Background: Cataract surgery using small-incision phacoemulsification techniques has advanced significantly, offering excellent refractive outcomes that both surgeons and patients now expect. The growing demand for improved visual outcomes following cataract surgery has led to the development of various IOLs, including monofocal and multifocal types. Therefore, the purpose of the study was to evaluate and compare the visual outcomes and optical quality parameters of monofocal and multifocal intraocular lenses. Aim of the study: The aim of the study was to evaluate and compare the visual outcomes and optical quality parameters of monofocal and multifocal intraocular lenses. Methods: This prospective, comparative study was conducted at the Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from June 2010 to May 2011, involving 60 patients with bilateral age-related cataracts and preoperative BCVA ≤ 0.5 logMAR. Patients received monofocal or multifocal IOLs via standardized phacoemulsification, with 6-month postoperative assessments covering visual acuity, spectacle independence, and optical quality metrics. Data were analyzed using independent t-tests and chi-square tests, with p<0.05 considered significant. Results: Multifocal IOLs significantly improved near vision (0.18 vs 0.40 logMAR, p<0.001) and spectacle independence (90% vs 16.7%, p<0.001) compared to monofocal IOLs, with slightly better distance vision (0.10 vs 0.15 logMAR, p=0.001). However, they showed higher rates of halos/glare (40% vs 13%, p=0.02) and reduced contrast sensitivity (40% vs 67%, p=0.04). Night driving difficulty was comparable (27% vs 20%, p=0.54). Conclusion: Multifocal IOLs offer superior visual rehabilitation and reduced spectacle dependence, highlighting the need for personalized IOL selection and preoperative counseling.

Background: Iron deficiency anemia (IDA) is a global nutritional challenge, particularly among pregnant women in developing countries, with significant adverse outcomes for both mother and neonate. The purpose of the study was to assess the relationship between maternal hemoglobin levels during pregnancy and their impact on neonatal health outcomes.

Aim of the study: The aim of the study was to evaluate the relationship between maternal hemoglobin levels during pregnancy and their impact on neonatal health outcomes. Methods: This cross-sectional study at the Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from January 2008 to December 2009, included 150 pregnant women. Data on sociodemographic, clinical, and neonatal outcomes were collected via interviews, medical records, and lab tests. Statistical analysis was conducted using version 22 software, with associations assessed using chi-square test (p < 0.05). Results: This study of 150 pregnant women found that 28.7% were anemic, with the majority in the third trimester and aged 21-29 years. Neonatal outcomes showed 36.7% low birth weight, 23.3% preterm births, and 47.4% neonatal anemia. Significant associations were found between maternal anemia (Hb <11 g/dL) and worse neonatal outcomes, including higher rates of low birth weight (58.1%), preterm birth (41.9%), neonatal anemia (81.4%), low APGAR scores (34.9%), and NICU admissions (27.9%). In contrast, mothers with hemoglobin ≥13.0 g/dL also showed some increased risks for adverse outcomes. Conclusion: This study emphasizes the critical impact of maternal hemoglobin levels on neonatal health, with anemia linked to adverse outcomes and optimal hemoglobin levels promoting better neonatal health.

Chest radiographs are one of the most common radiological procedures performed in medical practice. The chest radiograph should ideally include views of the heart, lungs, trachea, mediastinum, bones of the chest and upper part of the abdomen. Chest radiographs are normally taken in the posterior-anterior (PA) view with the patient in upright / standing position but for patients admitted in the intensive care unit (ICU) or other emergency situations, this is not possible and so they are taken in the supine (anterior-posterior views) or semi-erect position. Chest radiographs are done not only for diagnostic reasons to look for abnormalities in the lungs, soft tissues and bones but also to check the position of various invasive lines and tubes. In this article, we aim to discuss and compare the normal and abnormal positions of central venous catheter (CVC) on chest radiographs.

