Peadiatric tracheostomy: an experience in Tertiary Care Hospital

Tracheostomy is the surgical procedure originally described in 1[st] century BC. It is the life saving procedure when performed with appropriate indications and surgical technique. Tracheostomy in the pediatric population is a particularly hazardous procedure. Retrospective chart review This study was conducted at the Peoples University of Medical and Health Sciences Hospital Nawabshah between 2004 to 2008. Retrospective review of pediatric tracheostomy done in emergency or elective procedure under general anesthesia or local anesthesia was under taken. Name, age, indications, time of decanulation and follow up were evaluated. 31 Pediatric patients had tracheostomies within study period. There were 19 males and 12 females. Age range was 2 months to 10 years. The most common indication of tracheostomy was upper respiratory tract obstruction due to traumatic causes [54.83%]. 83.87% tracheostomies were done in emergency while 16.12% as elective procedure under general anesthesia or local anesthesia. Complications were encountered in 32.25%of patients. Most frequent complication was granulation tissue formation in the area around stoma [30%]. Complication rate was high in patients below 2 years of age [63%] and in patients having emergency tracheostomy [73.9%]. Decanulation was successfully done in all alive patients [87%]. Overall mortality rate was 12.9%. There was no tracheostomy related mortality. The indications for pediatric tracheostomy are changed from airway obstruction due to infection to trauma. Complication rate of tracheostomy is higher in younger age groups. Mortality and outcome of these patients depends primarily on underlying medical condition of the patient, otherwise pediatric tracheostomy is safe when performed in tertiary hospital settings

Montelukast versus nigella sativa for management of seasonal allergic rhinitis: a single blind comparative clinical trial

To compare the therapeutic role of leukotriene receptor blocker Montelukast with N. Sativa seeds in seasonal allergic rhinitis patients. Comparative uncontrolled single blind clinical assessment was carried out over forty seven untreated adult patients torment from seasonal allergic rhinitis and staring for outpatient management. All patients were chosen from different primary care health centers, registered and were divided in a single-blind approach to obtain Montelukast, 10 mg/day, group I [n=24] and 250 mg/day of N. Sativa, group II [n=23] orally for two weeks. Patients joined-up the study has completed the therapeutic plan. Montelukast and N. Sativa both demonstrated a significant and early decrease in daytime as well as ophthalmic symptoms, while montelukast showed diminished and late effects on nighttime symptoms when compared with N. Sativa. In addition montelukast has also been showing to cause drug allied side effects like headache, dizziness and heart burn. It would come into view that N. Sativa is safe and thoroughly free from threat of adverse effects. So it is a liable management alternative for seasonal allergic rhinitis patients

Otolaryngologic manifestations of gastroesophageal reflux disease

To determine frequency of endoscopic oesophagitis in the patients who complain the chronic laryngopharyngeal disorders in the absence of typical gastroesophageal Reflux Disease [GERD] symptoms. Descriptive study The study was carried out in the department of E.N.T at Nawabshah Medical Centre, Nawabshah over the period of two years [2004 to 2006]. One hundred patients of either sex and in the age group between 25-79 years with symptoms of chronic laryngopharyngeal disorders were selected for study. All patients had physical examination of upper aero digestive tract. Direct laryngoscopy was done to evaluate the status of larynx, however rigid esophagoscopy was done to evaluate the status of esophageal mucosa and biopsies from lower part of esophagus were taken in all patients. Eighty percent of patients with symptoms of chronic laryrigopharyngitis were also suffering from microscopic Oesophagitis. Among the 80% patients 87.5% were having non-erosive oesophagitis while 12.5% were having erosive oesophagitis. In significant number of patients with chronic upper respiratory symptoms resistant to the treatment, there was co existing gastroesophageal disease which could be the cause of the symptoms

Screening of beta thalassaemia trait using red cell indices and red cell count

To evaluate the sensitivity of mean corpuscular volume [MCV], mean corpuscular haemoglobin [MCH] and red blood cell [RBC] count for screening of beta thalassaemia trait [BTT] in population of Northern Pakistan. Blood samples from more than five hundred patients admitted in Hayatabad Medical Complex Hospital, Peshawar were taken and analyzed by Sysmex KX-21 Haematology Analyzer. MCV <80 fl, MCH <25 pg and RBC count >/= 5.0x10[12]/L were used for detecting BTT. HbA2 and serum ferritin levels were used to confirm the diagnosis. Forty-eight [8.5%] out of 563 subjects studied were found to have low MCV and MCH with normal or slightly raised RBC count. HbA2 and serum ferritin levels confirmed 44 patients as BTT, 03 as BTT with iron deficiency [ID] and one case of iron deficiency anaemia [IDA]. The analysis of the results showed 100% sensitivity and a positive predictive value of 97.9% of this screening procedure. The study concluded that low MCV and MCH in association with slight erythrocytosis is a reliable and sensitive index for screening beta thalassaemia trait

