Prevalence of Seizure Disorder in School Children in Kashmir

Seizure disorder is highly prevalent disorder particularly in developing countries. This study was undertaken to determine the prevalence of seizure disorder of school going children (6-16) years of age in all the six districts of Kashmir. Methods: The selection of schools was done by PPS (proportionate to population size) used in cluster survey. Questioner Performa was given to 60 randomly selected children from each selected school, 30 boys and 30 girls were screened to find out the prevalence of seizure disorder. To give adequate representation to all individuals of various strata both Govt and Private run schools from rural as well as urban areas were selected. Results: A total of 19 positive cases of epilepsy were detected during the survey period, After screening of 5760 children (rural and urban) the crude prevalence of epilepsy was found to be 3.3/ 1000 which is comparable to the other studies in the world. The Male prevalence in school going children was 3.8/1000 while female prevalence of epilepsy was 2.77/1000. Commonest type of seizure was generalized tonic clonic (GTC) 78.9%. Conclusion: The prevalence of seizure disorder in children of lower socio economic class was 3.5/1000.

Impact of Socio Economic Status and Cultural Factors on the Prevalence of Epilepsy: Study in Kashmir

Introduction: The social and economic problems cuased byepilepsy are offen under appricaiated. The message shouldreach the broadest population of effected individuals, many ofwhom are in low socio economic groups and are at higher riskfor development of epilepsy. Study aimed to asess the impactof socio economic status and cultural factors on the prevalenceof Epilepsy in school going Children (6-16 years) in Kashmir.Material and methods: This was a population based studyconducted in school children. The selection of school wasdone by using PPS Method (Proportionate to PopulationSize) used in cluster surveys. The Pretexed Questionnairewas administered to 60 randomly selected children from eachselected school, the positive responders were examined by theneurologist and psychologistResults: The crude Prevelance of epilepsy in school goingchildren was 3.8/1000 for males which was higher thanfemales 2.77. The Govt schools had higher prevalence3.81/1000 as compared to private schools 2.79/1000 reflectinghigher prevalence in economically weaker section. Childrenfrom lower middle class had highest prevalence 3.56/1000.Conclusion: The prevelance of Epilepsy seems to increasewith socio economic deprivation though the association maybe compounded by other factors. The over all prevelance wascomparable to other studies. However there is significantimprovement about the awareness of epilepsy in Kashmirvalley over the past decades.

Comparison of efficacy of topical with oral ciprofloxacin in patients of tubotympanic type of chronic suppurative otitis media to obtain dry ear

Background: Chronic suppurative otitis media [CSOM] is one of the common diseases in routine ENT practice

Objective: To compare the efficacy of topical ciprofloxacin with oral ciprofloxacin 500mg twice daily in achieving dry ear [Medical cure] in Tubo-tympanic type of Chronic suppurative otitis media

Methodology: Study Design: Quasi-experimental study. Place and Duration of Study: The study was carried out at ENT department of Bahawal Victoria Hospital Bahawalpur from 01 January to 30 September 2015. One hundered patients, 11 to 60 years of age of either gender having Tubo-tympanic type of chronic supportive otitis media were included. Patients with previous antibiotic treatment, pregnant or lactating women, history of hypersensitivity to Quinolones [ciprofloxacin], chronic suppurative otitis media of Attico-antral type, known case of DM and hypertension were excluded. Selected patients were divided into two groups [Group A and Group B] by using lottery method. Group A [n=50] was given Ciprofloxacin ear drops and Group B [n=50] was given Oral Ciprofloxacin 500mg twice daily. The patients were followed up to 08 weeks after treatment [at least two follow up visits] and examined otoscopically and under microscope to assess the efficacy. The efficacy of drugs was graded into four grades depending upon the decrease in discharge amount [Poor/no response, satisfactory, good and excellent]. The data was entered and analyzed by using SPSS version 20

