Accreditation and evaluation of veterinary medical institutes - a Pakistani perspective

The Higher Education Commission of Pakistan (HEC) is an independent, autonomous and constitutionally established institution that provides primary funding for higher education in Pakistan, which it also oversees, regulates and accredits. According to the HEC Charter: 'the HEC of Pakistan may set up national or regional evaluation councils or authorise any existing council/or similar body to carry out accreditation of institutions including their departments, facilities and disciplines by giving them appropriate ratings'. At present, 14 accreditation bodies operate under the umbrella of the HEC. Five were established under the HEC's Quality Assurance Agency, while nine councils associated with the accreditation and evaluation of medical institutes are independent bodies that were extant before the HEC was created, and are recognised by the HEC. The authors will discuss the role of the Pakistan Veterinary Medical Council (PVMC), the accreditation of veterinary institutes and associated issues of concern. They suggest that the PVMC should adopt an unbiased approach to new and established veterinary institutes to attain uniform accreditation of all veterinary institutes throughout the country. In addition, the government should consult the accreditation councils and professional bodies before setting up new institutes. The authors also suggest that, instead of placing new veterinary institutes under the aegis of non-veterinary universities, they should be made sub-campuses of established veterinary universities. In time, they will emerge as established institutes in their own right.

Synergistic potential of propolis and vitamin e against sub-acute toxicity of AlCl(3) in albino mice: in vivo study

Current study evaluated the synergistic potential of propolis and vitamin E against sub-acute toxicity of aluminum chloride on different biochemical parameters and liver histology. Swiss albino mice (n=42) were randomly divided into seven groups. Group I received 0.2 ml of 0.9 % saline solution, Group II received Propolis (50 mg/kg b.w.), Group III received vitamin E (150 mg/kg b.w.), Group IV received AlCl(3) 50 mg/kg b.w., Group V received AlCl(3) + Propolis, Group VI received AlCl(3) + vitamin E and Group VII received AlCl(3) + propolis + vitamin E. Blood and tissue samples were collected after 7 and 21 days. The body weight of the animals significantly increased in all groups except Group IV. The concentration of serum high density lipoprotein significantly decreased in Group IV and increased in Group V, VI and VII. The level of aspartate aminotransferase, alanine transferase, alkaline phosphatase, triglycerides, total cholesterol, and low density lipoprotein significantly increased in AlCl(3) treated group and increased in Group V, VI and VII. Tissue sections were processed and stained by hematoxylin and eosin. Group II showed cellular necrosis. Group V, VI showed decreased number of vacuolization, sinusoidal spacing and macrophage cell infiltration. Group VI showed less degenerative changes in the third week. Vitamin E and propolis in combination with Al provides more protection against AlCl(3) induced toxicity.

Towards accurate infrared spectral density of weak H-bonds in absence of relaxation mechanisms

Following the previous theoretical developments to completely reproduce the IR spectra of weak hydrogen bond complexes within the framework of the linear response theory (LRT), the quantum theory of the high stretching mode spectral density (SD) of weak H-bonds is reconsidered. Within the LRT theory, the SD is the one sided Fourier transform of the autocorrelation function (ACF) of the high stretching mode dipole moment operator. In order to provide more accurate theoretical bandshapes, we have explored the equivalence between the SDs given in previous studies with respect to a new quantum one, and revealed that in place of the basic equations used in the precedent works for which the SD I_Old(ω)=2Re∫₀^∞G_Old(t)e^-iωtdt where the ACF G_Old(t) = ⟨μ(0)μ(t)⁺⟩ = tr {ρ {μ(0)} {μ(t)}⁺}, one can use a new expression for the SD, given by I_New(ω)=2ωRe∫₀^∞G_New(t)e^-iωtdt where G_New(t)=μ(0)μ(t)⁺=1βtrρ_B∫₀^βμ(0)μ(t+iλℏ)⁺dλ. Here ρ_B is the Boltzmann density operator, μ(0) the dipole moment operator at initial time and μ(t) the dipole moment operator at time t in the Heisenberg picture, ℏ is the Planck constant, β is the inverse of the Boltzmann factor k_BT where T is the absolute temperature and k_B the Boltzmann constant. Using this formalism, we demonstrated that the new quantum approach gives the same final SD as used by previous models, and reduces to the Franck-Condon progression appearing in the Maréchal and Witkowski's pioneering approach when the relaxation mechanisms are ignored. Results of this approach shed light on the equivalence between the quantum and classical IR SD approaches for weak H-bonds in absence of medium surroundings effect, which has been a subject of debate for decades.

Assessing the quality of life among Pakistani general population and their associated factors by using the World Health Organization's quality of life instrument (WHOQOL-BREF): a population based cross-sectional study

BACKGROUND

Measuring quality of life (QOL) in a population is important for the predictions of health and social care needs. In Pakistan, health related quality of life data exist but there are no quality of life data of general population. In this study, quality of life was assessed among the Pakistani general population and their associated factors by using the World Health Organization's quality of life instrument (WHOQOL-BREF).

METHODOLOGY

A population-based cross-sectional study was carried out in all 52 Union Councils of District Abbottabad, Khaber Pkutunkhua province, Pakistan from March 2015 to August 2015. Multi-stage cluster sampling technique was employed in this study. Quality of life was measured by using the validated WHOQOL-BREF instrument, along with socioeconomic, demographic, and World Bank social capital questions in this population- based study. The data were collected through households, utilizing face to face interviews. The association between socio-demographic variables and quality of life domains were determined by using both univariate and multivariate analysis. Descriptive statistics were derived, and a multilevel linear regression using backward analysis allowing to obtain final model for each domain was achieved to recognize the variables that affect quality of life score.

RESULTS

A total of 2063 participants were included in this study (51.2% male, 48.2% female). Mean age of participants was 37.9, SD = 13.2; ranging from 18 to 90. Mean score of quality of life domains (physical, psychological, social relationship and environmental domains) were 65.0 (SD = 15.2), 67.4 (SD = 15.0), 72.0 (SD = 16.5), 55.5 (SD = 15.0), respectively. Overall, socioeconomic status was established to be the strongest predictor of poorer quality of life for all domains as a change in SES from high to low results in reduction about (β = - 5.85, β = - 9.03, β = - 8.33, β = - 9.98, p < 0.001). Similarly, type of residency was negatively associated with physical, psychological and environmental domains while age and sex were negatively associated with physical, psychological and relationship domains in final model. Furthermore social capital (β = 0.09, β = 0.13, β =0.14, β =0.15, p < 0.001) had a positive effect on Pakistani quality of life. Overall, subjective quality of life was found to be low in our population and extremely varied by socio-demographic variables.