Informed consent is required for all medical investigations and procedures and is considered a corner stone of modern medicine. This review article examines the question whether the right to consent is absolute by looking at the philosophical, ethical and legal principles underlying consent. There are several legal exceptions to the right of consent in the United Kingdom concerning minors, incapacitated patients, patients with mental illness and patients suffering from communicable diseases. Furthermore, the practical implications of consent and shortcomings of informed consent are discussed as well as the concept of advanced directives and lasting powers of attorneys. While a patient has a right to refuse treatment (all exceptions are discussed), there is no legal right to demand treatment in the United Kingdom. The patient's right to autonomy should always be respected and steps shall be taken to make consent truly informed. There is, however, no absolute right to consent on the basis of philosophical, ethical, legal and practical considerations.

The incidence of caesarean section is rising1 and there is evidence that women who have a caesarean section may be at increased risk of complications in a subsequent pregnancy2. Compared with vaginal delivery in the first pregnancy, caesarean section has been found to be associated with significantly increased rates of: uterine rupture in labour;3 placenta previa and placental abruption;4 placenta previa leading to peri-partum hysterectomy;5 stillbirth;6 and perinatal death7. Sometimes some unusual complication develops with which, we are not familiar. Here an uncommon complication following caesarean section in a post caesarean pregnancy has been reported. On examination, she was mildly anemic. Pulse was 88/min and BP was 126/80 mm Hg. She was free of any medical or surgical complications like morbid obesity, COPD and umbilical hernia. Per abdominal finding revealed a term size uterus with cephalic presentation and average liquor. FHS was 144/min and regular. Her previous caesarean section scar was low transverse and there was no scar tenderness.

An 82-year-old lady, who had suffered multiple strokes in the past and was currently on long term percutaneous endoscopic gastrostomy (PEG) feeding, was admitted as an emergency from a nursing home with a two-week history of productive cough and fever. She had been on PEG feeding since her first stroke six years previously. The first PEG tube (placed in 2001) subsequently fell out of position, and a second tube (15 French Frecka PEG tube) was inserted in 2003. On admission, she was pyrexial, dehydrated, and hypoxic on room air. Chest examination revealed bilateral crackles and neurological examination revealed expressive dysphasia, and spastic weakness in both lower limbs. Abdominal examination revealed an inflamed PEG site with purulent discharge. Blood tests revealed raised inflammatory markers with neutrophilia (WBC 20 x 109 /L with a neutrophil count of 12 x 109/L) and a raised C-reactive protein at 193 mg/L.

Objective: To find out basic understanding of HIV infection, degree of awareness regarding the ongoing treatment and reasons behind irregular follow-up visits of our HIV patients in the out-patient clinic. Participants and Methods: 75 patients of our inner-city community hospital HIV clinic (J.E. Wood Clinic of Pennsylvania Hospital, Philadelphia) were given an anonymous, survey questionnaire. 68 of them were sufficiently completed to be evaluated for the study. We collected information related to patients’ demographic and social status, knowledge about their HIV disease and compliance with follow-up appointments. Completed questionnaires were evaluated and comparative data was tallied using Microsoft excel sheet. We also reviewed relevant literature to understand our findings in the light of previous related studies. Results: Patients who had completed high school education or equivalent were 2.5 times more likely to remember the names of their HIV medications (95 % confidence interval CI=1.42 to 4.98) and 1.75 times more likely to remember their last CD4 count (95 % confidence interval CI=1.12 to 4.38). Women patients in our practice were 2.0 times more likely to practice use of protective measures during sexual activity (95 % confidence interval CI=1.22 to 4.67). 7 patients mentioned significant psychological problems in their daily life as the reason for non-adherence to medication or follow-up appointments. Conclusion: Identifying socio-economic, behavioral and psychological variables that intervene treatment of HIV patient is important as it can help us to provide patient specific support and guidance to improve treatment compliance. Abbreviations: Aids = acquired immunodeficiency syndrome; CD4 = Cluster of Differentiation antigen 4; CI = Confidence Interval; HIV = Human Immunodeficiency Virus; HAART = Highly Active Anti-Retroviral Therapy; WHO = World Health Organization.

