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Purpose: To compare the effectiveness and safety of suprachoroidal versus intravitreal Triamcinolone Acetonide in cases of resistant diabetic macular edema. Study Design: Quasi experimental study. Place and Duration of Study: This research was executed at Retina Department of Al-Ibrahim Eye Hospital, Karachi, Pakistan between 1st January 2022 till 30th June 2022. Methods: Thirty-four patients with resistant diabetic macular edema were selected through convenient sampling and divided equally into two groups. All patients underwent ocular examination. Group I was given single Intravitreal injection (IVI) of 0.1 mL Triamcinolone Acetonide at 4 mg per 0.1 mL concentration. Group II received same dosage of drug via Suprachoroidal injection (SCI). After 24 hours, they were assessed for side effects. After 6 weeks, second dose of same drug was administered. Patients were followed at 3 and 6 months. Results: No serious side effect was observed in any patient within 24 hours. At 1 month follow-up period, comparison between the two groups for BCVA, CMT and IOP was not significant (p > 0.05). When the two groups were compared at 3 months, both routes were equally effective but IOP remained more stable via SCI route. At 6 months, IOP remained elevated in group I but decreased in group II (p = 0.003). Conclusion: Triamcinolone Acetonide was effective by both routes in resistant diabetic macular edema in terms of improved BCVA and CMT but SCI was better in terms of IOP and cataract progression.

Pakistan has more than 18,000 brick kilns and produced about 45 billion bricks every year. Brick making in Pakistan is a traditional small-scale and unmanaged industry. Coal is a major source of fuel for brick kilns. In Pakistan, urbanization, in terms of building construction has increased by 10% per year from 2015 to 2020. That growth has increased demand of building construction stock by 80% which causes an increased production of building materials and bricks. This increase in demand for bricks will increase the consumption of coal used in brick manufacturing. Therefore, there is an urgent need to assess the health risk to people living near brick kilns. This study assesses the health risk due to the emission of air pollutants from brick kilns. Two non-carcinogenic pollutants (i.e., SO2 and Hg) and three carcinogenic pollutants (i.e., As, Cd and Cr) were selected for this health risk assessment. Both short-term and long-term health impacts were assessed. The AERMOD air dispersion model was used for predicting ground-level concentrations within a 10 km radius of the brick kilns. Non-carcinogenic health risk assessments indicate adverse health impacts from short-term concentrations, while long-term concentrations are within acceptable limits. Carcinogenic health risks also indicate adverse health effects from short-term concentration, while only As and Cr cause adverse health impacts from long-term concentration and exposure. The findings of this study show that a detailed assessment of the health effects caused by emissions from all of the brick kilns and ambient air concentration with meteorological conditions should be carried out.

Keenjhar Lake in Pakistan provides several ecosystems services including drinking water to millions of people. The seasonal variation (pre-, during, and post-monsoon) in Keenjhar Lake water quality was investigated during nine sampling rounds at ten locations. Water samples (n = 270) were analyzed for As, Cd, Cr(III), Cu, Fe, Hg, Mn, Ni, and Pb using atomic absorption spectrophotometry, Cr(VI) with a UV spectrophotometer, and water quality parameters (solids, oxygen, conductivity, and pH). Several elements exceeded WHO or Pakistan safe limits for unrestricted use including As (0.038 mg·L−1, 95th upper confidence limit), Cr(III) (0.15 mg·L−1), Cd (0.11 mg·L−1), Fe (0.42 mg·L−1), Ni (0.037 mg·L−1), and Pb (0.04 mg·L−1). Monsoon levels of chromium, Cu, Fe, Mn, and Pb were higher than other seasons, while As was highest during post-monsoon, and Ni was highest during pre and post-monsoon. There were significant spatial differences in metals concentrations in the lake. As, Cu, and Fe significantly declined in concentration with distance from the lake inlet. Using the lake as a source of drinking water presented unacceptable carcinogenic risk and non-carcinogenic hazards. This study suggests measures should be taken to limit discharge of pollution to the lake and future monitoring should consider seasonal monsoon effects on lake quality.

In developing countries like Pakistan, there is a lack of implementation of the environmental laws to manage discharges of untreated effluents, loaded with heavy metals, into freshwater. To evaluate the potential human health impacts from exposure to such polluted water, this study assessed the concentration of six heavy metals (i.e., Zn, Fe, Pb, Cu, Cd, and Mn) in the surface water in lower Sindh, Pakistan. Water samples were collected from eight locations around Kotri barrage at Indus River both during pre-monsoon and monsoon seasons to determine the temporal variations of the concentration of heavy metals. The concentrations of heavy metals were then compared with the drinking water quality guidelines of the World Health Organization (WHO). It was observed that in most cases, the concentrations of metals were significantly higher compared to WHO guidelines during the pre-monsoon period. To determine the potential human health risk associated with the exposure of heavy metals, both oral hazard index (HIoral) and dermal hazard index (HIdermal) were estimated. The results indicated that during pre-monsoon, HIoral was higher than the threshold limits at every location, while HIdermal was higher only at three locations. Nonetheless, during monsoon, these indices were within limits. It suggested that the health of the people dependent on these freshwater streams in the study area is at considerable risk. Finally, the findings of this study recommended the enforcement of the laws in its true spirit to regulate effluent discharges into these streams in order to avoid health vulnerability of millions of people.

