Aim: To evaluate the outcomes of cataract surgery in Pakistan. Methods: Cross-sectional, nationally representative sample of 16 507 adults (aged >30 years). Each underwent interview, logarithm of the minimum angle of resolution visual acuity (VA), autorefraction, examination of optic disc. Those with ,6/12 VA on presentation underwent best-corrected VA and dilated biomicroscopic ocular examination. Results: 1317 subjects (633 men) had undergone surgery in one or both eyes. Of the 1788 operated eyes, 1099 (61%) had undergone intracapsular cataract extraction (ICCE) and 607 (34%) extracapsular surgery with an intraocular lens (ECCE+IOL). Presenting VA: 275 (15.4%) eyes: 6/12 or better; 253 (14.1) ,6/12 >6/18; 632 (35.3%) 6/18 to 6/60; 85 (4.8%): 6/60 to 3/60; 528 (29.5%): ,3/60. With ''best'' refractive correction, these values were: 563 (31.5%), 332 (18.6%), 492 (27.5%), 61 (3.4%), 334 (18.7%), respectively. Of the 1498 eyes with VA (6/12 on presentation, 352 (23.5%) were the result of coincident disease, 800 (53.4%) refractive error and 320 (21.4%) operative complications. Eye camp surgery (OR 1.72, p = 0.002), ICCE (OR 3.78; p,0.001), rural residence (OR 1.36, p = 0.01), female gender (OR 1.55, p,0.001) and illiteracy (OR 2.44, p,0.001) were associated with VA of ,6/18. More recent ICCE surgeries were associated with a poorer outcome. The ratio of ECCE+IOL:ICCE in the last 3 years was 1.2:1, compared with 1:3.3 >4 years before the survey. Conclusion: Almost a third of cataract operations result in a presenting VA of ,6/60, which could be halved by appropriate refractive correction. This study highlights the need for an improvement in quality of surgery with a more balanced distribution of services.

The pilot survey demonstrated that the proposed examination process for the main survey is feasible. Particular strengths of this survey include the use of logMAR visual acuity testing and autorefraction of all subjects, a dilated posterior segment examination, and the use of a 'less than 6/12' threshold for further examination. This lower threshold addresses the burden of refractive error, which, with cataract, are two of the diseases specifically targeted by Vision 2020.

Objective: To find out the effectiveness of cardiac rehabilitation in patients with myocardial infarction in Pakistan. Study Design: Randomised controlled trial.

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Atrial fibrillation (AF) is the most common type of arrhythmias in clinical practice. It has been proven that the presence of AF increases the risk of stroke by five times relative to the population of people without AF. One of the important issues in the management of patients with atrial fibrillation is the management of the risk of thromboembolic complications, namely the optimal selection of anticoagulant therapy. Most oral anticoagulants (dabigatran, apixaban, rivaroxaban) are the most effective and safest drug in patients with nonvalvular AF compared to warfarin. However, even with the use of new oral anticoagulants, there is a proven risk of bleeding, which ranges from minor to life-threatening. Currently, there are approved non-specific strategies for reversing and replenishing clotting factors associated with the use of oral anticoagulants, with certain indications in a patient with severe or life-threatening bleeding, emergency surgery, or before thrombolytic therapy. Over the past few years, specific oral anticoagulants antagonists have been actively studied. Of the specific oral anticoagulants antagonists, only idarucizumab has been approved in Russia (registration of the drug in Russia since September 2018), which makes it safer to use dabigatran in real clinical practice. The article presents clinical cases illustrating the effectiveness of the use of a specific antagonist dabigatran etexilate (idarucizumab) in patients with nonvalvular atrial fibrillation. Clinical examples illustrate the difficulties of managing patients with atrial fibrillation and hemorrhagic complications while taking oral anticoagulants.