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Introduction Tracheostomy, although a common surgical procedure, is associated with potential complications. Complications can be avoided with accurate technique and proper operative and postoperative care. A surgeon should know the complications of the procedure and how to avoid them so that complications may be prevented or minimized. Objective To determine the frequency of complications in patients undergoing elective and emergency tracheostomies. Methods The cross-sectional study was conducted at the Department of Otorhinolaryngology - Head and Neck Surgery, and Intensive Care Unit (ICU) of PIMS Hospital, Islamabad, from March 1 to August 31, 2023, with a total duration of six months. A total of 110 patients admitted to the ICU and presented in an emergency falling within the inclusion criteria were counted in the study. Patients were split into two groups, i.e., elective tracheostomy (group A) and emergency tracheostomy (group B). All patients were followed for three months for adverse events related to the tracheostomy. All information was collected on Proforma and analyzed using the SPSS 23 version (IBM Corp., Armonk, NY). Results The mean age of participants was 48.47±12.68 years in group A and 49.54±10.99 years in group B (p=0.636). 40 (72.7%) and 37 (67.3%) patients were male and 15 (27.3%) and 18 (32.7%) female in groups A and B, respectively. The results of post-operative complications in both groups A and B were observed, respectively, for surgical emphysema (2 [3.6%] vs. 5 [9.1%], p=0.241), hemorrhage (2 [3.6%] vs. 4 [7.3%], p=0.401), wound infection (3 [3.6%] vs. 6 [10.9%], p=0.279), tube blockage (0 [0.0%] vs. 1 [1.8%], p=0.315), tube displacement (0 [0.0%] vs. 3 [5.5%], p=0.079), and tracheoesophageal fistula (0 [0.0%] vs. 2 [3.6%], p=0.154). The overall complications in elective tracheostomies were 7 (12.7%) and in emergency tracheostomies were 21 (38.2%). Conclusion We concluded that patients who had an emergency tracheostomy experienced more postoperative complications than those who underwent an elective tracheostomy.
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INTRODUCTION: The clinical use of intravitreal bevacizumab (IVB), a recombinant humanized monoclonal antibody that functions as an anti-vascular endothelial growth factor (anti-VEGF), has recently increased in patients with retinal ischemic diseases such as proliferative diabetic retinopathy (PDR). The short-term and long-term complications associated with this procedure have not been well established. We aimed to study the possible short-term complication of intraocular pressure (IOP) fluctuations shortly after IVB injection in patients with PDR. MATERIALS AND METHODS: A prospective case series of diabetic patients with PDR who underwent IVB injection was performed in the Department of Ophthalmology, Medical Teaching Institution, Khyber Teaching Hospital, Peshawar, Pakistan, from November 1, 2020, to May 1, 2021. The total number of PDR patients of both sexes included in the study was 101. A slit lamp examination was performed, and IOP readings were recorded before and 30 min after IVB injection using Goldmann applanation tonometry (GAT). IBM Statistical Package for the Social Sciences version 22 for Windows was used to analyze the data. Safety of the procedure, defined as IOP ≤20 mmHg 30 min after IVB injection, was determined and stratified according to sex, age, duration of diabetes, and baseline IOP. A post-stratification chi-square test was applied, and a p-value <0.05 was taken as statistically significant. RESULTS: In this study, 60.4% of the participants were male and 39.6% were female. The age of the patients ranged from 30 to 75 years, with a mean age of 55.66±6.37 years. The mean duration of diabetes among the participants was 7.73±2.94 years and the mean baseline IOP was 15.40±1.77 mmHg. Safety (IOP ≤20 mmHg 30 min after IVB injection) was observed in 90.1% of the patients. CONCLUSION: IVB injections are safe for use in patients with PDR in terms of immediate IOP changes. However, patients with higher baseline IOP (>15 mmHg) are more likely to develop increased IOP post-procedure and prophylaxis may be prudent in such cases.
