Tanveer Anjum Chaudhry

Retinopathy of prematurity: an evaluation of existing screening criteria in Pakistan

Aim To evaluate if broadening the criteria for retinopathy of prematurity (ROP) screening to include babies with gestational age ≥32 weeks and/or birth weight ≥1500 g, would have an impact on the number of babies diagnosed as having ROP. Methods A prospective cohort study was carried out at the Aga Khan University Hospital, Karachi, Pakistan. Infants with gestational age ≤35 weeks or birth weight ≤2000 g born in this hospital from May 2010 to December 2012 were screened for the presence of ROP 4–6 weeks after birth. Subsequent examinations were performed at intervals based on the findings of initial eye examinations. Infants diagnosed as having ROP were treated with argon laser therapy. Neonatal risk factors were also assessed. Cumulative incidence of ROP was calculated for babies falling within and outside current screening criteria. Multivariate logistic regression analysis was performed to examine the predictors of ROP. Results A total of 301 infants were screened: 27 (9%) babies developed ROP, of which 19 had stage 3 ROP or worse. None of the babies falling outside the current screening criteria developed ROP. The incidence of ROP in the infants meeting the current screening criteria was 11.5%. Multivariate logistic regression analysis showed that only gestational age (adjusted relative risk 0.774, 95% CI 0.603 to 0.994) was independently associated with the development of ROP. Conclusions In our population ROP was not seen to occur in infants older than 32 weeks gestational age and/or weighing more than 1500 g.

Knowledge of patients’ visual experience during cataract surgery: a survey of eye doctors in Karachi, Pakistan

BackgroundSeveral recent studies have recommended that ophthalmologists must be aware of the visual sensations (and their associated anxiety/fear) experienced by patients undergoing cataract surgery. We assessed the knowledge of a group of eye doctors in Pakistan regarding these phenomena.MethodsThis was a cross-sectional survey. Eye doctors (ophthalmologists, residents and medical officers) attending the Ophthalmological Society of Pakistan Annual Conference 2011, in Karachi were invited to participate in the study. A self-administered structured questionnaire was used to examine their knowledge of visual sensations and their associated anxiety/fear experienced by patients during cataract surgery. Simple frequencies and proportions were calculated to describe the data.ResultsA total of 150 ophthalmologists, residents and medical officers were invited to participate in the study. Of these, 68 (45.3%) responded. The mean age (±SD) of the participants was 42.9 (13.2) years. The proportion of participants who thought that patients could experience visual sensations during cataract surgery under regional anaesthesia was 89.7% and that under topical anaesthesia was 73.5%. The most frequently cited sensations included: light perception, changes in light brightness, movements, instruments and surgeon’s hands or fingers.The eye doctors estimated that 38.9% and 64.3% patients would see at least something during cataract surgery under regional anaesthesia and topical anaesthesia, respectively. They also believed that 24.2%-36.9% of patients may experience anxiety/fear as a result of visual sensations during such surgery. Approximately half of the eye doctors did not think that retained vision was a source of fear or anxiety for the patients. While most of them acknowledged the importance of preoperative counselling in helping to alleviate such fear/anxiety, the majority of them did not regularly counsel their patients on what to expect during the surgery.ConclusionOur study reveals that a significant proportion of eye doctors do not have adequate knowledge of the visual phenomenon and their associated anxiety or fear, that patients can experience during cataract surgery. Targeted educational interventions are needed to increase awareness of this phenomenon among eye care professionals.

Failure of chemotherapy in the first reported cases of Acanthamoeba keratitis in Pakistan

Abstract Acanthamoeba keratitis is a painful and progressive infection of the cornea that can result in loss of vision. Here, for the first time in Pakistan, we report two cases of Acanthamoeba keratitis. The first patient was a 37-year-old female who presented with severe itching, redness, pain, along with loss of vision. The patient was a regular soft contact lens wearer. The second patient was a 25-year-old female who had been using soft contact lenses for the past two years. She presented with a burning sensation and extreme pain, along with loss of vision. Both patients were treated for a possible microbial keratitis with topical moxifloxacin hydrochloride drops, vancomycin drops, propamidine isethionate ointment, amphotericin B drops, and amikacin drops. However, the response was inadequate and both patients were referred for corneal transplant. Acanthamoeba castellanii was isolated by placing contact lenses and contact lens cases on non-nutrient agar plates containing a lawn of non-invasive Escherichia coli K-12 HB101 bacteria. The polymerase chain reaction (PCR) using genus-specific probes confirmed the identity of Acanthamoeba spp., whereas the morphological characteristics of trophozoites and cysts were suggestive of A. castellanii in both cases. With growing use of contact lenses for vision correction/cosmetic use coupled with sub-standard lens care in this region and the possibility of non-contact lens-associated Acanthamoeba keratitis, a need for increased awareness of this sight-threatening infection is discussed further.

Contact lens use and its compliance for care among healthcare workers in Pakistan.

Background: Poor care and hygiene of contact lens (CL) results in eye problems and infections. Healthcare workers have an important role in advocating correct lens care. Objectives: To determine the practices of CL care and the adverse consequences of poor CL care among healthcare workers. Setting and Design: A cross-sectional study in one public and three private sector hospitals in Karachi, Pakistan, in 2009–2010. Materials and Methods: We questioned 500 healthcare workers of all ages and both sexes, who wore CL, about compliance with advice on care and any complications due to improper hygiene practices. Ethical approval was obtained. Chi-square tests were used to determine significance and p-value less than 0.05 was considered statistically significant. Results: Of the total CL users, 385 (77%) were females. Most (75%) respondents wore CL to correct myopia, whereas 54% wore CL only occasionally. Surprisingly, only 24% knew the CL cleaning protocol. Lens solution was changed daily by 33% of users and after more than 2 weeks by 42%. Although 412 (82%) participants practised reasonable hand hygiene before inserting CL, 88 (18%) did not. Infection and eye dryness were statistically significantly (P < 0.01) associated with sex, hand-washing, and frequency of CL use. Conclusion: Noncompliance with the CL protocol was common among healthcare workers in our society. This behavior calls for targeted health education and awareness programs for healthcare workers.

Prevalence of vitamin A deficiency in socioeconomically disadvantaged localities in Quetta, Pakistan.

type lectins, disintegrins and phospholipase A2. Different components of the venom may be measurable at different time points. This may explain the relatively short half-life of the venom initially and longer half-life later. The small proteins may be excreted first at faster rates, followed by high molecular weight proteins that are cleared slowly. These long half-life proteins probably contribute to platelet stimulation, agglutination and sequestration, as persistent plasma venom is associated with prolonged thrombocytopaenia, although coagulation defects are already normalized. In addition, we observed that the onset of thrombocytopaenia was later than that of prolonged VCT. These data suggest that fibrinogen and platelet destruction are mediated by different components of the venom. In conclusion, this is the first study on GPV venom kinetics in humans. The clearance of venom was found to be slower than those of cobra and Russell’s viper. Haemostatic abnormalities were not associated with initial venom antigenaemia but were caused by prolonged venom exposure from delayed clearance and/or re-absorption. Therefore, antivenom should be considered in patients with delayed or long-lasting coagulopathy.