Objectives: The purpose of this study was to compare the use of subconjunctival injection of fluconazole (2 mg/ml) with topical amphotericin B (0.5 mg/ml) eye drops in dealing with cases of fungal corneal ulcer

Background: Fungal corneal ulcer is the most devastating eye infections which may cause loss of vision in severe cases, more commonly in the countries which are developing.

Materials and Methods: This study was carried out on 74 eyes of 74 patients with resistant corneal ulcers attending the outpatient clinic of department of Ophthalmology Ayub Teaching Hospital Abbottabad between January 2020 and June 2021.

Results: Group 1 included 37 cases treated with topical amphotericin B; the study showed amelioration of keratitis in nine cases (24%), and 28 cases (76%) developed complications. Group 2 included 37 cases treated with subconjunctival fluconazole injection; the study revealed statistically noteworthy result (P < 0.01) of amelioration of keratitis in 34 cases (92%), and in three cases (8%) complications developed.

Conclusion: Fungal corneal ulcer is the most devastating ocular infection and is a challenge

Objectives: The purpose of this study was to compare the use of subconjunctival injection of fluconazole (2 mg/ml) with topical amphotericin B (0.5 mg/ml) eye drops in dealing with cases of fungal corneal ulcer Background: Fungal corneal ulcer is the most devastating eye infections which may cause loss of vision in severe cases, more commonly in the countries which are developing. Materials and Methods: This study was carried out on 74 eyes of 74 patients with resistant corneal ulcers attending the outpatient clinic of department of Ophthalmology Ayub Teaching Hospital Abbottabad between January 2020 and June 2021. Results: Group 1 included 37 cases treated with topical amphotericin B; the study showed amelioration of keratitis in nine cases (24%), and 28 cases (76%) developed complications. Group 2 included 37 cases treated with subconjunctival fluconazole injection; the study revealed statistically noteworthy result (P < 0.01) of amelioration of keratitis in 34 cases (92%), and in three cases (8%) complications developed. Conclusion: Fungal corneal ulcer is the most devastating ocular infection and is a challenge

Background: Diabetic retinopathy (DR) is a leading cause of preventable visual impairment and blindness among adults and older people with diabetes. Identifying key determinants of DR is essential for risk stratification, targeted prevention, and optimal resource allocation. Objective: To synthesize current evidence on socio-demographic, clinical, biochemical, behavioral, and health‑system determinants of DR among adults and elderly individuals with diabetes. Methods: A narrative review of observational studies, large screening cohorts, and systematic reviews was conducted. Evidence was organized into major determinant domains: (1) socio-demographic factors; (2) diabetes‑related clinical characteristics; (3) comorbidities and biochemical markers; (4) lifestyle and behavioral factors; and (5) health‑system and self‑care–related determinants. Emphasis was placed on factors consistently associated with presence, severity, or progression of DR in adults and older adults with type 1 or type 2 diabetes.

Results: Longer duration of diabetes, poor glycemic control (elevated HbA1c and fasting plasma glucose), and hypertension emerged as the most consistent determinants of DR and its progression. Additional clinical determinants included dyslipidemia, albuminuria and impaired renal function, anemia, and coexisting microvascular complications such as nephropathy and neuropathy. Socio-demographic characteristics (older age, male sex, and low socioeconomic status) were associated with higher DR risk in many but not all studies. Behavioral and health‑system determinants, including smoking, physical inactivity, poor adherence to therapy, lack of home glucose monitoring, limited exposure to diabetes education, and irregular clinic follow‑up, were linked to higher DR prevalence or more advanced disease. Conclusions: Determinants of DR among adults and elderly individuals with diabetes are multifactorial and interrelated. Integrating tight glycemic and blood pressure control with regular retinal screening, management of renal disease and anemia, structured patient education, and targeted support for socioeconomically disadvantaged groups is critical to reducing the burden of DR in aging diabetic populations.

