While Le Corbusier's urban projects are generally considered confrontational in their relationship to the traditional urban fabric, his proposal for the Venice hospital project remained an exercise ...in preserving the medieval fabric of the city of Venice through a systemic replication of its urban tissue. This book offers a detailed study of Le Corbusier's Venice hospital project as a plausible built entity. In addition, it analyses it in the light of its supposed affinity with the medieval urban configuration of the city of Venice. No formal attempt to date has been made to critically analyse the hospital project's design considerations in comparison to the medieval urban configuration of the city of Venice. Using a range of methodologies including those from architectural theory and history, using archival resources, on-site analysis, and interviews with important resource persons, this book is an interpretation of the conceptual basis for Le Corbusier understanding of the structural formulation of the city of Venice as mentioned in The Radiant City (1935). In doing so, it deciphers the diagrammatic analysis of the city structure found in this work into a set of coherent design modules that were applied in the hospital project and that could become a point of further investigation. Architects and other architecturally interested laypeople with an interest in Venice will find the book a valuable addition to their knowledge. For architectural historians the book makes an important link between modernism and the historically grown Venice.
Dr Mahnaz Shah is a Lecturer in Design Theory at the Cardiff School of Art and Design, Cardiff Metropolitan University.
Contents: Foreword, Robert Maxwell; Foreword, Tim Benton; Introduction; History of the project; The urban context; Analysis of the project; Important findings; Table of important events; Bibliography; Index.
Introduction: Adding adjuvant drugs to intrathecal local anesthetics improves the quality and duration of the sensory blockade and prolongs postoperative analgesia. Intrathecal opioids are ...synergistic with local anesthetics, thereby intensifying the sensory block without increasing the sympathetic block. This study was designed to comparatively evaluate the two different dosages of nalbuphine as intrathecal adjuvants on subarachnoid block (SAB) characteristics of 0.5% hyperbaric bupivacaine.Methods: A randomized, triple arm study was conducted on 60 adult female patients with American Society of Anesthesiologists physical status I and II, aged 30-60 years, scheduled for total abdominal hysterectomy under SAB. Patients were randomized into three groups: group I received 15 mg of 0.5% hyperbaric bupivacaine, group II received 15 mg of 0.5% hyperbaric bupivacaine with 1.6 mg of nalbuphine, and group III received 15 mg of 0.5% hyperbaric bupivacaine with 2.4 mg of nalbuphine. The primary outcome was the duration of analgesia, while secondary outcomes included onset, duration of sensory and motor block, maximum cephalic extension, and two dermatome segment regressions.Results: The onset time of the sensory block was 3.2 ± 1.0 minutes, 3.5 ± 1.6 minutes, and 3.1 ± 1.1 minutes in groups I, II, and III, respectively. The onset time of the motor block was 8.5 ± 1.0 minutes, 8.5 ± 1.1 minutes, and 8.2 ± 1.1 minutes in groups I, II, and III, respectively. The onset of sensory and motor blocks was comparable among the three groups with no statistically significant difference (p > 0.05). The total duration of analgesia was 117.8 ± 23.3 minutes, 166.8 ± 27.8 minutes, and 181.8 ± 25.9 minutes in groups I, II, and III, respectively, with a statistically significant difference. Few incidences of manageable hypotension, but no incidences of bradycardia or respiratory insufficiency, occurred. Five patients of the control group shivered, which was managed well by tramadol 50 mg and ondansetron 4 mg. No patient suffered from pruritus, sedation, respiratory depression, nausea, and vomiting.Conclusion: The study concluded that intrathecal nalbuphine in a 1.6 mg dose is an effective adjuvant to 0.5% hyperbaric bupivacaine for SAB. It potentiated the SAB characteristics and enhanced the duration of analgesia with no effect on respiration. Nalbuphine in a dose of 2.4 mg did not offer any added advantage.
To describe the association between the presence of epithelial defects and the development of diffuse lamellar keratitis (DLK), “Sands of the Sahara” syndrome, following laser in situ keratomileusis ...(LASIK).
Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
In this retrospective study, the postoperative clinical course and surgical outcomes in 735 eyes of 358 consecutive patients who had myopic LASIK between December 1998 and August 1999 were reviewed. Of the 735 procedures, 680 were primary LASIK procedures and 55 were retreatments performed by lifting the existing flaps. The incidence and severity of DLK and the relationship of DLK to epithelial defects were tabulated.
Diffuse lamellar keratitis developed in 9 of the 16 eyes that had postoperative epithelial defects. Seventeen eyes without epithelial defects also developed DLK. The presence of an epithelial defect increased an individual’s risk of developing DLK 24 times (95% confidence interval, 13 to 45). In 8 eyes, the inflammation resolved following treatment with intense topical corticosteroids. One eye had irrigation under the flap because of dense central inflammation; the final outcome was mild inferior corneal steepening. All eyes recovered preoperative best spectacle-corrected visual acuities.
Patients who have epithelial defects of any size following LASIK are at significantly increased risk of developing DLK.
To determine the prevalence of allergic conjunctivitis in children in selected schools in Karachi, Pakistan.