CONCLUSIONS

Increasing age, having average and lower socioeconomic status and living in the rural area were found to be the strong predictor of poorer quality of life in all domains, while total social capital score had a positive effect on Pakistani quality of life scores.

Use of Gabapentin in the Treatment of Substance Use and Psychiatric Disorders: A Systematic Review

Objective: Gabapentin (GBP) is an anticonvulsant medication that is also used to treat restless legs syndrome (RLS) and posttherapeutic neuralgia. GBP is commonly prescribed off-label for psychiatric disorders despite the lack of strong evidence. However, there is growing evidence that GBP may be effective and clinically beneficial in both psychiatric disorders and substance use disorders. This review aimed to perform a systematic analysis of peer-reviewed published literature on the efficacy of GBP in the treatment of psychiatric disorders and substance use disorders. Methods: This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed and Ovid MEDLINE literature databases were screened and filtered by using specific search terms and inclusion/exclusion criteria. The full texts of selected studies were subsequently retrieved and reviewed. The search terms generated 2,604 results from the databases. After excluding all duplicates, 1,088 citations were left. Thereafter, we applied inclusion and exclusion criteria; a total of 54 papers were retained for detailed review. Results: This literature review concludes that GBP appears to be effective in the treatment of various forms of anxiety disorders. It shows some effectiveness in bipolar disorder as an adjunctive therapeutic agent, while the evidence for monotherapy is inconclusive. In substance use disorders, GBP is effective for acute alcohol withdrawal syndrome (AWS) with mild to moderate severity; it reduces cravings, improves the rate of abstinence, and delays return to heavy drinking. GBP may have some therapeutic potential in the treatment of opioid addiction and cannabis dependence, but there is limited evidence to support its use. No significant benefit of GBP has been conclusively observed in the treatment of OCD, PTSD, depression, or cocaine and amphetamine abuse. Conclusion: GBP appears to be effective in some forms of anxiety disorders such as preoperative anxiety, anxiety in breast cancer survivors, and social phobia. GBP has shown to be safe and effective in the treatment of alcohol dependence. However, the literature suggests that GBP is effective as an adjunctive medication rather than a monotherapy. More clinical trials with larger patient populations are needed to support gabapentin's off-label use in psychiatric disorders and substance use disorders. It is worth noting that numerous clinical studies that are discussed in this review are open-label trials, which are inherently less rigorously analyzed. Therefore, more extensive investigations are required to examine not only the efficacy of GBP, but also its safety and tolerance.

Entropy Analysis of 3D Non-Newtonian MHD Nanofluid Flow with Nonlinear Thermal Radiation Past over Exponential Stretched Surface

The present study characterizes the flow of three-dimensional viscoelastic magnetohydrodynamic (MHD) nanofluids flow with entropy generation analysis past an exponentially permeable stretched surface with simultaneous impacts of chemical reaction and heat generation/absorption. The analysis was conducted with additional effects nonlinear thermal radiation and convective heat and mass boundary conditions. Apposite transformations were considered to transform the presented mathematical model to a system of differential equations. Analytical solutions of the proposed model were developed via a well-known homotopy analysis scheme. The numerically calculated values of the dimensionless drag coefficient, local Nusselt number, and mass transfer Nusselt number are presented, with physical insights. The graphs depicting the consequences of numerous parameters on involved distributions with requisite deliberations were also a part of this model. It is seen that the Bejan number is an increasing function of the thermal radiation parameter.

Study of the oil interaction towards oil spill recovery skimmer material: Effect of the oil weathering and emulsification properties

The primary aim of this research was to identify the physicochemical properties of the oil and water-in-oil (W/O) emulsions used during a NOFO Oil-on-Water field trials that reduced the performance of the skimmers recovery efficacy during the trials. Extensive studies were performed at SINTEF laboratories with the residues of oil topped (i.e. evaporative loss of crude oil components by distillation process at large scale) for the field trial and compared it with different residues of oil topped by bench scale laboratory procedures. In order to obtain a sufficient stable W/O emulsion for the field trial, bunker fuel oil (IFO380) and various concentrations of an emulsifier (Paramul®) were also added to the residues of oil topped on large scale and investigated through interfacial tension, contact angle, droplet adhesion and "dip and withdraw" tests. The investigations revealed that the addition of an emulsifier lowered the interfacial tension of oil residues, which consequently reduced the adherence properties of the oil and emulsions to the surface of the skimmer material. Too high concentration of an emulsifier (>0,5%) also had a negative effect on the stability of W/O emulsion.

Revealing of Core Shell Effect on Frequency-Dependent Properties of Bi-based Relaxor/Ferroelectric Ceramic Composites

In this study, electromechanical characteristics of (1-x) Bi_0.5Na_0.5TiO₃–xSrTiO₃ (ST26, x = 0.26)/(1-y) Bi_0.5Na_0.5TiO₃–ySrTiO₃ (ST10, y = 0.1) (matrix/seed) composites were studied. The ST26 (high relaxor phase) and ST10 (a relaxor ferroelectric (RF), high ferroelectric phase) composite with large (r-ST26-ST10) and small (t-ST26-ST10) grains exhibited frequency-related dielectric properties and large strain response at a low triggering electric field (an incipient piezoelectricity). It is ascribed to a matrix-seed effect originating from the inhomogeneous composition due to the presence of two phases. The r-ST26-ST10 composite sintered at 4 h, prominent material, showed a high normalized dynamic strain (d₃₃*) of ~700 pm/V (large grains) with stable frequency dependence properties at a low field of 40 kV/cm. The properties of the r-ST26-ST10 composite exhibit less decay with frequency-related polarization and strain compared to those of t-ST26-ST10 composite. The increase in soaking time promotes the diffusion and homogenization of the microstructure in composites, leading to changes in the core-shell structure in the solid solution. The polarization and strain of the ST26-ST10 composites with the frequency are linked to the stability of the internal random fields created by non-ergodic relaxor phase of seed and the amount of phase change in the ergodic relaxor matrix.

