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Background: Pterygium is a progressive fibrovascular tissue that affects the conjunctiva and cornea. The aim of the study was to compare the efficacy of Sub-conjunctival injection of Mitomycin C versus Bevacizumab in pterygium treatment focusing on their impact on recurrence rates to improve postoperative outcomes. Methods: The Randomized clinical trial was conducted in the Ophthalmology department of Ziauddin University over 8 months. 54 patients aged above 18 with grade 2 or 3 pterygium were divided into 2 groups of 27. Group A received a Subconjunctival injection of Mitomycin C while Group B received Bevacizumab. Patients were monitored at 1st and 3rd week post injection followed by pterygium excision 1 month later. The postoperative follow-up was conducted at the 1st, 3rd, and 6th months to assess improvement in symptoms and recurrence. The data was analyzed using SPSS version 23; the Chi-square test and Paired T-test were applied with a significance level of p < 0.05. Results: The study analyzed data from 54 patients with pterygium, having a mean age of 42.03±8.23 years, with a male-to-female ratio of 3:1. The common symptoms were Redness (40.74%), itching (27.8%), and decreased visual acuity (31.4%). Post-injection outcome in terms of pterygium vascularity and thickness was better in group B. The recurrence rates at the 6th-month post excision were 1 (7.4%) and 3 (18.5%) in group B. Conclusion: Mitomycin C as an adjuvant treatment demonstrates superior efficacy in reducing pterygium recurrence and improving postoperative vision, compared to Bevacizumab.

OBJECTIVE: The purpose of our research was to analyze and compare the outcome of Endonasal Endoscopic (EE-DCR) versus Endoscopic Trans-canalicular Laser assisted Dacryocystorhinostomy (TC-DCR) for the treatment of Dacryocystitis METHODOLOGY: This study was a non-randomized control trial executed by the Department of Ophthalmology in collaboration with the Otorhinolaryngology (ENT) department at Ziauddin University Hospital Karachi. The study spanned two years, from August 2021 to July 2023. All patients were selected based on inclusion criteria, presented with complaints of epiphora in the ophthalmology department, and were assessed clinically by an ophthalmologist and ENT surgeon. The data was compiled in SPSS 23, and comparative data was analyzed using a chi-square test. RESULTS: In this research, we analyzed and compared the functional and anatomical outcomes of EE-DCR versus TC-DCR. The mean age of participants was 39.4± 2.3 years in both groups. In the EE-DCR group, there were 15 men (26.3%) and 42 women (73.7%), while in the TC-DCR group, there were 13 men (22.5%) and 27 women (67.5%). The outcome for TC-DCR was successful in 90% of cases, slightly higher than 84.2% for EE-DCR. CONCLUSION: TC-DCR is considered a better surgical approach than EE-DCR because it is minimally invasive, safe and less time-consuming. The outcome of both procedures was assessed postoperatively in terms of functional and anatomical success rate, and TC-DCR showed slightly better results.

Abstract Objective: Our study aims to assess the efficacy of a low dose of atropine (0.01%) in slowing the progression of myopia. Method: This prospective randomized controlled trial was conducted in the Ophthalmology department of Ziauddin University Hospital, Karachi. The study spanned a duration of four years, from July 1 2019 to June 30, 2023. A group of individuals presented at the eye outpatient department (OPD) with complaints of blurred vision underwent clinical examination and were diagnosed with myopia based on inclusion criteria. Data was collected and analyzed using SPSS 23, with the paired t-test employed for variable comparisons. Results: Our study analyzed and compared the results of the interventional group, where atropine eye drops (0.01%) were administered daily at bedtime, with the control group, which received Tear Natural II eye drops as a placebo. Patients were followed for three years, with two years dedicated to observing treatment responses and a one-year washout period for the drug. A comparison of baseline and 24-month means revealed an increase in myopia of 0.84 in the interventional group and 1.55 in the control group. Conclusion: Myopia is one of the leading causes of the development of sight-threatening conditions. Its progression can be slowed down by proper treatment with Atropine. The 0.01% dosage of atropine exhibited a favourable risk-benefit profile with minimal impact on visual function.