This cross-sectional study was conducted in September and October 2008 as part of the ...School Eye Health Initiative launched by the Aga Khan University, Karachi and the Adamjee Eye Hospital, Karachi. Children in the selected schools underwent vision assessment and a slit lamp examination by an ophthalmologist. The main objective was to detect allergic conjunctivitis which was ascertained by the presence of papillae in the upper tarsal conjunctiva, redness of the eyes, and presence or history of itching and burning.
A total of 818 children aged 5-19 years were examined. Of these, 19.2% (95% CI 16.5% to 21.9%) had allergic conjunctivitis. There was a significant association between increasing age and allergic conjunctivitis (Odds ratio: 1.19, 95% CI: 1.12, 1.26; P < 0.001). Boys had a higher burden of allergic conjunctivitis than girls; however this difference was not statistically significant (Odds ratio: 1.31, 95% CI: 0.90, 1.91, p = 0.153).
There is a very high prevalence of allergic conjunctivitis in children in the selected schools in Karachi. Further research is needed to identify factors that contribute to such a high burden of this condition and to assess whether a similar pattern is also observed elsewhere.
Central corneal thickness of Pakistani adults Channa, Roomasa; Mir, Fazia; Shah, Mahnaz Naveed ...
Journal of the Pakistan Medical Association,
04/2009, Letnik:
59, Številka:
4
Journal Article
To determine the average central corneal thickness (CCT) of healthy adults in the ophthalmology clinic of a tertiary care hospital of Pakistan.
This was a cross-sectional study conducted in the ...ophthalmology clinics of Aga Khan University Hospital, Karachi Pakistan. One hundred normal subjects (200 eyes) were studied. An ultrasound pachymeter was used to measure CCT.
The mean (+/- SD) age of the study population was 44.29 +/- 15.18 years with a median of 47 years (range: 16-73). Twenty three percent of the subjects had diabetes mellitus, 29% hypertension and 6% had history of ischaemic heart disease. The mean (SD) CCT measurements were 531.08 +/- 33.37) and 531.29 +/- 33.33 micrometers in the right and left eyes respectively and were not significantly different from each other. There was no statistically significant correlation between CCT and IOP (r = 0.158, p = 0.12). We did not find a significant association between CCT and other independent variables like age, sex, presence of co-morbidity i.e. Diabetes Mellitus (DM), Hypertension (HTN), Ischaemic Heart Disease (IHD), myopia, hypermetropia, systemic and eye medication use.
The average CCT values obtained in the hospital-based study closely match those of the African Americans. A population-based study would be needed to provide unbiased CCT estimate in Pakistani population.
To study the disease spectrum and salient management features of 36 patients with histopathologically-confirmed rhinocerebral zygomycosis seen at our academic center over a 16-year period.
...Retrospective review of patients admitted to the Aga Khan University Hospital in Karachi, Pakistan from January 1991 to December 2006 with histopathologically-confirmed zygomycosis of the head and neck.
Mean patient age was 40 +/- 5.0 years (range, 34-63 years), and 23 (64%) patients were male. Thirty-two (89%) patients were referred from clinical services other than otolaryngology. Underlying predisposing conditions included diabetes mellitus (21 patients), haematologic diseases (9), and renal failure (6). Twenty (55%) patients had limited sinonasal disease, ten (28%) had orbital involvement, and six (17%) had intracranial extension. All patients underwent rigid nasal endoscopy and biopsy, and black necrotic tissue was seen in 22 (61%) instances warranting endoscopic or open surgical debridement. Four of 6 patients undergoing open surgery required orbital exenteration. Overall patient survival was 56% (20/36 patients). Diabetic patients had improved survival (17/21, or 81%) compared to patients with haematologic disorders (3/9, or 33%) (p = 0.001). All six patients with intracerebral disease died. Eighteen of the 22 (82%) patients treated with surgery plus amphotericin B survived vs. two of 14 (14%) receiving amphotericin B alone (p < 0.001).
In rhinocerebral zygomycosis, an aggressive, multidisciplinary, diagnostic and therapeutic approach that utilizes CT or MRI staging, and combines endoscopic or open surgical debridement with amphotericin B-based antifungal therapy offers the best chance of recovery.
Purpose: To assess the annual number of glaucoma operations and admissions in the public sector tertiary care hospitals in Pakistan. Methods: Eye departments in all 18 public tertiary care centers in ...the country were requested to provide data on the number of glaucoma operations and admissions during 1998. Of these, 13 hospitals agreed to participate. Eye departments' logbooks or patients' records were used to collect data retrospectively on the total number of eye admissions, the total number of glaucoma admissions, the type of glaucoma, and the total number and type of glaucoma operations. Results: Glaucoma accounted for 8.1% (1942/23931) of all eye admissions. Open-angle glaucoma was responsible for 37.6% or 731 glaucoma admissions followed by secondary glaucoma (35.0%) and angle-closure glaucoma (18.2%). During 1998, 1407 glaucoma-related operations were performed in the selected hospitals. The mean (±SD) and the median number of operations performed were 108.2 (±59.6) and 112 (range: 17-206), respectively. Trabeculectomies accounted for 1043 (74.1 %) of all procedures. Their number ranged from 16 to 170 (median: 84) in the selected hospitals. Conclusions: We believe that the annual number of glaucoma operations performed in the public tertiary care hospitals in Pakistan is far less than required. In-depth research is therefore needed to explain if this is because of gaps in service provision or a genuine shift to medical management of glaucoma on an outpatient basis.
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