A numerical treatment of MHD radiative flow of Micropolar nanofluid with homogeneous-heterogeneous reactions past a nonlinear stretched surface

The impact of nonlinear thermal radiation in the flow of micropolar nanofluid past a nonlinear vertically stretching surface is investigated. The electrically conducting fluid is under the influence of magnetohydrodynamics, heat generation/absorption and mixed convection in the presence of convective boundary condition. The system of differential equations is solved numerically using the bvp4c function of MATLAB. To authenticate our results, two comparisons with already studied problems are also conducted and an excellent concurrence is found; hence reliable results are being presented. Complete deliberation for magnetite nanofluid with Ferric Oxide (Fe₃O₄) nanoparticles in the water-based micropolar nanofluid is also given to depict some stimulating phenomena. The effect of assorted parameters on velocity, homogeneous-heterogeneous reactions, temperature and micropolar velocity profiles are discussed and examined graphically. Moreover, graphical illustrations for the Nusselt number and Skin friction are given for sundry flow parameters. It is examined that temperature distribution and its associated boundary layer thickness increase for mounting values of the magnetic parameter. Additionally, it is detected that the Nusselt number decays when we increase the values of the Biot number.

Bacterial biosensing: Recent advances in phage-based bioassays and biosensors

In nature, different types of bacteria including pathogenic and beneficial ones exist in different habitats including environment, plants, animals, and humans. Among these, the pathogenic bacteria should be detected at earlier stages of infection; however, the conventional bacterial detection procedures are complex and time-consuming. In contrast, the advanced molecular approaches such as polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) have significantly reduced the detection time; nevertheless, such approaches are not acceptable to a large extent and are mostly laborious and expensive. Therefore, the development of fast, inexpensive, sensitive, and specific approaches for pathogen detection is essential for different applications in food industry, clinical diagnosis, biological defense and counter-terrorism. To this end, the novel sensing approaches involving bacteriophages as recognition elements are receiving immense consideration owing to their high degree of specificity, accuracy, and reduced assay times. Besides, the phages are easily produced and are tolerant to extreme pH, temperature, and organic solvents as compared to antibodies. To date, several phage-based assays and sensors have been developed involving different systems such as quartz crystal microbalance, magnetoelastic platform, surface plasmon resonance, and electrochemical methods. This review highlights different taxonomic species and genera of phages infecting eight common disease-causing bacterial genera. It further overviews the most recent advancements in phage-based sensing assays and sensors. Likewise, it elaborates various whole-phage and phage components-based assays. Overall, this review emphasizes the importance of electrochemical biosensors as simple, reliable, cost-effective, and accurate tools for bacterial detection.

Short term surgical outcomes of Wilms tumour from a single institute

Wilms tumour is the commonest solid tumour of childhood in Pakistan. In developed world the long-term outcome of Wilms tumour have significantly improved reaching up to 98% long term survival. We have no National data of prevalence, treatment and survival of this condition in Pakistan. Surgical treatment also varies in various parts of the country. We have studied our patients presenting with a diagnosis of Wilms tumour to our institute from Jan 2014 to April 2016. A total of 42 patients were operated for Wilms tumour. The most common symptoms were abdominal mass (75%), pain (28%) and fever (19%). A total of 48 tumour resections were performed, 45 total nephrectomies and 3 had nephron sparing surgery (NSS). Mean operative time was 225±78.7 minutes. Mean blood loss was 165±223.5ml. Mean size of the tumour was 102±48.4mm and mean weight of the tumour was 433±400.7gm. Ninety percent patients had a favourable histology. Mean high dependency unit (HDU) stay was 1.16±1.2 day and mean hospital stay was 6.89±3.47 days. Complications were observed in 8 patients. Surgery remains a major part of treatment for Wilms tumour.

Analysis Of Palatal Rugae Pattern In Population Of Abbottabad: A Forensic Study

BACKGROUND

Identification of unknown dead bodies' especially bony remains is done by different methods like DNA typing, Finger printing, Dental and other skeletal data, facial reconstruction and rugae pattern study. Palatal rugae pattern study or Ruguscopy gives a unique method of identification in cases of skeletal remains due to its uniqueness, resistance to heat, and stability throughout life.

METHODS

This simple random sampling was carried out on 102 study models (casts of palate) of patients having 880 rugae patterns above 20 years of age in Khan Dental Clinic near Ayub Medical College, Abbottabad. The study is based on classification given by Thomas et al. Casts were taken from palate and then individual casts studied for rugae pattern. They were classified and variations studied for uniqueness.

RESULTS

Each individual had different set of palatal rugae which are not same, in all its dimensions like size shape number etc.

CONCLUSIONS

With the help of this study we can conclude that Palatal rugae pattern give unique method for individual identification.

Nutritional Assessment Focusing On Women And Children In Palas Valley-Kohistan

BACKGROUND

Proper nutrition and health are fundamental rights and nutrition is a cornerstone that affects and defines the health of all people, rich and poor. The study was done with the objectives to assess the people of Palas valley with regard to their nutritional status and dietary habits to devise ways and means to overcome primary and associated reasons for these problems.

METHODS

In this descriptive cross-sectional study residents of Palas valley of district Kohistan were included in the study through multistage cluster sampling method. The Palas valley was divided in to two: Kuz Palas (Lower Palas) and Bar Palas (Upper Palas). Two union council each from Kuz and Bar Palas were randomly selected Among the households, one adult male, one woman of childbearing age, one male child and one female child was selected randomly..

RESULTS

A total of 160 adult and children were interviewed and assessed for the nutritional status. Out of total of 80 children 61 (76.25%) had visible BCG scars. Among children 77.5% were either thinly built or had poor built. Among male adults 95% were of normal built. In adult females, 60% were either of thin built or poor built. Twenty-two percent of male children and 30% of female children were found underweight. Fourteen (35%) males and females have a BMI between 17.1-18.5 while only 6 (15%) of the females have BMI more than 18.5.

CONCLUSIONS

Poverty and illiteracy in the absence of effective social and health services is playing havoc with the population of Palas valley. Poor sanitation and poor personal hygiene expose them to infections and parasitic diseases. Poor availability of food, lack of awareness and tough customs and traditions expose lead to malnutrition.

Prevalence of foot and mouth disease virus in apparently healthy buffaloes brought to Islamabad slaughterhouse in Pakistan

This study was conducted to determine the sero-prevalence of foot and mouth disease (FMD) in buffaloes (Bubalus bubalis) slaughtered at Islamabad slaughterhouse, Pakistan. Sera and oro-pharyngeal (OP) fluid were collected from 630 healthy buffaloes. These animals originated from various livestock markets from 14 districts of Punjab. The age of animals ranged from 1 to 15 years. Sera were analyzed using FMD virus (FMDV) nonstructural proteins (NSP) and indirect ELISA. The sero-prevalence of FMD was 47.1% (n=297). There was a strong association between age of animal and its risk of being positive for FMD NSP ELISA (Odds ratio 1.27; p<0.001; CI 1.22-1.32). The OP fluids were tested for the presence of FMDV by real time PCR. FMDV specific signals were detected in 33 samples (11.1%). Virus recovery attempts were made after treating them with tri-chloro-tri-flouroethane onto LFBK cell line and four FMD isolates were recovered. This study indicated high sero-prevalence of FMDV in buffaloes slaughtered at abattoir in Islamabad. Furthermore, the virus recovery from these animals is suggestive of their possible role in persistence and transmission of FMDV to other animals.