Background: Postoperative pain after lower abdominal surgery contributes to delayed mobilization, opioid-related side effects, and patient dissatisfaction. Ultrasound-guided transversus abdominis plane (TAP) block and local wound infiltration are two widely practiced regional analgesic techniques whose comparative efficacy remains debated. Objective: To compare the analgesic efficacy of ultrasound-guided TAP block with local wound infiltration in patients undergoing elective lower abdominal surgery under spinal anaesthesia. Methods: In this prospective, randomized, observer-blinded study, 80 ASA I-II patients aged 18-60 years undergoing elective lower abdominal surgery were randomized to receive either a bilateral ultrasound-guided TAP block (Group T, n=40) or local wound infiltration (Group W, n=40), each with 20 mL of 0.25% bupivacaine per side. Postoperative pain was assessed using a visual analogue scale (VAS) at 0, 2, 4, 6, 12, and 24 hours. Time to first rescue analgesia, 24-hour tramadol consumption, postoperative nausea and vomiting (PONV), complications, and patient satisfaction were recorded. Results: Baseline demographic and surgical characteristics were comparable between groups. Group T had significantly lower VAS scores than Group W at 2, 4, 6, 12, and 24 hours (p<0.001 at all time points). Time to first rescue analgesia was significantly longer in Group T (342.5 ± 58.4 min) than Group W (168.7 ± 41.2 min; p<0.001), and 24-hour tramadol consumption was significantly lower in Group T (142.5 ± 32.6 mg vs 218.4 ± 38.9 mg; p<0.001). PONV was numerically lower in Group T (10% vs 22.5%; p=0.13), and patient satisfaction was significantly higher in Group T (87.5% vs 60% rating good/excellent; p=0.005). No block-related complications were recorded in either group. Conclusion: Ultrasound-guided TAP block provides superior, more sustained postoperative analgesia than local wound infiltration after lower abdominal surgery, with reduced opioid requirement and greater patient satisfaction, and should be considered a valuable component of multimodal analgesia where feasible.

Background: Insulin resistance is a key pathophysiological mechanism underlying type 2 diabetes mellitus, metabolic syndrome, and cardiovascular diseases. Recent evidence suggests that elevated serum uric acid (SUA) may contribute to the development of insulin resistance through oxidative stress, endothelial dysfunction, and chronic inflammation. Objectives: To assess the association between serum uric acid levels and insulin resistance among adults and to determine the relationship between SUA and metabolic parameters. Materials and Methods A hospital-based cross-sectional study was conducted among 150 adults aged 25–60 years. Anthropometric measurements, fasting plasma glucose, fasting serum insulin, lipid profile, and serum uric acid levels were measured. Insulin resistance was assessed using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Participants were categorized into tertiles according to serum uric acid levels. Statistical analyses included Pearson correlation, one-way ANOVA, and multiple linear regression. Results

Mean HOMA-IR values increased significantly across increasing tertiles of serum uric acid (p<0.001). Serum uric acid showed a significant positive correlation with fasting insulin (r=0.54), HOMA-IR (r=0.62), BMI (r=0.48), and triglycerides (r=0.45). Participants with hyperuricemia demonstrated significantly higher insulin resistance compared with normouricemic individuals.

Conclusion Elevated serum uric acid is significantly associated with insulin resistance and adverse metabolic parameters. Serum uric acid may serve as a useful biochemical marker for identifying individuals at risk of metabolic syndrome and type 2 diabetes mellitus.

Introduction: Dry Eye Disease (DED) is a multifactorial disorder of the ocular surface characterized by loss of tear film homeostasis and accompanied by ocular symptoms. Increased use of digital devices has emerged as an important risk factor for DED due to prolonged visual tasks and reduced blink rate. Objectives: To determine the prevalence of Dry Eye Disease among digital device users attending a tertiary care hospital and to identify associated risk factors. Materials and Methods A hospital-based cross-sectional study was conducted among adult digital device users attending the ophthalmology outpatient department of a tertiary care hospital. Participants underwent detailed ophthalmic evaluation including Ocular Surface Disease Index (OSDI) questionnaire, Tear Break-Up Time (TBUT), Schirmer's test, and slit-lamp examination. Demographic characteristics, duration of digital device use, environmental exposures, and systemic comorbidities were recorded. Data were analyzed using appropriate statistical methods, and associations between risk factors and DED were evaluated. Results A total of ___ participants were included. The prevalence of DED was ___%. Higher prevalence was observed among participants using digital devices for more than 6 hours/day, females, contact lens users, and individuals exposed to air-conditioned environments. Significant associations were found between DED and prolonged screen exposure, reduced blinking frequency, and existing ocular surface disorders (p < 0.05). Conclusion Dry Eye Disease is highly prevalent among digital device users. Prolonged screen exposure and environmental factors are major contributors. Early screening, ergonomic modifications, and preventive strategies may reduce disease burden.