Cetirizine and nigella sativa: comparison of conventional and herbal option for treatment of seasonal allergic rhinitis

To compare the efficacy of the second-generation antihistamine cetirizine with Nigella sativa [N. sativa] seeds in management of seasonal allergic rhinitis [SAR]. Comparative uncontrolled clinical trial. Forty untreated adult patients, suffering from seasonal allergic rhinitis, seeking outpatient treatment were selected from different primary care clinics. They were enrolled and randomized in a single-blind manner to receive Cetirizine, 10 mg/day, group I [n=20] and 250 mg/day of N.sativa, group II [n=20] orally for 14 days. Response to treatment was evaluated at the end of the study. All patients completed the treatment. Both study drugs i.e cetirizine and N.sativa were equally effective at relieving the symptoms of seasonal allergic rhinitis; however, the group using cetirizine had more sedation and other adverse effects. It appears that N.sativa is has minimal adverse effects and is therefore a safe treatment option for the patients of seasonal allergic rhinitis

Nagilla sativa: a non-conventional herbal option for the management of seasonal allergic rhinitis

Seasonal allergic rhinitis [SAR] is one of the top reasons for patient visits to primary care physicians because of its bothersome symptoms. This highly prevalent disease also impairs quality of life, sleep, and work. Oral antihistamines are one of the most frequently prescribed medications for the management of SAR but they have their own side effects. Hence the effects of traditional Nigella sativa seeds, on seasonal allergic rhinitis were studied in 20 patients. Daily dosages of 250 mg of seeds for a 15 days period significantly reduced the symptom severity scores of allergic rhinitis in patients. It was concluded that Nigella sativa seeds could be successfully used for seasonal allergic rhinitis

Incidence of spontaneous bacterial peritonitis in liver cirrhosis, the causative organisms and antibiotic sensitivity

To find out the incidence of spontaneous bacterial peritonitis in patients with liver cirrhosis having ascites, the causative organisms and their antibiotic sensitivity. This study was conducted in Medical Ward of Khyber Teaching Hospital, Peshawar from 1st June 2001 to 31 of March 2003. Patients having liver cirrhosis confirmed previously by histopathology and now presenting with fever with or without chills, abdominal discomfort, increasing abdominal distension, confusion and hepatic encephalopathy, were included. A total of 200 patients were studied. Out of 200 patients included, spontaneous bacterial peritonitis [SBP] was present in 102 patients. Classical SBP was present in 38.23%; Culture Negative Neutrocytic Ascites [CNNA] was present in 57.84% while Bacterascites was present in 03.92% of patients. E Coli was isolated in 58.13%, Streptococcus pneumoniae in 18.60%, Staphylococcus auras in 09.13%, Klebsiella in 09.13% and Acinetobacter in 04.65%. Out of 102 cases of SBP, blood cultures were positive in 21.56%, urine cultures in 15.68% and throat swabs in 10.78% of patients. E Coli was again the commonest organism isolated from blood cultures. All the organisms were sensitive to 3rd generation cephalosporins, and quinolones. Spontaneous bacterial peritonitis is quite a common complication of liver cirrhosis with ascites. Patients usually present with abdominal pain, abdominal tenderness, fever with or without rigors, jaundice, and hepatic encephalopathy. E Coli is the commonest organism followed by streptococcal pnaemoniae. Quinolones and 3rd generation cephalosporins are 100% effective in the management of spontaneous bacterial peritonitis

Primary source of infection in tuberculous cervical lymphadenitis: a prospective study

To search for the primary site of infection inpatients with cervical tuberculous lymphadenitis. DESIGN: A prospective study. PLACE and DURATION OF STUDY The study was carried out at the departments of ENT Civil Hospital Karachi, Chest medicine JPMC Karachi and Ojha institute of Chest diseases Karachi, over the period of two years [June 2000 - July 2002] SUBJECT and METHODS: One hundred patients with a clinical suspicion of cervical tuberculous lymphadenitis were included in the study. All Patients had a physical examination of the upper aerodigestive tract. Routine endoscopy and biopsy of the nasopharynx were performed. All of them had excisionallincisional biopsy of the cervical lymph node. Seventy-five patients had histologically confirmed tuberculous cervical lymphadenitis. Culture o f the lymph node specimen showed mycobacterium tuberculosis in 68 [90%]. In 45 [60%] patients with cervical tuberculous lymphadenitis, the primary foci of infection could not be found. Twenty-nine [39%] had radiographic evidence of active or healed pulmonary tuberculosis. Sputum culture from two patients showed mycobacterium tuberculosis. Five patients [6%] had tuberculous nasopharyngitis. In one of them, the tuberculous nasopharyngitis was primary as no other evidence of mycobacterium infection was found. In present study the pulmonary foci are the primary infection site in cervical tuberculous lymphadenitis. The mycobacterial infection of otherparts of the upper aerodigestive tract was not found