Nonlinear radiation effect on MHD Carreau nanofluid flow over a radially stretching surface with zero mass flux at the surface

A mathematical model is envisaged to study the axisymmetric steady magnetohydrodynamic (MHD) Carreau nanofluid flow under the influence of nonlinear thermal radiation and chemical reaction past a radially stretched surface. Impact of heat generation/absorption with newly introduced zero mass flux condition of nanoparticles at the sheet is an added feature towards novelty of the problem. Further, for nanofluid the most recently organized model namely Buongiorno's model is assumed that comprises the effects thermophoresis and Brownian motion. Utilizing suitable self-similar transformations, the set of partial differential equations with high nonlinearity are converted into a dimensionless system of ordinary differential equations. Set of these transmuted equations are numerically solved by MATLAB built-in function bvp4c. Impact of germane parameters on all involved profiles are plotted to examine the heat and mass transfer characteristics. This study reveals that the temperature distribution is an escalating function of the heat generation and nonlinear radiation parameters. Also, it is noted that the incrementing values of chemical reaction parameter lowers the nanoparticles concentration profile. A comparison of the present investigation with already published explorations in limiting case is also added to authenticate the presented results; hence reliable results are being presented.

Genetic stability of foot-and-mouth disease virus during long-term infections in natural hosts

Foot-and-mouth disease (FMD) is a severe infection caused by a picornavirus that affects livestock and wildlife. Persistence in ruminants is a well-documented feature of Foot-and-mouth disease virus (FMDV) pathogenesis and a major concern for disease control. Persistently infected animals harbor virus for extended periods, providing a unique opportunity to study within-host virus evolution. This study investigated the genetic dynamics of FMDV during persistent infections of naturally infected Asian buffalo. Using next-generation sequencing (NGS) we obtained 21 near complete FMDV genome sequences from 12 sub-clinically infected buffalo over a period of one year. Four animals yielded only one virus isolate and one yielded two isolates of different serotype suggesting a serial infection. Seven persistently infected animals yielded more than one virus of the same serotype showing a long-term intra-host viral genetic divergence at the consensus level of less than 2.5%. Quasi-species analysis showed few nucleotide variants and non-synonymous substitutions of progeny virus despite intra-host persistence of up to 152 days. Phylogenetic analyses of serotype Asia-1 VP1 sequences clustered all viruses from persistent animals with Group VII viruses circulating in Pakistan in 2011, but distinct from those circulating on 2008–2009. Furthermore, signature amino acid (aa) substitutions were found in the antigenically relevant VP1 of persistent viruses compared with viruses from 2008–2009. Intra-host purifying selective pressure was observed, with few codons in structural proteins undergoing positive selection. However, FMD persistent viruses did not show a clear pattern of antigenic selection. Our findings provide insight into the evolutionary dynamics of FMDV populations within naturally occurring subclinical and persistent infections that may have implications to vaccination strategies in the region.

Dispersibility and biotransformation of oils with different properties in seawater

Dispersants are used to remove oils slicks from sea surfaces and to generate small oil-droplet dispersions, which may result in enhanced biodegradation of the oil. In this study, dispersibility and biodegradation of chemically dispersed oils with different physical-chemical properties (paraffinic, naphthenic and asphaltenic oils) were compared in natural temperate SW at 13 °C. All selected oils were chemically dispersible when well-known commercial dispersants were used. However, interfacial tension (IFT) studies of the dispersed oils showed different IFT properties of the oils at 13 °C, and also different leaching of the dispersants from oil droplet surfaces. Biodegradation studies of the chemically dispersed oils were performed in a carousel system, with initial median droplet sizes <30 μm and oil concentrations of 2.5-2.8 mg/L. During biodegradation, oil droplet concentrations were rapidly reduced, in association with the emergence of macroscopic 'flocs'. Biotransformation results showed that half-lives of semivolatile total extractable organic carbon (TEOC), single target 2- to 4-ring PAH, and 22 oil compound groups used as input data in the oil spill contingency model OSCAR, did not differ significantly between the oils (P > 0.05), while n-alkanes half-lives differed significantly (P < 0.05). Biotransformation was associated with rapid microbial growth in all oil dispersions, in association with n-alkane and PAH biotransformation. These results have implications for the predictions of biodegradation of oil slicks treated with dispersants in temperate SW.

Red Cell Alloimmunization In Multitransfused Thalassaemia Major Patients

BACKGROUND

Lifelong transfusions are life savers for thalassaemia patients but are associated with many complications. Alloimmunization is a major problem for blood banks. Antigens of foreign red blood cells induce the formation of antibodies in patients suffering from thalassaemia. The purpose of this study was to examine the frequency of red cell alloantibodies and to express the type of these antibodies in thalassaemia patients.

METHODS

Patients that have received multiple transfusions were included in this study. Those with the positive Coombs test (DAT) results were excluded from the study and remaining patients were screened for antibodies. A panel of known blood group antigens was used for the patients who had a positive antibody screening test because they had alloantibodies in their serum. First, three cell panel was applied. If the screen was positive then eleven cell panels was used to identify the specific antibody. Both the cell panels were applied at room-temperature, liss (low ionic strength saline) and coombs phase.

RESULTS

Three hundred & two patients were selected out of which 65.6% (n=198) were males and 34.4% (n=104) females. Patient's age ranged from 1.5 years to 26 years ±5.40 years. All of the patients were given regular red cell transfusion at 2-4 weeks interval. They were given non leukodepleted transfusions. It is not the practice in any thalassaemia Centre in Pakistan to give phenotypically matched blood for Kell, Kidd, Duffy or any other minor group antigens to patients on regular blood transfusion. Alloimmunization was positive in 12 (4.0%) of the 302 patients studied. Male were 66.67% (n=8) and female were 33.33% (n=4). Samples of these positive patients were further tested to determine specificity of alloantibodies. Anti Cw was most common, detected in 4 out of 12 (1.3%) patients. Anti K, k, S and Lua were detected in 2 out of 12 (0.7%) each.