Background: Ocular surface foreign bodies are the second most common emergency condition in the ophthalmology department OPD, which can be easily prevented through proper precautionary measures. Also, they can be either superficial or embedded into the cornea or conjunctiva. In this study, we aimed to create awareness regarding the prevention and management of such cases to reduce ocular complications. Methods: This prospective cross-sectional study was carried out in the Ophthalmology department of Ziauddin University Hospital Karachi. The study duration was 4 years from 16th November 2019 to 15 November 2022. Patients presented to the ophthalmology department OPD with complaints of ocular foreign bodies were examined clinically and a total of 427 patients were included in the study who fulfilled the inclusion criteria. The data was collected and analyzed on SPSS 23. The chi-square test was used to compare the variables. Results: Our study analyzed that ocular surface foreign bodies had a strong association with the profession. The metallic foreign bodies were found in 283(66.3%) patients and the remaining 144 (37.7%) were non-metallic. There was a strong correlation found between the type of foreign body and the site of ocular involvement. The p-value was significant with 0.0001. Conclusion: The majority of ocular surface foreign bodies were workplace-related due to a lack of awareness of protective measures. A counseling workshop should be arranged regarding its importance for workers in their workplaces which will improve their work capacity, and health and reduce economic burden.

Background: Compared with the general population, patients with diabetes mellitus (DM) usually show higher platelet reactivity, which increases their risk of atherothrombotic events, such as acute coronary syndrome, during the percutaneous coronary intervention (PCI). Endothelial nitric oxide synthase (eNOS) gene polymorphisms have been associated with many diseases, but their role as risk factors of coronary artery disease (CAD) in DM is yet unknown. Although acetylsalicylic acid and clopidogrel are prescribed individually or in combination for high-cardiovascular risk patients with overall improvements in outcomes, DM patients are still at greater risk of recurrent ischemic events. Objective: This study was conducted to determine the effect of DM on the association of e-NOS polymorphisms with clopidogrel resistance in patients with CAD undergoing PCI. Methods: Three-hundred twenty-four of CAD patients were recruited in this case-control study. All patients were subjected to platelets function test within at least two hours before PCI techniques to determine the clopidogrel resistance first then classified accordingly to clopidogrel resistance group (case group n=111) and non-clopidogrel resistance group (control group n=213). Each group was subdivided into a diabetic patient’s group and nondiabetic patients’ group. Blood samples were taken for genotyping analysis and phenotyping determination by measuring the level of nitric oxide in the plasma via colorimetric method. The genotype analysis was carried using allele-specific polymerase chain reaction based on the banding pattern on gel electrophoresis(GEP) to evaluate whether genetic e-NOS polymorphisms (T786C, exon 7 G894T and intron 4 (4a4b) affect NO formation in both groups. Odds ratios for these polymorphisms were then estimated for the clopidogrel and non-clopidogrel resistance groups. Results: Approximately 34.25% of the study population showed clopidogrel resistance. No significant difference in serum NO levels between the case and control groups (26.1 ± 1.52 µM vs. 25.41 ± 1.18 µM; P = 0.727) was observed. The effect of diabetes on clopidogrel resistance was significant in the case group (20.06 ± 1.82 µM) in diabetes patients when compared with 26.52 ± 2.40 µM in non- diabetes patients (P = 0.03), but within a control group, the effect diabetes on clopidogrel resistance was not significant (P = 0.07), while the effect of diabetes was not significant in diabetes patient (P = 0.09) and nondiabetes (P = 0.4) when the comparison between case and control. The study found that e-NOS intron 4 (4a4b) polymorphisms genotypes were significantly associated in the diabetic group as compared with non –diabetic group in patients' resistant to clopidogrel [ab genotype: OR = 2.4 (1.1–5.69), P=0.02; aa genotype: OR = 2.8 (0.89–8.7), P=0.03], while there was a negative association between diabetic group and non–diabetic group in patients' sensitive to clopidogrel. However, e-NOS polymorphisms of the T786C and exon 7 G894T genotypes showed no association between diabetic and nondiabetic patients of both resistant or sensitive patients except mutant homozygous CC of T786C showed a significant association between diabetic and non-diabetic patients in case and control groups (P = 0.02, 0.04) respectively. Conclusions: Our study indicates that e-NOS gene polymorphisms, specifically the 4a allele (4a/ab) and mutant homozygous CC (T786C), maybe determinants of clopidogrel resistance in diabetic CAD patients. [ABSTRACT FROM AUTHOR]