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Traumatic posterior chamber intraocular lens (PC-IOL) extrusion via a self-sealing scleral tunnel, created for manual small-incision cataract surgery (MSICS), is a rare occurrence that has never been reported before. Usually, the PC-IOL protrudes through a ruptured cornea or falls back into the vitreous after blunt trauma. Here, we present a case of PC-IOL extrusion along the uveal tissue through the scleral tunnel in an 80-year-old woman with a history of MSICS who fell and hit her right eye on the stairs, resulting in sudden and painful loss of vision in the same eye. The IOL, along with necrotic uveal tissue, was removed from the subconjunctival space, and the ruptured scleral tunnel was sutured. After initial management, her best-corrected visual acuity (BCVA) was 6/36 with aphakic spectacle correction. The patient was advised to undergo secondary scleral fixation of the intraocular lens. The scleral tunnel made in MSICS is a potentially weak area, and the PC-IOL can come out through it. Therefore, suturing the scleral tunnel with a non-absorbable nylon 10-0 suture should be considered during MSICS. This provides additional support to the weakened scleral wall.
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Introduction Color vision testing was first seen as a parameter to be tested in the 1700s. Nowadays, it is a well-known phenomenon with significant quality-of-life implications. Structures involved in color vision include the lens, pupil, retinal cone photopigments, and several photoreceptor processes that translate the incoming spectrum of different light wavelengths into a processed colored image. An initial color vision assessment was made simply by comparing the color perception of the individual to that of the examiner. The most commonly used tools to screen for color vision defects today are color plates, such as the Ishihara color plates. In the modern age, smartphones have evolved to become an essential part of our everyday lives with applications such as Eye Handbook, which allow easier access to color vision testing using color plates displayed on smartphone screens. In this study, we compared color vision testing on Android and iOS devices to the standard Ishihara booklet. Materials and methods A cross-sectional validation study was performed on patients presenting to the Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan for six months. The sample size collected was 162 with a 95% confidence interval. The age range of the sample population was kept at 12-70 years. A patient was selected for participation in the study, and a color vision assessment was performed using the Ishihara color plates and Android and iOS smartphones. The collected data was then entered into IBM SPSS (Statistical Package for the Social Sciences) Statistics 25 for analysis, with the p-value being kept at 0.05. Results The sample size was 162, with the gender distribution being predominantly male (69.14%). The average age of the participants was 35.94 (SD = 12.04). The result of the two-tailed paired sample z-testwas not significant based on a p-value of 0.565, indicating the null hypothesis cannot be rejected. This finding suggests the difference between the mean of Ishihara and the mean of the iPhone was not significantly different from zero. Similar results were found for comparisons between Android smartphones and the Ishihara booklet. Conclusions Previous studies conducted showed nearly 60% of subjects with normal color vision correctly identified all colors on standard Ishihara color plates. The two-tailed paired sample t-test conducted in our study showed no significant difference between either of the smartphone groups (iPhone or Android) and the Ishihara booklet group, indicating that smartphones present a viable alternative to standard Ishihara booklet testing. However, there are certain limitations to our study. Different types of smartphone screens present a challenge in standardization while testing color vision, something that is not a problem when using the Ishihara booklet. However, smartphones are more widely available, more versatile, and present far greater ease of access. Both these factors should be considered when comparing the two in future studies.