Results: The mean age of group Apatients was 27 +/- 5 and in group B was 30 +/- 5 years. Males were 67 [67%] and females were 33 [33%] with ratio of 2:1. Bilateral CSOM in 27 [27%] and Unilateral was found in 73 patients [73%]. Efficacy was excellent in 52%, good in 24%, satisfactory in 8% and poor/ no response in 11% patients of Group A while it was excellent in 36%, good in 24%, satisfactory in 1% and poor/no response in 30% patients of Group B

Conclusion: This study concluded that Topical ciprofloxacin is more effective than oral ciprofloxacin in the medical treatment of tubo-tympanic type of CSOM to obtain dry ear

Frequency of three complications [bleeding, laceration of external auditory canal and perforation of tympanic membrane] in patients with aural foreign bodies

To determine the frequency of three major complications of the foreign body in the external auditory canal i.e. the haemorrhage, the laceration and the perforation of the tympanic membrane. Cross sectional study. This study was conducted in the Department of ENT, Bahawal Victoria Hospital, Bahawalpur from 25-12-2012 to 24-09-2013. Total 284 cases that presented during nine months of duration were included in our study. General anaesthesia was used not only when initial attempt under direct visualization was unsuccessful, but also for those having history of previous attempts, and uncooperative patients. 25% of patients developed haemorrhage, 13.8% were having laceration while none of the patient presented with tympanic membrane perforation. Cotton bud was found to be the commonest foreign body [33.7%] and bleeding was associated with it. In this study, the cotton bud was found to be the commonest foreign body in external auditory canal. Use of cotton bud although is easy for cleaning of ears but if it is broken inside the external auditory canal, can cause serious complications like bleeding and laceration as found in this study. Public should be educated about this preventable medical emergency

Tonsillectomy under local anesthesia: is it safe, feasible and practicable?

Background: Tonsillectomy is one of the most common ENT surgeries

Objective: The study was done to evaluate the feasibility of tonsillectomy under local anesthesia

Subjects and Methods: A total number of 80 consecutive patients whose tonsillectomy was performed under local anesthesia with systemic analgesic injections were included in this cross- sectional study. Peroperative difficulties and problems were noted. Similarly in post-operative period, the rate of complications was noted to conclude upon the feasibility of tonsillectomy under local anaesthesia

Results: A total of 80 patients were included in this study, with 36 females. Following complications were noted, Trismus [5%], difficult dissection [10%], primary hemorrhage [3.7%], reactionary hemorrhage [2.5%] and throat pain [10%]

Conclusion: We concluded that the procedure is safe, feasible and practicable but should be done with certain precautionsi

Management of oesophageal foreign bodies

The aim of the study was to evaluate the management of foreign bodies in the oesophagus and to determine the association with socioeconomic status. This cross-sectional analytical study was carried out in the Department of Ear, Nose and Throat and head and neck surgery of Bahawal Victoria Hospital affiliated with Quaid-i-Azam Medical College, Bahawalpur, Pakistan, between December 2012 and May 2013. The medical records of 34 consecutive cases of foreign body ingestion were searched, and the data were recorded on a questionnaire prepared for this purpose. The average age of the patients was 10.38 years; 29 cases [85.2%] were in children under 12 years. There were 18 females [52.9%] and 16 males [47.1%]. Thirty patients [88%] presented with a history of dysphagia, and 25 [73.6%] had vomiting. The site of impaction was the post-cricoid region in 22 patients [66%], the lower oesophagus in 5 [15%], the mid-oesophagus in 4 [13%], the posterior pharyngeal wall in 1 [3%] and the pyriform fossa in 1 patient [3%]. Coins were the most common foreign body [61.8%]. Socioeconomic analysis showed that 18 patients [52.9%] were in the low socioeconomic class, 12 [35.3%] in the middle class and 4 [11.8%] in the upper class. The presence of a foreign body in the oesophagus is a serious condition, and early removal is recommended. Foreign body lodgement is commoner among poor families

Normative spirometric values in adult kashmiri population.