To investigate the self-reported quality of sleep in a population of psychiatric in-patients and to explore any associations between sleep quality and clinical and demographic factors. Method: This was a cross-sectional survey of 46 psychiatric-disordered patients’ self-reported quality of sleep on the acute adult wards at a London psychiatric hospital (the Highgate Mental Health Centre) using the Pittsburgh Sleep Quality Index (PSQI). Relevant demographic and clinical parameters were obtained concurrently by review of medical records. Results: There was a high prevalence (78%) of subjects categorized as “poor sleepers” (defined as a global PSQI score of 5 or more). Subjective good quality sleep was associated with formal detainment in hospital (under Section 3 of the Mental Health Act (1983) (p=0.01). No statistically significant associations were found between other clinical or demographic variables to distinguish between good and poor sleepers. There was a statistically significant difference the two groups for all PSQI component scores and global scores. Conclusion: This study represents the first attempt to examine the degree of self-reported sleep quality among a population of psychiatric in-patients in a UK hospital. Results indicate that poor subjective sleep quality is a common finding, suggesting the need to improve strategies to manage sleep-related problems on the ward. Further studies are needed to replicate these results and to derive comparisons from a suitable patient population control group.

Aim: Main objective of this study was to evaluate the immunogenicity of hepatitis B vaccines commonly available in the Pakistan’s market. For this purpose, we compared immunogenicity and reactogenicity of four recombinant hepatitis B vaccines in apparently healthy young female volunteers in Karachi. Introduction: Today most of the world’s people recognize the importance of vaccination and more than 80% of the world children are now immunized against diseases covered by EPI (expended program on immunization). The Hepatitis B vaccines have been available since 1982 and more than one billion doses have been used. Approximately 100 countries, consistent with World Health Organization policy, have added HB vaccination to their routine childhood immunization programs. Infect many developing countries have scored astonishing success in controlling communicable diseases through mass vaccination and environmental sanitation. Materials and Methods: A total of 243 apparently young healthy female students of two Universities of the city were included in this study performed during Jan 2003 to Jan 2006, after receiving written informed consent. Four recombinant yeast derived HB vaccine were used as test regimens i.e. Euvax-B (LG Chemicals Ltd., Korea), Heptis-B (Boryang, Korea), Amvax-B (Amson, Pakistan) and Engerix-B (GS & K, Belgium). Participants were injected with the vaccine of their own choice. Information broachers of the four vaccines were distributed among participants to help them make a choice. anti-HBV antibody titres were recorded using EILSA (IMX-ELISA, Abbott). Results: A total of 243 HBV and HCV negative individuals came forward with the interest for immunization with the Hepatitis B vaccine of their own choice. Out of total 729 doses administered to 243 individuals during this study (Jan’2003 – Jan’2006) ……, 195 were of Engerix-B, 420 were Heptis-B, 75 were Amvax-B, and 39 doses were of Euvax-B. Among these four candidate vaccines Engerix-B came up with the least adverse effects, Euvax-B and Heptis-B showed moderate level of side effects, while Amvax-B showed maximum level of side effects. Although, none of these vaccines showed very sever type of adverse effects like demylination or central nervous system disorders during last 05 years period, except soreness, indurations, swelling, redness, mild pain, granuloma formation, and mild fever at the time of injection or just after injecting the vaccine, which was recovered within couple of hours. Conclusion: Overall serum protection rate achieved in case of Engerix-B was 95.9%, in case of Euvax-B, it was 95.2%, in case of Heptis-B was 95.0% , and in case of Amvax-B it was 95.1%, which fulfils the WHO requirements for a hepatitis B vaccine (i.e. seroprotection rate of > 95%), P values observed were lesser than 0.05 indicating significance of the vaccines and good safety profile in subjects.