l Comparison of Efficacy of Topical Ofloxacin and Gentamycin in Tubotympanic Type of Chronic Suppurative Otitis Media

Objectives: To compare the eficacy of 0.3% topical ofloxacin 4 drops thrice daily with topical gentamycin 0.3%, 4 drops thrice daily in patients with active tubotympanic type of CSOM. Study Design: Randomized controlled trial study. Place and Duration of Study: This study was carried out in the Department of ENT and Head and Neck Surgery, HMC, Peshawar from Jan 2012 to July 2012. Materials and Methods: This Randomized controlled trial was conducted, consisting of 134 patients with ear discharge for more than three months which were randomly allocated to two groups each consisting of 67 patients. Patients in group A received gentamycin 0.3% in a dosage of four drops thrice daily, while patients in group B received 0.3 % ofloxacin four drops thrice daily for ten days. Patients were followed for two weeks after therapy for ear symptoms assessment, otoscopy and examination under microscopy. Results: A total of 134 patients of chronic suppurative otitis media were included in the study. Results showed that the rate of resolution of ear discharge [otorrhea] is significantly higher in patients treated with topical Ofloxacin than gentamycin [98.5% vs 89.6%]. [Pc0.05] Conclusion: Topical Ofloxocin is a better choice in management of CSOM than topical Gentamycin in terms of resolution of ear discharge.

Presentation and diagnosis of allergic fungal sinusitis

Allergic fungal sinusitis [AFS] is a form of fungal disease that has recently been considered a distinct clinicopathologic entity. Other forms of fungal sinusitis include acute-fulminant [invasive], chronic indolent [invasive] and mycetoma [non-invasive]. Objectives were to assess the presentation and to describe the diagnostic techniques for allergic fungal sinusitis in our setup. Descriptive study was conducted in the Department of ENT and Head and Neck Surgery, Khyber Medical College and Khyber Teaching Hospital, Peshawar from January 2002 to April 2008. Twenty-three cases of allergic fungal sinusitis [ASF] were selected for the study. Data like, name, age, sex, address, clinical features, labs [Eosinophil count] and imaging studies [CT and/or MRI] were recorded, including the pre- and postoperative treatment, operative findings and postoperative results, recurrence of disease were also recorded. Surgical procedures were performed on all cases followed by medical treatment. Study revealed that AFS is a disease of younger age, mainly occurring in 2[nd] and 3[rd] decade of life, with male to female ratio 1:1.3. Allergic rhinitis [91%] and nasal polyposis [91%] were important associated factors. Nasal obstruction [96%], nasal discharge [91%], post-nasal discharge [87%] and unilateral multi sinus extension were important clinical features. Increased eosinophil count and increased IgE level was found in 78% cases. Histopathological analysis showed fungal hyphae in all cases and aspergillus was predominant organism on culture. Orbital erosion was seen in 78% and skull base erosion was observed in 9%. Recurrence of disease was seen in nine cases. Allergic fungal sinusitis [AFS] is a disease of young immunocompetent adults. Nasal obstruction, nasal discharge, nasal allergy and proptosis were the most common presentations. Initial diagnosis of allergic fungal sinusitis requires high index of suspicion in patients presenting with chronic rhinosinusitis, such cases should be properly evaluated. Differentiation from invasive forms of fungal sinus disease is crucial

Role of postoperative medical treatment in the management of allergic fungal sinusitis

To evaluate the effectiveness, of postoperative medical treatment in the management of allergic fungal sinusitis with orbital and/or skull base erosion. Descriptive study. This study was conducted in the Department of ENT and Head and Neck Surgery, Khyber Medical College and Khyber Teaching Hospital Peshawar between January 2002 and April 2007. Eighteen cases of allergic fungal sinusitis with orbital and/or skull base erosion were selected for the study. Demographic data like, name, age, sex, address, clinical features, labs and imaging studies were recorded, clinical data including the pre and post-operative medical treatment, operative findings and postoperative results, recurrence of disease were recorded. All patients were divided into three groups on the basis of postoperative medical treatment. Study revealed that Allergic Fungal Sinusitis [AFS] is a disease of younger age, mainly occurring in 2[nd] and 3[rd] decade of life, with male to female ratio 1:1.25. The recurrence was 100% in group-l who were on oral antifungal therapy postoperatively. The recurrence of disease was 40% in patients of group-2 who were on topical nasal steroid, antihistamine and saline irrigation postoperatively. The recurrence rate was much lower 11% in group-3 patients who received oral and topical nasal corticosteroids postoperatively. AFS is a disease of young immunocompetent adults. Surgical debridement and drainage combined with topical and oral corticosteroids can lead to resolution of disease in majority of the cases and prevent recurrences. Antifungal medication has no role in the treatment of allergic fungal sinusitis

Immunization status against hepatitis B virus and determination of anti-HBS antibody titer in medical and dental students

This study was aimed to determine anti-HBs antibodies titer in medical and dental students to monitor success of hepatitis B vaccination. This study was conducted on students of Khyber Medical College and Khyber College of Dentistry, Peshawar. Serum samples from students who were vaccinated were tested for the determination of anti-HBs antibody titer using microparticle enzyme immunoassay [MEIA]. Out of 520 students surveyed, only 176 [33.84%] had either one injection or complete course of vaccine. None of them had checked their anti-HBs antibodies titer; 119 students [67.61%] had used Engerix-B, 41 [23.30%] students did not remember the brand of the vaccine while only 16 [9.09%] had used Heber-biovac HB. Twelve [6.8%] students tested were non-reactive for antibodies [titer <10.0 mIU/ml] while in 36 [20.5%] students antibodies titer was 10 and 100 mIU/ml respectively and 128 [72.7%] had antibodies titer more than 100 mIU/ml. Time lapsed between vaccination and detection of antibody titer was U - 6 years, 76 [43.1%] students had been tested after one year and 5 [2.8%] after 6 years and 41 [23.5%] students after 2 years. Only one third had their partial or complete course of their vaccination. Antibody titers were reactive in majority of students who had completed the course. Students entering medical and dental schools need to be better educated about hepatitis B and its vaccination

Gossypiboma of nose and nasopharynx: a report of two cases

Gossypiboma is an iatrogenic complication which can occur in any surgical procedure. It is an uncommon condition and is under reported in literature. Due to non-anticipation it is usually missed or misdiagnosed leading to delayed diagnosis. We present two cases of gossypiboma in the nose and nasopharynx respectively