Background. Normative values of pulmonary functions of healthy population are affected by different geographic, ethnic, climatic and demographic factors. Objective. Present study was designed to derive normative spirometric values, prediction equations for future reference in adult Kashmiri population. Methods. Pulmonary function testing was carried out on 3080 normal healthy non-smoking individuals (1974 males; age 18-65 years) of Kashmir valley. Multiple regression analysis was used to develop prediction equations for use in this population. Results. Forced vital capacity (FVC, L/s) (4.3±0.8 versus 3.0±0.5; p<0.05), forced expiratory volume in the first second (FEV1, L/s) (3.9±0.7 versus 2.6±0.5; p<0.05) and peak expiratory flow rate (PEFR, L/s) (7.9±1.8 versus 5.3±1.2; p<0.05) were significantly higher in males in comparison with females. All the other parameters except FEV1/PEFR ratio were significantly higher among males (p<0.05). Irrespective of gender, all the parameters declined with increasing age. Females had higher FEV1/PEFR ratio (p<0.05) in age group of 15-30 years. Overall the inter-group difference across the districts studied was not significant. Spirometric parameters manifested an overall negative correlation with increasing body mass index (BMI), although FVC and FEV1 in males with low BMI were high (p<0.05). Conclusion. These prediction equations can be utilised as reference values for future use in adult Kashmiri population.

Juvenile nasopharyngeal angiofibroma, experience of 35 cases with different surgical approaches

1] To study the clinical presentation. 2] To study the outcome regarding recurrence, prognosis and complications of different surgical approaches ofjuvenile nasopharyngeal angiofibroma. Observational study. The study was conducted at department of Ear, Nose, Throat. Head and Neck Surgery, Quaid-e-Azam Medical College and Bahawal Victoria Hospital Bahawal Pur, from March 2005 to February 2009. All young male patients presenting in ENT OPD/COD with complaint of recurrent nose bleeding, nasal obstruction and nasopharyngeal mass were admitted in ward. Detailed history was taken and thorough clinical examination done. Routine investigations and CT scan done in all cases. Staging done according to Fisch staging systems. Sufficient quantity of blood arranged and patient prepared for surgery. Specimen removed was sent for histopathological examination to confirm clinical diagnosis. Follow up was done for 12-18 months to see the recurrence and complications. Total 35 young male patients clinically diagnosed as JNA and postoperatively confirmed by histopathology were included in the study. Age range was between 10-25 years, majority were between 12-20 years [n-31]. All patients were male. All patients presented with epistaxis, nasal obstruction and nasopharyngeal mass. Other presenting symptoms were, anemia [n-29], nasal mass [n-27], ear blockage [n-27], nasal discharge [n-25], headache [n-22], snoring [n-15], speech defect [n-11] and proptosis [n-6]. All patients under went surgery. Seventeen patients were approached through lateral rhinotomy, 12 through transpalatal approach and 06 through Weber Furguson approach. In 05 patients recurrence occurred and in 11 patients postoperative complications occurred. Meticulous surgical approach depending on the stage of .TNA reduces the risk of recurrence and complications

Different clinical presentations of breast cancer: an overview of 100 patients

To describe different modes of presentation of carcinoma breast in patients presenting at Bahawal Victoria Hospital Bahawalpur. It was a descriptive case series study, conducted in surgical units, Bahawal Victoria Hospital Bahawalpur. The duration of study was from January 2009 to December 2009. 100 female patients of proven carcinoma breast with informed consent were included in this study. All the data was collected on pre designed proforma and results were analyzed using SPSS 10,0 version, The commonest age group developing carcinoma breast was 31-50 years [59%]. Seventy six patients came from rural areas of Bahawalpur and nearby districts. Eighteen patients completed 10 years of schooling while only 5 patients were post-graduate. Twelve patients [12%] were un-married, Total 81% patients presented with lump in the breast. Left breast was involved in 56% of cases and right in 43% cases, One patient had bilateral carcinoma of breast. The duration of illness was ranged from 1 month to 5 years. The commonly observed stage of presentation was Stage III with 46 cases and 16 patients presented in stage IV. Infiltrating ductal carcinoma was the most common histological type 87% cases proved on histology to be infiltrating ductal carcinoma, Breast cancer is very common in the females, when diagnosed at an earlier stage have a more favorable prognosis compared to those at late stage. The females try to hide this problem and present at more advance stage

