hyperlipidemia. Hypertension (52.7%), IHD (44%) and Diabetes (36.2%) figured prominently in the family history. USA and STEMI were the major types of ACS (43.0% and 40.5% respectively). At discharge 67.8% of patients were stable without symptoms, 13.3% were stable but with symptoms, 16.4% were referred for further investigations and 2.5% had died. The review of the available data in Pakistan, supported by the present study in a cohort of 1400 patients from 17 CCUs in the country, the emerging profile of patients with AMI is that the majority are male, relatively younger as compared to Western population, have smoking and hypertension followed by diabetes as the major risk factors. USA and STEMI are the dominant types of ACS and the majority of patients are likely to have hypertension, IHD and diabetes in their families. Better control of risk factors and the awareness of preventive strategies are needed. (author)

[en] To compare the disease patterns in two data sets of patients, five years apart, at the National Institute of Cardiovascular Diseases (NICVD), a tertiary care cardiac hospital in Karachi. The underlying objective was to determine any changes in cardiovascular disease patterns at an acute cardiac unit over a period of five years. A retrospective descriptive study was conducted on patients admitted in West Ward, National Institute of Cardiovascular Diseases (NICVD), Karachi in September, 2000 and September, 2005. Patient's record files were reviewed and the relevant information was recorded on a proforma designed for the purpose. In September, 2000, a total of 414 patients were admitted. Of these 71.25% were males. Majority of patients (72.92%) were in the fifth decade of life or beyond. Acute coronary syndrome (ACS) was the commonest presentation, present in 39.8% of the patients. 27.3% had myocardial infarction (MI) while 10.34% were diagnosed with heart muscle diseases. The overall mortality was 3.4%. In September, 2005, a total of 446 patients were admitted. Of these, 63% were males. 71.29% were in the fifth, sixth, and seventh decades of life. 43.04% patients were admitted with acute coronary syndromes (ACS), 26% with myocardial infarction (MI) and 13.45% with heart muscle diseases. The overall mortality was 1.34%. The almost similar results in two data sets of patients five years apart suggests that the cardiovascular disease burden and pattern has not changed significantly at this center. There is a preponderance of cardiovascular illnesses in males and older age groups. ACS and MI account for majority of admissions. (author)

[en] To compare outcome of supracondylar humerus fractures in children treated with closed lateral and cross K-wire fixation. Methodology: This comparative study was conducted at private medical centers of Dabgari garden, Peshawar on patients presenting with supracondylar fracture of elbow from January 2013 to December 2016. Lottery method used to divide patients into A and B groups; In group A, cross K-wires, while K-wires from lateral entry were used in group B. Bawman’s angle and anterior humeral line were measured on X-ray postoperatively and during follow up. At 10 week post op, functional outcome was measured using Flynn’s criteria. Results: Out of 100 patients, 46 were males while 54 females. The mean age was 6.11+1.98 years. None had neurological injury. Bowman’s angle immediate post operatively in two groups was in 45(90%) and 42(84 percent), respectively (p=0.372) and at 3 weeks after post operatively was in 44(88%) & 39(78%), respectively (p=0.183). Anterior humeral line immediate post operatively in both groups was in 40(80%) & 36(72%), respectively (p=0.349) and at 3 weeks post operative is in 39(78%) & 34(68%), respectively (p=0.26). Outcome in both groups was excellent in 41(82%) & 37(74%), respectively (p=0.334). Conclusion: Pinning for supracondylar fractures of the humerus is good option and both techniques had no significant difference in terms of functional outcome. Large sample size study is recommended. (author)