CONCLUSIONS

Thalassemia major patients on regular blood transfusions can develop red cell alloantibodies. Detailed pretransfusion screening would add towards better management of these patients.

Genetic diversity and comparison of diagnostic tests for characterization of foot-and-mouth disease virus strains from Pakistan 2008-2012

We report the laboratory analysis of 125 clinical samples from suspected cases of foot-and-mouth disease (FMD) in cattle and Asian buffalo collected in Pakistan between 2008 and 2012. Of these samples, 89 were found to contain viral RNA by rRT-PCR, of which 88 were also found to contain infectious FMD virus (FMDV) by virus isolation (VI), with strong correlation between these tests (κ = 0.96). Samples that were VI-positive were serotyped by antigen detection ELISA (Ag-ELISA) and VP1 sequence acquisition and analysis. Sequence data identified FMDV serotypes A (n = 13), O (n = 36) and Asia-1 (n = 41), including three samples from which both serotypes Asia-1 and O were detected. Serotype A viruses were classified within three different Iran-05 sublineages: HER-10, FAR-11 and ESF-10. All serotype Asia-1 were within Group VII (Sindh-08 lineage), in a genetic clade that differs from viruses isolated prior to 2010. All serotypes O were classified as PanAsia-2 within two different sublineages: ANT-10 and BAL-09. Using VP1 sequencing as the gold standard for serotype determination, the overall sensitivity of Ag-ELISA to correctly determine serotype was 74%, and serotype-specific sensitivity was 8% for serotype A, 88% for Asia-1 and 89% for O. Serotype-specific specificity was 100% for serotype A, 93% for Asia-1 and 94% for O. Interestingly, 12 of 13 serotype A viruses were not detected by Ag-ELISA. This study confirms earlier accounts of regional genetic diversity of FMDV in Pakistan and highlights the importance of continued validation of diagnostic tests for rapidly evolving pathogens such as FMDV.

Buoyancy effects on the radiative magneto Micropolar nanofluid flow with double stratification, activation energy and binary chemical reaction

A mathematical model has been developed to examine the magneto hydrodynamic micropolar nanofluid flow with buoyancy effects. Flow analysis is carried out in the presence of nonlinear thermal radiation and dual stratification. The impact of binary chemical reaction with Arrhenius activation energy is also considered. Apposite transformations are engaged to transform nonlinear partial differential equations to differential equations with high nonlinearity. Resulting nonlinear system of differential equations is solved by differential solver method in Maple software which uses Runge-Kutta fourth and fifth order technique (RK45). To authenticate the obtained results, a comparison with the preceding article is also made. The evaluations are executed graphically for numerous prominent parameters versus velocity, micro rotation component, temperature, and concentration distributions. Tabulated numerical calculations of Nusselt and Sherwood numbers with respective well-argued discussions are also presented. Our findings illustrate that the angular velocity component declines for opposing buoyancy forces and enhances for aiding buoyancy forces by changing the micropolar parameter. It is also found that concentration profile increases for higher values of chemical reaction parameter, whereas it diminishes for growing values of solutal stratification parameter.

Surgical Outcome of Pancreaticoduodenectomy in Pancreatic and Periampullary Neoplasms

OBJECTIVE

To report the results in the surgical treatment of pancreatic and periampullary neoplasms with emphasis on surgical technique, short-term postoperative outcome and the lessons learnt.

STUDY DESIGN

Case series.

PLACE AND DURATION OF STUDY

This study was carried out at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, from October 2014 to May 2016.

METHODOLOGY

Patients undergoing surgical treatment of pancreatic and periampullary neoplasms were selected. Patients' characteristics including demographics, surgical technique, and 30-day morbidity and mortality were recorded. International Study Group of Pancreatic Fistula (ISGPF) classification was used to define postoperative pancreatic fistula and Clavien-Dindo classification to grade complications.

RESULTS

Atotal number of 65 patients underwent the trial of dissection; 50 had pancreaticoduodenectomy and 15 patients underwent palliative bypass and were excluded from analysis. Sixty-four percent were males and 36% were females. The most common tumor was periampullary (n=29, 58%) followed by pancreatic head (14, 28%) and duodenal tumors (n=07, 14%). Mean age was 52.92 ±13.27 years; mean operating time was 470 ±358.28 minutes and median blood loss was 400 (287-500) ml. Pancreaticogastrostomy (PG) was the preferred reconstruction technique in 37 (74%) verses pancreaticojejunostomy (PJ) in 13 (26%) patients. Four (08%) patients needed portal vein reconstruction and two (04%) replaced right hepatic artery resection and reconstruction due to tumor involvement. There were seven Grade A, and one Grade B and C pancreatic fistulae each. Three patients (06%) needed endoscopic therapy for gastrointestinal hemorrhage from pancreatic stump. There was one death in postoperative period.

CONCLUSION

Pancreaticoduodenectomy is a safe procedure with excellent postoperative outcome, if carried out in a specialized hepato-pancreato-biliary unit. APG reconstruction can be a safer alternative to PJ.

Obesity, Fat Topography And Risk Of Carcinoma Breast

BACKGROUND

Carcinoma breast is most common cancer and the leading cause of cancer related deaths in women, with a multifactorial aetiology. This case control study was aimed at studying the possible link of body fat with the pathogenesis of carcinoma breast.

METHODS

A case control study extending over a period of two years (2015-2016) was conducted in which the body size and shape of 56 carcinoma breast cases was studied against 168 controls who had no breast disease.

RESULTS

Fifty-six women suffering from carcinoma breast had a higher BMI and fat distributed in the abdominal area A high BMI was found to be protective in pre-menopausal women (OR= 0.14 by; 95% CI: 0.02-0.77) while it was a risk factor in post-menopausal women (OR=2.39 by; 95% CI: 1.02-5.55). Waist-to-hip ratio (WHR) of ≥0.9 was associated with an increased risk of carcinoma breast compared to WHR ≤0.8 (OR=3.857 by; 95% CI: 0.875-17.05).

CONCLUSIONS

the results show there is an increased risk of carcinoma breast in women having more fat cantered around the abdomen.

Efficacy of two regimens of dexamethasone for Management of preterm labour: pilot study

BACKGROUND

Dexamethasone is widely used for prevention of respiratory distress syndrome (RDS), necrotising enterocolitis (NEC) and intra-ventricular haemorrhage (IVH) in preterm babies; decreasing the neonatal mortality rate. There is no consensus on the dose of corticosteroid administered to the mother expected to have a preterm baby. This study is conducted to compare the effectiveness of two popular regimens of dexamethasone administration in decreasing incidence of RDS, necrotizing enterocolitis, IVH and neonatal mortality rate.