Background: Comfort, treatment success, and post-procedure recovery all depend on effective pain control during interventional radiological procedures. Despite its prevalence, general anesthesia (GA) is riskier and more resource-intensive than other options. The use of ultrasound to guide nerve blocks has recently become a popular non-invasive method for providing localized pain relief. The purpose of this research was to evaluate the relative merits of general anesthesia and ultrasound-guided nerve blocks in alleviating discomfort associated with interventional radiology treatments. Methods: This prospective comparative study included 40 patients undergoing interventional radiological procedures. Patients were divided into two groups: Group A (n=20) received ultrasound-guided nerve blocks, and Group B (n=20) received general anesthesia. Pain intensity was assessed using the Visual Analog Scale (VAS), and additional parameters such as procedure duration, recovery time, analgesic requirement, and complications were recorded. Statistical analysis was performed using independent t-test and chi-square test, with p<0.05 considered significant. Results: In comparison to the GA group, the UGNB group had a significantly reduced mean intraoperative VAS score (2.1 ± 0.9) (p<0.01). The UGNB group also had lower scores for postoperative discomfort (2.5 ± 1.1 vs 4.2 ± 1.3, p<0.01). Nerve block patients had a considerably quicker recovery time (45.6 ± 10.2 minutes) than general anesthetic patients (92.4 ± 15.6 minutes, p<0.001). The UGNB group had less side effects, including nausea and respiratory depression, and required fewer extra analgesics. Conclusion: Opting for ultrasound-guided nerve blocks instead of general anesthesia for interventional radiology treatments allows for more effective pain control, quicker recovery, and fewer problems. For certain patients, UGNB offers a viable alternative that is both safe and effective.

Introduction Maintaining apical patency during root canal therapy remains controversial. While it may aid in debris removal and reduce apical blockage, it has also been implicated in postoperative pain due to potential extrusion of irritants. This study evaluates the effect of apical patency on postoperative pain in patients undergoing root canal therapy. This study seeks to clarify the impact of apical patency on postoperative pain in a well-defined clinical population. Materials and Methods: This was a prospective, randomized clinical study conducted at the Department of Conservative Dentistry and Endodontics, involving 100 patients requiring primary root canal treatment in single-rooted teeth. Patients were randomly assigned into two groups of 50 each: Group A (Patency Group): Apical patency maintained using a #10 K-file extended 0.5–1 mm beyond the working length during cleaning and shaping. Group B (Non-Patency Group): Apical patency was not maintained; instrumentation remained strictly within the canal length. Patients recorded their pain levels using a 10-point Visual Analog Scale (VAS) at 6 hours, 24 hours, 48 hours, and 7 days post-treatment. Flare-ups were defined as severe pain or swelling. Results: Group A consistently reported higher pain scores than Group B at 6 and 24 hours postoperatively, with statistically significant differences (p < 0.05). By 48 hours, the difference in pain scores between the groups became statistically non-significant. At 7 days, both groups had nearly negligible pain, indicating full recovery. A larger percentage of patients in Group A experienced moderate-to-severe pain (VAS ≥ 4) at early time points, especially at 6 hours (30% in Group A vs. 8% in Group B). By 24 hours, this difference narrowed but remained evident. At 6 hours: 30% of Group A had moderate-to-severe pain vs. only 8% in Group B. At 24 hours: 16% of Group A reported pain vs. just 4% in Group B. Females in Group A reported higher pain (VAS 4.7) than males (VAS 4.5) at 6 hours. Females in Group B reported lower pain (VAS 2.8) than males (VAS 3.0). Group A experienced a greater absolute drop in pain (VAS reduced from 4.6 to 0.4) compared to Group B (2.9 to 0.3). Conclusion: Apical patency is associated with increased early postoperative pain but does not influence long-term pain. Clinicians must weigh its mechanical benefits against short-term discomfort.