To validate the global registry of acute coronary event (grace) risk score in a Pakistani population at Tabba Heart Institute Karachi in patients with non ST-Elevation Myocardial Infarction (NSTEMI) and Unstable Angina (UA).In this prospective Observational registry study, 530 adults hospitalized patients with a diagnosis of Non-ST-Elevation Myocardial Infarction and unstable angina were enrolled between March 2012 and August 2012 at the Tabba Heart Institute, Karachi, Pakistan. For each patient, the grace risk score was calculated and its discrimination evaluated and correlated with in-hospital mortality using the Kendall's tau-b bivariate correlation test. Each patient was grouped either into high, intermediate or low risk groups according to their GRS.A total of 530 patients with NSTEMI and UA were included; the overall mean grace risk score in our population was 131.87 +/- 41.56. The GRACE Risk Score showed good discrimination, with Area under the ROC curve of 0.803 (95% CI 0.705-0.902, P0.001). During the in-hospital stay, total of 19 (3.6%) patients died, and out of those 15 (8.4%) patients belonged to high risk group.GRACE RS strongly validates the in-hospital mortality among our patient population presenting with a wide spectrum of complications. However, more multicentre registries on a larger population with long-term follow up are required to study detailed trends in our population.

To determine the association of the pro-brain natriuretic peptide (NT-proBNP) plasma levels with twodimensional echocardiographic determination of left ventricular dimensions and ejection fraction (EF) in acute dyspneic patients.An observational cross-sectional study.Tabba Heart Institute, Karachi, from January to June 2010.One hundred patients were selected by consecutive purposive non-probability sampling who had presented with acute dyspnoea. NT-proBNP levels were assessed by commercial tests (Roche Diagnostics). The clinical diagnosis of congestive heart failure (CHF), echocardiographic assessment of left ventricular dimensions and function were compared with NT-proBNP levels. Receiver operating characteristic (ROC) curve was estimated for NT-proBNP and compared. The chi-square test was applied for categorical and student's t-test for numerical data at 0.05 levels of significance were used to compare patients with and without heart failure. Further comparative analysis between groups on the basis of ejection fraction was done by one way ANOVA test.Seventy-nine patients (79%) had CHF as a cause of their dyspnoea. Patients with CHF were older (61.9 ± 14 years vs. 58.6 ± 14 years, p=0.368), had a lower EF (36.9% vs. 61%, p0.0001), had a higher LV dimensions, left ventricular end diastolic dimension - LVEDD (49.94 ± 5.6 vs. 42 ± 7.9 mm, p0.0001), left ventricular end systolic dimension - LVESD (37.31 ± 6 vs. 29.21 ± 10.9 mm, p0.0001) and a higher NT-proBNP (10918 ± 1228 vs. 461 ± 100 pg/mL, p0.0001) than patients without CHF. NT-proBNP values increased with the severity of ventricular impairment. Significant differences were found between patients with LVEF25 % and patients with moderate ventricular impairment (LVEF = 26 - 40%) and mild ventricular impairment (LVEF = 41-60%, p0.001). The group of patients with LV dilation, had significantly higher BNP levels than those with normal LVEDD (12416 ± 1060 pg/ml vs. 6113 ± 960, p = 0.009) and LVESD (10416 ± 1160 vs. 4513 ± 960 pg/ml, p = 0.008). Area under ROC curve for the diagnosis of CHF was significantly higher for NT-proBNP (AUC 0.99, p0.003). The sensitivity of NT-proBNP value of300 pg/mL for the diagnosis of CHF was 100% and specificity was 42%. A cut-point of 300 pg/mL NT-proBNP had 100% negative predictive value to exclude acute CHF.NT-proBNP is strongly associated with two-dimensional echocardiographic determination of left ventricular dimensions and EF in identifying CHF in patients with acute dyspnoea.

To determine the diagnostic significance of plasma NT-proBNP estimation in patients presenting with acute dyspnea in Emergency Department.An observational, cross sectional study.From January to June 2008 at Liaquat National Hospital, Karachi.In this study, 100 patients were selected with purposive non-probability sampling who had presented to the emergency department with acute dyspnea. Plasma NT-proBNP levels, chest X-ray and transthoracic echocardiography were performed at the time of admission. NT-proBNP levels were assessed by commercial tests. The clinical diagnosis of congestive heart failure, patient's hospital course and discharge diagnosis were cross-tabulated with NT-proBNP levels. The chi-square test for categorical data and Student's t-test for numerical data was applied at 0.05 level of significance to compare patients with and without heart failure (HF). Further comparative analysis between age groups was done by one way ANOVA test.The mean NT-proBNP level among the 79 subjects with a final diagnosis of heart failure was 10918 compared with 461 pg/ml in those without heart failure (p=0.001). The diagnostic accuracy of NT-proBNP at a cutoff of 300 pg/milliliter (ml) was 100 percent. An optimal strategy to identify acute HF was to use age-related cut-points of 450 and 900 pg/ml for ages50 and50 years, which yielded 100% sensitivity and 86% specificity for acute HF. An age-independent cut-point of 300 pg/ml had 100% negative predictive value to exclude acute HF.NT-proBNP is useful in establishing or excluding the diagnosis of congestive heart failure in patients with acute dyspnea.