METHODS

Randomized control trial was conducted at Ayub Teaching Hospital, Abbottabad from 1st to 31st August, 2014. Sample size was set at 50. Block randomization was employed in the trial to allocate the patients into corresponding groups 'A' and 'B'. Group A was administered 6mg dexamethasone in 4 doses 12 hours apart and group B was administered 2 doses 12 hours apart.

RESULTS

Forty-eight patients participated in the study with 24 patients in each group. Mean age and period gestation of participants were 28.4 years±4.3 SD and 34 weeks±1.9 SD respectively. Four patients in group A gave birth to neonate with RDS compared to two cases in group B. Group B had higher incidence of necrotizing enterocolitis and neonatal mortalities. However, none of these differences observed were statistically significant. No case of IVH was reported in either of the groups..

CONCLUSIONS

Both the popular regimens of dexamethasone administration are equally effective in decreasing the incidence of neonatal diseases.

Associations between gender and outcome of acute psychiatric admission, looking specifically at length of stay and type of admission

Introduction

There is little published data regarding the association between gender and outcomes in acute inpatient psychiatry. We present outcomes from a study of 5601 acute psychiatric admissions.

Objective

The objective of this study was to identify associations between gender and outcome of acute psychiatric admission, looking specifically at length of stay and at whether they were detained in hospital.

Methods

The relationship between gender and acute psychiatric inpatient length of stay and detention status was analyzed for all admissions over 90 months from Sept 2002 to Feb 2010. There were 5601 consecutive admissions included in this study, 2862 of which were male and 2739 were female. There were no exclusions. Data was complete for more than 99% of subjects, and was extracted from part of routine service data on an anonymous- basis. The subjects were admitted into two acute inpatient wards in central Norfolk. Data was analyzed using SPSS. Ethics consent was granted by the research ethics committee.

Results

The study showed no significant difference in average length of stay (female = 32.98, male = 32.11; P = 0.595). Additionally, no significant difference was found linking gender to detention status (26% female, 25% male; P = 0.517) as opposed to informal or voluntary admission.

Conclusion

The study found no evidence of a gender bias regarding overall length of stay and legal status in acute admissions. Further research should be conducted in this area to examine whether there is any gender bias in outcomes relating to diagnosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Seroprevalence of foot-and-mouth disease in large ruminants in periurban dairy farms near Islamabad, Pakistan

Background

Foot-and-mouth disease (FMD) is an enzootic viral disease affecting livestock in Pakistan.

Objectives

To determine the seroprevalence of FMD in large ruminants in periurban dairy farms near Islamabad.

Methods

Serum samples were collected from 636 large ruminants during 2011 to 2012; 584 (92%) were buffaloes (Bos bubalis bubalis) and 52 (18%) were cattle (Bos taurus indicus). The population sampled was mainly adult (n = 514) and female (n = 596). Sera were assayed for antibodies against a nonstructural protein of the FMD virus using a Chekit FMD-3ABC bo-ov enzyme immunoassay Kit (Idexx Laboratories). Data were analyzed using a χ2 test and multiple logistic regression.

Results

The seroprevalence of FMD in the ruminants was 46% (n = 293, 95% confidence interval (CI); 42.18- 49.95) and was significantly higher in buffaloes (285, 97%; χ2 = 21.46; P < 0.001) than in cattle (8, 3%). The risk of seropositivity increased significantly with age (χ2 = 72.71; P < 0.001); adult animals were 7.05 times more likely (odds ratio (OR) 7.05, 95% CI 3.60-13.79; P < 0.001) to be seropositive after adjusting for the effect of species. Buffaloes were more likely to be seropositive (OR 3.99, 95% CI 1.78-8.92, P = 0.001). Sex was not significantly associated with FMD seropositivity (OR 0.58, 95% CI 0.17-1.95, P = 0.38).

Conclusions

Large ruminants in periurban dairy farms near Islamabad have a high FMD virus seroprevalence and play a potential role in the persistence and transmission of FMD in Pakistan.

Corneal Complications And Visual Impairment In Vernal Keratoconjunctivitis Patients

BACKGROUND

Vernal kerato-conjunctivitis (VKC) is an infrequent but serious form of allergic conjunctivitis common in warm and humid areas where air is rich in allergens. It affects both eyes asymmetrically. Although VKC is a self-limiting disease but visions affecting corneal complications influence the quality of life in school children. The aim of this study was to list the corneal complications due to this condition and to find out the extent of visual impairment among VKC patients.

METHODS

This cross-sectional study was conducted in the department of Ophthalmology, Benazir Bhutto Shaheed Hospital on 290 eyes of diagnosed cases of VKC. The diagnosis of VKC was made on the basis of history and examination. Visual acuity was recorded using Snellen's notation and visual impairment was classified according to World Health Organization classification for visual disabilities.

RESULTS

The mean age of presentation was 10.83±6.13 years. There were 207 (71.4%) males and 83 (28.6%) females. Corneal scarring was observed in 59 (20.3%) eyes. Keratoconus was found to be in 17 (5.9%) eyes. Shield ulcer was detected in 09 (3.1%) eyes while 07 (2.4%) eyes had corneal neovascularization. Majority of the patients with visual loss had corneal scarring and the complication that led to severe visual loss in most of the eyes was Keratoconus.

CONCLUSIONS

Vernal kerato-conjunctivitis in the presence of corneal complications is a sight threatening disease and can lead to severe visual impairment.

Intravaginal probiotics modulated metabolic status and improved milk production and composition of transition dairy cows