Background: Coronary intervention is related to local vascular and systemic inflammation that leads to the stimulation of inflammatory reaction, caused by the rupture of the atherosclerotic plaque and the tunica media fallowing extension of the stent and insertion of a metallic foreign body. Arterial wall damage occurs in addition to the release of inflammatory and chemoattractant factors which stimulate an inflammatory response, leading to leukocyte and platelet activation. Bioresorbable vascular Scaffold (BVS) is considered the fourth revolution in interventional cardiology. It has introduced a novel technology in the treatment of coronary artery disease (CAD). Trimetazidine (TMZ) is an anti-ischemic agent which minimizes the myocardial damage induced by the percutaneous coronary intervention (PCI). Objective: To assess the effect of TMZ on the acute inflammatory response after BVS implantation in patients with CAD. Patients and Methods: A total of 40 diabetic patients with stable coronary artery disease were assigned into two groups: the control group and TMZ treated group. Both groups were admitted to AL-Najaf center for cardiac surgery and Tran’s catheter therapy. Thus, patients under went elective coronary scaffold implantation. Serum blood was collected from peripheral vein before implantation, 12 hrs and 24 hrs after implantation. Collected samples were used to measure IL-8, hs-CRP, cTn-I, MMP-9 and VCAM-1 levels by sand wichELISA method in addition to determine the WBC count. Results. Scaffold implantation produced significant changes in serum levelIL-8, hs-CRP, cTn-I, WBC and VCAM-1(p<0.05).However, no significant change in serum level MMP-9was found (p>0.05).On the other hand, TMZ treatment produced a significant decrease in cTn-I, hs-CRP levels and the WBC count (p<0.05).No significant changes in serum IL-8, MMP-9and VCAM-1were found (p>0.05). Conclusion: Trimetazidine reduced the systemic inflammatory response induced by implantation of Bioresorbable coronary scaffold. [ABSTRACT FROM AUTHOR]

The main objective of this study is to assess the possible protective role of Trimetazidine in the prevention of contrast induced nephropathy in patients with renal impairment undergoing coronary angiography or percutaneous coronary intervention. This was a randomized single-blind clinical trial study. A total of 100 consecutive diabetic patients with symptomatic ischemic heart disease and chronic kidney disease (CKD) were subjected to an elective percutaneous coronary intervention, at ALSADR teaching hospital /Al- Najaf Center for Cardiac surgery and Tran Catheter Therapy, Najaf, Iraq, in period between May and December 2018. The Patients were divided into two groups: Group I-Control Group (n=45) these patients with chronic kidney disease and critical coronary stenosis and they were needed to be subjected to coronary intervention. Group IITreatment Group (n=44) also these patients with chronic kidney disease and critical coronary stenosis and they were need to be subjected to coronary intervention and treated with 35 mg tablet /twice daily of Trimetazidine for the period of three days , starting 48 hours before surgical procedure and for 24 hours post the procedure. Trimetazidine significantly reduce the elevation in serum levels of nuclear factor kappa B , high-mobility group box 1, expression of Tolllike receptor 2 (p<0.05) while insignificantly reduce the elevation in serum levels of creatinine and urine level of Neutrophils gelatinaseassociated lipocalinis (p > 0.05). Our study concluded that Trimetazidine reduce the acute kidney injury response and systemic inflammatory response induced by contrast administration after coronary intervention. [ABSTRACT FROM AUTHOR]

Coronary artery disease (CAD) is the single most common cause of morbidity and mortality in developed world. PCI with stent implantation is a widely used, safe and effective technique for the treatment of symptomatic ischemic heart disease. Stenting, however, causes significant injury to the vascular wall, resulting in a repair process that requires inflammatory process activation. This study was done to assess the effect of pre PCI atorvastatin reload on toll like receptor 2 expressions with its downstream signaling. A double blind randomized prospective trail in which 60 patients with stable angina pectoris, who are scheduled for an elective PCI at Al-Najaf Center for Cardiac Surgery and Trans Catheter were enrolled and were assigned randomly1:1 into two groups, after an ethical committee of the University of Kufa /Faculty of medicine approval, 30 patients who received low dose atorvastatin 40mg daily without reload (control group). Stent implantation was associated with an elevation in TLR 2 expression in peripheral monocyte in both study groups after stenting but significantly higher expression level was observed among control group than atorvastatin reload group (p<0.05) at 4hrand 12hr post PCI. Inflammatory cytokine (MMP9, MCP-1, and IL-6) were significantly increased after stenting in both study groups (P<0.005) but higher in control group than atorvastatin reload group (p<0.05) also myocardial injury markers (CKMB, troponin I) were significantly higher in control group than atorvastatin reload group (p<0.05). We conclude that atorvastatin reload before coronary artery interventions attenuate toll like receptor 2 expression on peripheral monocyte and significantly reduce serum level of MMP9,MCP-1 and IL-6and cardiac injury markers(CK·MB and cardiac troponin I) [ABSTRACT FROM AUTHOR]