Facing this problem, we prepared an oral oxygenating airway device, to maintain an open unblocked airway in addition to adequate oxygenation, in the early recovery period for patients undergoing nasal surgery. Our device (Fig 1,2) is an oral airway size 4 or 5 with a siliconised soft endotracheal tube (ETT) size 5.5 mm fixed alongside the airway with its bevel directed laterally to provide easy insertion of the airway. The distal end of the ETT is cut 4-5 cm from the airway to be connected to a breathing circuit through a 15 mm connector or connected directly to tubing of oxygen flow-meter supplying humidified oxygen at a low flow rate of 1-2 L/minute to provide FIO2 35- 40%. This device was tried successfully in 54 patients scheduled to septoplasty and rhinoplasty.

The concept of empowerment, which has been around for decades, also seems to be enjoying a renaissance, being one of the current buzzwords in ‘modern’ health care. Other buzz phrases, among many, include ‘freedom of choice’, ‘equity’, ‘right to participation’, ‘increased role of the consumer.’ Empowerment, theoretically, enables new customers to stand up for themselves, demand their therapeutic rights and choose their own treatment. Fine when you are well. However, should I develop a serious illness, particularly one in which I have no great expertise, and because I cannot conceivably amass the entire body of medical knowledge before I see the doctor or nurse about my condition, I would prefer the physician/nurse to outline the treatment plan. I do not want to be called a client, customer or punter, because such derisory terms are more apt to make me feel, ironically, ‘disempowered’.

The Clinical Assessment of Skills and Competencies (CASC) is the final examination towards obtaining the Membership of the Royal College of Psychiatrists (MRCPsych). It assesses skills in history taking, mental state examination, risk assessment, cognitive examination, physical examination, case discussion and difficult communication.1 The CASC is the only clinical examination, having replaced the earlier format, which had clinical components at two stages.

Problem Based learning (PBL) has redefined the role of a tutor, from being a teacher in the traditional ‘pedagogy’ style of learning to a facilitator in the ‘andragogy’ approach. This has often led to ‘tutor difficulties’ in accepting, and adapting to this transition. Faculty training remains critical for successful implementation of a PBL based curriculum, and considerable resources are exhausted in teaching new tutors the art of facilitating a PBL group. The aim of this article is to explore the concept that a PBL tutor coming from a PBL background may be beneficial compared to faculty training, and this concept is supported by a literature review that identifies common characteristics between a PBL student and a PBL tutor.

Sudden death is known to occur in patients with primary cardiac tumours; however, it is rare and is estimated to constitute 0.005% of all sudden deaths. We report here two cases of sudden death that occurred in patients with left atrial myxoma. We also present a brief review of available literature on this subject

Aorto-enteric fistulas are a rare cause of gastrointestinal (GI) bleeding. The high mortality associated with this condition and relatively low incidence make this a diagnostic and management challenge. This case report describes a classic presentation of such a case along with a discussion on the diagnosis and treatment of this condition. We hope that this will be a clinical reminder to all physicians particularly those involved in managing GI hemorrhage in an acute medical take.

Extrinsic oesophageal compression from vascular structures usually remains asymptomatic. Occurrence of dysphagia is an uncommon problem. We present a rare case of dysphagia lusoria from right sided aortic arch presenting as pill-induced oesophagitis caused by a testosterone pill. A thorough literature review on both the conditions is then presented to address pathogenesis, diagnosis, and management.

Acute lung injury is a syndrome with a diagnostic criteria base on hypoxaemia and a classical radiological appearance, with acute respiratory distress syndrome at the severe end of the disease spectrum. Its incidence is common, it is likely to exist outside the intensive care setting and therefore is a condition relevant to all clinicians. Genetically predisposed individuals are subject to environmental triggers which can be intra or extrapulmonary in nature. An inflammatory response causes damage to alveolar epithelial cells and vasculature, impairing gas exchange and can lead to multiple organ failure. Management centres around supportive care and treating the cause, but evidence supports use of low tidal volume ventilatory settings and conservative intravenous fluid strategies. Long term outcomes are related to neuromuscular, cognitive and psychological issues rather than pulmonary, and rehabilitation during recovery needs to focus on this.