The objective of this investigation was to evaluate whether intravaginal infusion of probiotics (a lactic acid bacteria cocktail) around parturition would influence metabolic status and increase milk production of transition dairy cows. One hundred pregnant Holstein dairy cows were assigned to 1 of the 3 experimental groups receiving intravaginal infusion of probiotics or carrier (i.e., sterile skim milk) once a week at wk -2, -1, and +1 relative to calving as follows: 2 consecutive probiotics before parturition and 1 carrier dose after parturition (TRT1), 3 consecutive probiotics doses around parturition (TRT2), and 3 consecutive carrier doses around parturition (CTR). The probiotics were a lyophilized culture mixture composed of FUA3089 and FUA3138 and FUA3140 with a cell count of 10 to 10 cfu/dose. Blood was sampled from wk -2 to +3 and milk was sampled on the third day in milk (DIM) and from wk +1 to +5 on a weekly basis. Feed intake and milk production was monitored until wk +8. Results showed that the TRT2 group (366.12 ± 49.77 μmol/L) had a lower ( = 0.01) concentration of NEFA in the serum than the CTR group (550.85 ± 47.16 μmol/L). The concentrations of IgG in the milk were 32.71 ± 3.00 mg/mL in the TRT1 group, 17.47 ± 4.54 mg/mL in the TRT2 group, and 6.73 ± 3.43 mg/mL in the CTR group at 3 DIM ( < 0.01). Meanwhile, both the TRT1 and the TRT2 group had lower haptoglobin in the milk compared with the CTR group at 3 DIM ( < 0.01). The TRT1 group had greater milk protein content than the CTR group (2.99 ± 0.04 vs. 2.82 ± 0.04%; = 0.02), whereas the TRT2 group tended to have greater lactose content compared with the CTR group (4.53 ± 0.03 vs. 4.44 ± 0.03%; = 0.05). The effect of treatment interacted with parity with regards to milk production and feed efficiency. Multiparous cows in the TRT1 and TRT2 groups had greater milk production and feed efficiency than those in the CTR group ( < 0.01 and = 0.02, respectively). Among primiparous cows, those in the TRT2 group had greater milk production ( = 0.04) whereas those in the TRT1 group had lower feed intake ( < 0.01) than those in the CTR group. Both the TRT1 and the TRT2 groups had enhanced feed efficiency compared with the CTR group ( < 0.01). In conclusion, intravaginal infusion of lactic acid bacteria modulated concentrations of selected serum metabolites and milk components and increased milk efficiency of transition dairy cows.

Anti-cholinergic and Ca2+-antagonist mechanisms explain the pharmacological basis for folkloric use of Sisymbrium irio Linn. in gastrointestinal, airways and vascular system ailments

ETHNOPHARMACOLOGICAL RELEVANCE

Seeds of Sisymbrium irio Linn has been used traditionally in different regions of Pakistan for the treatment of gastrointestinal, airways and vascular system ailments. To insight the pharmacological basis, in vitro study was conducted in order to validate its folkloric uses.

MATERIAL AND METHODS

70% aqueous-methanolic extract of seeds from S. irio (Si.MEs) was tested on isolated rabbit aorta, jejunum and trachea strip hanged in tissue bath having physiological solutions aerated with carbogen and their responses were measured and recorded via Power Lab.

RESULTS

The Si.MEs exhibited the transient spasmogenic effect (0.01-1.0mg/mL) on spontaneous jejunum contractions, followed by the spasmolytic effect. The addition of atropine resulted in blocking in spasmogenic effect while the spasmolytic effect was originated, suggesting the presence of an antimuscarinic effect. Likewise verapamil, Si.MEs (0.03-5mg/mL) repressed the high concentration K⁺(80mM)-induced contraction and also drifted the Ca²⁺ concentration-response curves toward right (0.3-3.0mg/mL), possibly signifying the Ca²⁺ channel blockade. Furthermore, Si.MEs exhibited nonspecific relaxant effect on carbachol (1µM)- and high concentration K⁺(80mM)-induced tracheal contractions in a way comparable to dicyclomine, suggesting the coexistence of Ca²⁺-antagonistic and/or antimuscarinic properties. Additionally, Si.MEs also relaxed the phenylephrine(1µM)- and high concentration K⁺(80mM)-induced aortic contraction (0.01-3mg/mL), suggesting blockade of Ca²⁺ channel. Moreover, oral administration of Si.MEs, as high as 6g per kg, did not produce lethality among the treated groups of mice.

CONCLUSIONS

Aqueous-methanolic extract of seeds from S. irio (Si.MEs) exhibited the bronchodilator and gut modulator (spasmogenic and spasmolytic) activities, probably through dual blockade of muscarinic receptors and Ca²⁺ channels, whereas, vasodilator effect may be due to Ca²⁺ channels blockade.

Empirical Comparison of Human Behavior and Performance with Different Display Devices for Virtual Environments

Although a wide range of display devices is used in virtual environment (VE) systems, no guidelines exist to choose an appropriate display for a particular VE application. Our goal in this research is to develop such guidelines on the basis of empirical results. In this paper, we present a preliminary experiment comparing human behavior and performance between a head-mounted display (HMD) and a four-sided spatially immersive display (SID). In particular, we studied users' preferences for real vs. virtual turns in the VE. The results indicate that subjects have a significant preference for real turns in the HMD and for virtual turns in the SID. The experiment also found that females are more likely to choose real turns than males. We suggest that HMDs are an appropriate choice when users perform frequent turns and require spatial orientation.

Role Of Symptomatic Treatment In Comparison To Antibiotics In Uncomplicated Urinary Tract Infections

BACKGROUND

Uncomplicated urinary tract infections (UTIs) are the most common bacterial infections among women presenting to primary care causing rapidly increasing strains of resistant bacteria to the growing antibiotic industry. Restricting antibiotics to necessary indications is the only solution. The objectives of the study were to compare the efficacy of symptomatic treatment vs antibiotic in patients with uncomplicated UTI, in terms of individual symptom score, i.e., frequency, urgency, dysuria, supra pubic pain scores and total symptoms scores.

METHODS

A randomized control trial (RCT) in 100 women (15-50 years) with symptoms of urinary frequency, urgency, dysuria and pain supra pubic region, associated with uncomplicated UTI, at Urology department, AMI, Abbottabad. Two treatment strategies were compared in uncomplicated UTI patient). Patients were randomized to antibiotic or symptomatic treatment groups on consecutive non-probability basis (50 in each group) given for 05 days. Efficacy of medications was assessed by comparing pre and post treatment symptom scores along with the post treatment scores of both groups compared to see statistical significance of difference by independent samples t-test.

RESULTS

There was a statistically significant difference in symptoms improvement in both treatment arms of all scores, i.e., p-value=0.000. Whereas only dysuria score was able to show a statistically significance of difference in post Rx scores comparison of both groups, p-value=0.004.

CONCLUSIONS

Symptomatic treatment is not inferior to antibiotic treatment when proper patient selection is undertaken, resulting in decreased need for unnecessary antibiotics use.

Hidden Obligatory Fluid Intake in Critical Care Patients

Introduction:

In addition to the fluid intake in the form of intravenous maintenance or boluses in intensive care unit (ICU) patients, there are sources of fluids that may remain unrecognized but contribute significantly to the overall fluid balance. We hypothesized that fluids not ordered as boluses or maintenance infusions—“hidden obligatory fluids”—may contribute more than a liter to the fluid intake of a patient during any random 24 hours of critical care admission.