Management of recurrence in nasal polypi

To investigate the incidence of recurrence in nasal polypi and assess the efficacy of various modalities of the treatment currently available to prevent the recurrence. This study was carried out in the ENT and Head and Neck Surgery Department, B.V. Hospital Bahawalpur from January 2006 to December 2007. A total of 160 cases were included in the study. Most of the cases were between the ages 11-30 years. The youngest patient was of 5 years age while the eldest was of 70 years. Mean age was 24 years. The disease is most prominent in males. Out of 160, male patients were 98 and female were 62. Male to female ratio is 1.6:1. Nasal polypi are mostly bilateral [75%] while 25% were unilateral. 14% were right sided and 11% were left sided. About 60% of the patients were having symptoms for less than one year, 26% presented in 1-3 years period and only 16% presented after 3.years. Out of 160 cases, 56 [35%] patients were recurrent i.e. they had undergone already operative procedures, mostly nasal polypectomy. Nasal polypectomy was performed in 67.5% of the cases and ethmoidectomy in 32.5%. Ethoidectomy is better than nasal polypectomy and has lesser recurrence rate but a great care must be observed as the ethmoid is very close to the orbit and brain. External erthmoidectomy is the best of all surgical procedure to prevent the recurrence. Use of topical steroids after nasal polypectomy also prevents the patient from recurrence of nasal polypi

Superficial cervical swelling in children; role of fnac in diagnosis - experience at Bahawalpur

Fine needle aspiration cytology [FNAC] is commonly used first line diagnostic test for palpable cervical swelling by ENT and Head and Neck surgeon. To analyze the diagnostic importance of FNAC by knowing its sensitivity and specificity in children having palpable cervical swelling. Prospective study. Department of ENT and Head Neck Surgery QAMC, Bahawalpur. July 2006 to June 2007. 82 cases of superficial cervical swelling with ages between 5 and 12 years were selected. Most of them were of poor socioeconomic class. All underwent FNAC for diagnosis and results were analyzed after comparing with histopathology examinations. Out of 432 total patients [of all ages] who attended the ENT department during the study period, only 82 were selected for the research which fulfilled the inclusion criteria. These were 5-12 years old, both sexes, 47 boys [57.3%] and 35 girls [42.75%]. Sixty eight [83%] patients had benign diseases while 14 patients [17%] had malignant lesions. Out of the 68 benign lesion [44.11%] were reaction hyperplasia [non specific inflammation], followed by tuberculous lymphadenitis [38.23%], cystic masses [5.88%], benign tumours [4.4%] and nodular goiter [7.35%]. Out of 14 malignant lesions, 6 [42.85%] had Hodgkin's Lymphoma, 2 [14.28%] had Non Hodgkin's Lymphoma, 3 [21.42%] patients had squamous cell carcinoma and 1 [7.14%] patient each of rhabdomyosarcoma, undifferentiated carcinoma and pleomorphic adenoma. In our study sensitivity and specificity of FNAC to diagnose the malignant lesion was 85.7% and 89.7% respectively. Accuracy of FNAC in our study was 89.0%. FNAC is highly helpful to diagnose the pathology of cervical swelling in children. It has high rate of sensitivity, specificity and accuracy to diagnose the malignancy in these lesions. Proper and specific sampling needs complete cooperation of the child and sedation may be necessary for this. Expertise is required for FNAC reporting