This study aims to assess the possible protective role of Trimetazidine in the prevention of contrast induced nephropathy in patients with renal impairment undergoing coronary angiography or percutaneous coronary intervention. This was a randomized single-blind clinical trial study. A total of 100 consecutive diabetic patients with symptomatic ischemic heart disease and chronic kidney disease (CKD) were subjected to an elective percutaneous coronary intervention, at ALSADR teaching hospital /Al- Najaf Center for Cardiac surgery and Tran Catheter Therapy, Najaf, Iraq, in period between May and December 2018. The Patients were divided into two groups: Group I-Control Group (n=45) these patients with chronic kidney disease and critical coronary stenosis and they were needed to be subjected to coronary intervention. Group II- Treatment Group (n=44) also these patients with chronic kidney disease and critical coronary stenosis and they were need to be subjected to coronary intervention and treated with 35 mg tablet /twice daily of Trimetazidine for the period of three days. Trimetazidine significantly reduce the elevation in serum level of monocyte chemo tactic protein1, expression of Toll-like receptor 2 and the urine levels of kidney injury molecule-1,F2-isoprostanes (p<0.05) while insignificantly reduce the elevation in serum level of creatinine . (p > 0.05). Our study concluded that Trimetazidine reduce the acute kidney injury response and systemic inflammatory response induced by contrast administration after coronary intervention. [ABSTRACT FROM AUTHOR]

The present study aims to evaluate the effect of pre percutaneous coronary intervention (PCI) atorvastatin reload on peripheral monocyte of toll-like receptor 2 and toll like receptor 4 expression and their correlation with cardiac injury markers (troponin I and creatine kinase Muscle brain isoenzyme) in a patient with stable angina. A double-blind randomized prospective trial in which 60 stable angina patients scheduled for an elective PCI were randomly allocated into two groups after, control group: 30 patients who received low dose atorvastatin 40 mg daily without reload. Atorvastatin reloads group: 30 patients who were already on the usual dose of atorvastatin with further 80 mg and 40 mg at 12 & 2 hrs. before PCI, respectively. TLR2 and TLR4 levels were assayed in peripheral monocyte by flow cytometry and cardiac troponin I, CK-MB, MCP-1 and HMG-box-1 protein were also measured before and at 4 hrs, 12 hrs after PCI. Stent implantation was associated with an elevation in TLR2 and TLR4 expression in peripheral monocyte in both study groups after stenting but significantly higher expression level was observed among the control group (P < 0.05) at 4 hr and 12 hr post PCI. Inflammatory cytokine (HMG Box-1 protein MCP-1) were remarkably elevated after stenting in both study groups (P < 0.005) but significantly higher in control group as compared to the atorvastatin reload group (P < 0.05 ) also myocardial injury markers (CKMB, troponin I) were significantly higher in control group than atorvastatin reload group (P < 0.05).there is a positive correlation between TLR2 and TLR4 expression with serum level of cardiac troponin I and CK-MB Atorvastatin reload before coronary artery interventions attenuate toll-like receptor 2 and 4 expressions on peripheral monocyte and significantly reduce serum level of HMG-box-1protein, MCP-1 and cardiac injury markers (CK_MB and cardiac troponin I) and Increase peripheral monocyte expression of TLR2 and TLR4 associated with elevated serum level of cardiac injury markers (CK_MB and cardiac troponin I). [ABSTRACT FROM AUTHOR]

The aim of the study was to assess the activity of pre-PCI atorvastatin reload on the acute inflammatory responses and in Toll-Like Receptor 4 expressions with its downstream signaling. A double-blind randomized prospective study, 30 patients who received low dose atorvastatin 40 mg/day without reload. While, 30 patients who were already on the usual dose of atorvastatin with further 80 mg & 40 mg at 12 and 2 hrs before PCI respectively. TLR4 expression in peripheral monocyte investigate by flow cytometry, and cardiac troponin I, CK-MB, HsCRP and HMG-BOX protein by ELISA technique immediately before and at 4 hrs, 12 hrs. After PCI. Stent implantation was associated with an elevation in TLR 4 expression in peripheral monocyte of both study groups after stenting with higher expression level was found among control group (p<0.05) at 4 hr and 12 hr post-PCI. HsCRP, HMGbox1protein were lower in atorvastatin reload group (p<0.05), and the myocardial injury markers (CKMB, troponin I) were significantly higher among the control group than atorvastatin reload group (p<0.05). Atorvastatin attenuated toll-like receptor 4 expressions on peripheral monocyte subsequently its downstream effects HsCRP and HMGBOX1-protein. [ABSTRACT FROM AUTHOR]