Methods:

Patients admitted to the Harlem Hospital ICU for at least 24 hours were included in this study (N = 98). Medical records and nursing charts were reviewed to determine the sources and volumes of various fluids for the study patients.

Results:

The mean hidden obligatory volume for an ICU patient was calculated to be 978 mL (standard deviation [SD]: 904, median: 645) and 1571 mL (SD: 1023, median: 1505), with enteral feeds compared to the discretionary volume of 2821 mL (SD: 2367, median: 2595); this obligatory fluid volume was affected by a patient’s need for pressor support and renal replacement therapy.

Conclusion:

Hidden obligatory fluids constitute a major source of the fluid intake among patients in a critical care unit. Up to 1.5 L should be taken into account during daily decision making to effectively regulate their volumes.

Preparation, characterization and application of Cu–Ni/TiO2in Orange II photodegradation under visible light: effect of different reaction parameters and optimization

A series of mono- and bimetallic Cu–Ni/TiO₂photocatalysts were preparedviawet impregnation. The addition of metal onto the surface of TiO₂led to a better photocatalytic performance for Orange II photodegradation under visible light irradiation.

ARE WE TELLING THE DIABETIC PATIENTS ADEQUATELY ABOUT FOOT CARE?

BACKGROUND

Diabetes mellitus affects more than 285 million people worldwide. The prevalenceis expected to rise to 439 million by the year 2030. Diabetic foot ulcers precede 84% of non-traumatic amputations in diabetics. One lower limb is lost every 30 seconds around the worldbecause of diabetic foot ulceration. Apart from being lengthy, the treatment of diabetic foot is alsovery expensive. There is very limited emphasis on foot care in diabetic patients. Even indeveloped countries patients feel that they do not have adequate knowledge about foot care. Thisstudy was conducted to find out how much information is imparted by doctors to diabetic patientsabout foot care.

METHODS

This cross-sectional study was conducted in admitted patients of theDepartment of Medicine, DHQ Hospital, Abbottabad from May 2014 to June 2015. One hundredand thirt-nine diabetic patients more than 25 years of age were included by non-probability consecutive sampling.

RESULTS

The mean age was 57.17 (±11.1) years. 35.3% of patients weremale and 64.7% were female. The mean duration of diabetes in patients was 8.3 (±6) years. Only36.7% of patients said that their doctor told them about foot care. Less than 40% of patients knewthat they should daily inspect their feet, wash them with gentle warm water, and dry themafterwards. Only 25.2% of the participants knew how to manage corns or calluses on feet. 66.5%of patients knew that they should not walk bare foot. Overall, 63% of our patients had less than50% knowledge of the 11 points regarding foot care that the investigators asked them.

CONCLUSION

Diabetic foot problems are the one of the costliest, most disabling and dishearteningcomplication of diabetes mellitus. Doctors are not properly telling diabetic patients about footcare. There is a deficiency of knowledge among the diabetic patients regarding foot care.

Electromechanical properties of Nb doped 0.76Bi0.5Na0.5TiO3–0.24SrTiO3 ceramic

In this report, the piezoelectric, dielectric and ferroelectric characteristics of 0.76Bi_0.5Na_0.5TiO₃ (BNT)–0.24SrTiO₃ (ST) with niobium (Nb) (Nb-added BNT–24ST) ceramics synthesized by using a solid-state reaction are described.

PREVALENCE AND ASSOCIATED FACTORS OF DENTAL CARIES, GINGIVITIS, AND CALCULUS DEPOSITS IN SCHOOL CHILDREN OF SARGODHA DISTRICT, PAKISTAN

BACKGROUND

According to a pathfinder survey conducted by World Health Organization, dental caries is the single most common chronic childhood disease in Pakistan. The update information regarding dental health of school children of Sargodha district is required to plan community caries prevention programs and for better understanding of existing situation, and may improve longevity, treatment, and care.

METHODS

This cross sectional study was conducted in four randomly selected schools of Sargodha district, stratified by gender selected. Two well-trained dentists examined the oral cavities of children for dental caries, gingivitis, and calculus deposits. The sample consisted of children aged between 3-12 years.

RESULTS

The overall prevalence rate of gingivitis, calculus, and dental caries was found as 14.5%, 14.3%, and 45.9% respectively. A significant association was found between DMFT score (p < 0.001), gingivitis (p < 0.01), and calculus (p < 0.05) with the increase in age of children. More children living in urban area were detected with gingivitis (p < 0.01), calculus (p < 0.01), and dental caries than children residing in rural areas. Incidence of gingivitis (p < 0.05), calculus, and dental caries in primary (p < 0.001) and permanent teeth were found higher in those children who were not brushing their teeth. Experience of dental caries in primary teeth was found higher (p < 0.01) in children who brushed occasionally. Study also showed that none of the children ever visited dentist for treatment.

CONCLUSIONS

The results emphasize the need for initiation of awareness programs to achieve 0 DMFT/df scores.

OPTICAL COHERENCE TOMOGRAPHIC CHARACTERISTICS OF IDIOPATHIC CHOROIDAL NEOVASCULARISATION

BACKGROUND

Idiopathic choroidal neovascularisation (ICNV) is the development of choroidal neovascularisation (CNV) in young adults without any apparent manifestations of primary ocular or systemic diseases We aim to assess characteristics and pathological changes at various stages in ICNV by optical coherence tomography (OCT).

METHODS

We reviewed clinical charts of 40 ICNV eyes and classified them into three stages. Active stage < 1 month, intermediate 1-3 months and cicatricial > 3 months period after initiation of treatment in naïve ICNV eyes. OCT characteristics of these morphological changes were determined. Parameters such as mean volume (MV), central macular thickness (CMT) and neovessels size (thickness and diameter) were analyzed and compared using one -way ANOVA.

RESULTS

We have 12 males and 28 females with a mean age of 30.1 ± 7.80 years. In active stage, heterogenous activity of CNV was observed, along with disrupted RPE layer, surrounded by subretinal fluids and loss of foveal depression. In intermediate stage, CNV reflection appears homogenous with smooth peripheral Retinal pigment epithelium (RPE) lesion and reduction in retinal thickness. In cicatricial stage, OCT presents dome shaped elevation, strong homogenous reflection, absence of subretinal fluids and reformation of foveal depression. We have found that difference in mean volume and choroidal neovessels thickness was statistically significant in the three stages.

CONCLUSIONS

In our study we have concluded that OCT is useful tool for following the clinical course of ICNV and understanding the pathological changes in CNV regression.