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Introduction Standard automated perimetry (SAP) is the gold standard of visual field assessment in patients with neuro-ophthalmic conditions. Glaucoma is a progressive optic neuropathy characterized by damage to the ganglion cell complex with corresponding visual field defects and intraocular pressure (IOP) being the only modifiable ocular risk factor. Recent advances in technology have paved the way for remote screening and monitoring of visual field defects with the aid of a computer or tablet-based software. One such personal computer (PC)-based software is 'Specvis', which has shown promising reliability as compared to SAP. The primary objective of this study was to compare Specvis and Humphrey Field Analyzer (HFA) visual field reports in the graphical domain while secondary objectives were to estimate the ease of use of Specvis in comparison to HFA and comparison of test duration between Specvis and HFA. Materials and methods This was a cross-sectional validation study performed at a tertiary care ophthalmology institute in Rawalpindi, Pakistan. Subjects presenting to the outpatient department were recruited based on consecutive sampling technique and were divided into healthy and diseased groups. Basic data collection instrument after informed consent was filled with demographic data, ophthalmic data, disease condition, and attached with analysis reports of both HFA and Specvis for assessment by three senior ophthalmology consultants independently. A total of 218 eyes of 109 subjects were included in this pilot study. SAP was done on the VF 30-2 program using HFA 3. The same patient then performed the visual field assessment on a PC with Specvis installed and settings adjusted to match the VF 30-2 program of HFA as closely as possible. Visual fields of a subject obtained from HFA and Specvis were then coupled and sent to three different senior ophthalmologists. The assessment was done by comparing the greyscale visual field printouts in the graphical domain and scored based on a 5-point Likert scale which were then analyzed for inter-observer reliability. After each test, all subjects were asked to rate the difficulty level of performing the test on HFA and Specvis based on a 5-point Likert scale. The duration of the test performed on HFA and Specvis was also noted for comparison. Results We observed male preponderance in our study participants (n=128, 58.72%). The majority of the participants were non-diseased (n=170, 77.98%) while advanced glaucoma was the commonest disease in the diseased group (n = 22, 10.09%). The mean age of the participants was 40.71 (SD=15.24). The observations for the HFA test duration had an average of 213.33 seconds (SD=33.49, Min=174.00, Max=314.00) while the Specvis test duration had an average of 267.36 seconds (SD=35.98, Min=228.00, Max=370.00). A significant positive correlation was observed between score 1, score 2, and score 3 given by the three ophthalmologists. A significant negative correlation was observed between ease of using HFA and age, with a correlation of -.28. A significant negative correlation was also observed between ease of using Specvis and age. Conclusion Specvis, a computer-based free open-source software used in our study, can give promising results in diagnosing as well as monitoring the progression of visual field defects. It can act as a significantly cost-effective and readily available bridge between visual field examination by confrontation method and SAP.
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Objective The objective of this study is to assess the relationship between the site of tympanic membrane (TM) perforation and the type and degree of hearing impairment. The secondary objective was to compare the duration of the disease and the degree of hearing loss. Study design This is a prospective observational study. Place and duration of the study This study was carried out in the Department of Otolaryngology/Head and Neck Surgery at the Pakistan Institute of Medical Sciences, Islamabad, from May 2021 to April 2022. Patients and methods Of all the screened patients, 77 fulfilled the inclusion criteria. Patients aged 10-40 years with inactive mucosal chronic otitis media and unilateral perforation in one quadrant were included. The site of TM rupture was observed, and audiometric analysis was performed. Results The mean age of participants was 25 ± 8.61 years, with a preponderance of the female gender (57.1%). A total of 32 (41.6%), 19 (24.7%), 19 (24.7%), and seven (9.1%) perforations involved posterosuperior, anterosuperior, anteroinferior, and posteroinferior quadrants respectively. Conductive, mixed, and sensorineural hearing loss was found in 52 (67.5%), 18 (23.4%), and seven (9.1%) cases, respectively. Of all the subjects, 13 (16.9%) had the disease for < one year, 39 (50.6%) for one to five years, 17 (22.1%) for five to 10 years, and eight (10.4%) for > 10 years. There was a statistically significant association between the degree of hearing loss and the site of perforation. No significant association was found between the site of perforation and the type of hearing loss. Duration of disease and degree of hearing loss also had no significant association. Conclusion The extent of hearing loss was found to be directly influenced by the anatomical site of perforation, with the posterosuperior quadrant perforation producing the greatest degree of impairment.