The relationship between timing of admission to a hospital and severity of injuries following 2005 Pakistan earthquake / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>The objective of this study was to establish the relationship between the timing of admission to a hospital and the severity of injuries following an earthquake.</p><p><b>METHODS</b>It was a retrospective chart review of injured patients admitted to a tertiary care teaching hospital following the 2005 Pakistan earthquake. Age, gender, injury severity score, type of injuries, complications, operations, hospital stay and mortality were studied and compared at different time intervals using SPSS.</p><p><b>RESULTS</b>Most injuries were musculoskeletal [145 (59%)] vs. all other injuries, including minor lacerations [103 (41%)], but the percentage of non-musculoskeletal injuries was higher within 24 h (67% vs. 53% respectively, p = 0.4). Injury severity score (25 ± 10 vs. 16 ± 9, p=0.01), multiple injuries [73% vs. 45%, p=0.05] and crush syndrome [20% vs. 03%, p = 0.02] were significantly higher in patients admitted within 24 h. More patients with head and neck injuries were admitted within 24 h (27% vs. 18%, p = 0.4). Patients admitted within 24 h had higher complication rates (67% vs. 32%, P = 0.01) as well as mean operative procedures (2.8 ± 1.9 vs. 1.9 ± 1.9, p= 0.08).</p><p><b>CONCLUSION</b>Our study showed that patients admitted to a hospital within 24 h following an earthquake had more severe injuries and higher complication rate than those admitted after 24 h.</p>

Gastroesophageal reflux disease in patients with chronic obstructive pulmonary disease

Objective: To evaluate the gastroesophageal reflux symptoms in Chronic Obstructive Pulmonary Disease [COPD] patients and Upper Gastrointestinal [GI] endoscopy findings in these patients

Study Design: Cross sectional study

Place and Duration of Study: This study was conducted at Dow University Hospital and Civil Hospital Karachi from January 2013 to December 2013

Materials and Methods: 100 of COPD were selected and assessed for presence of gastro esophageal reflux [GERD] symptoms. Data was analyzed on SPSS version 13

Frequency and percentage were computed for categorical variable like gender, gastro-esophageal reflux symptoms and upper GI endoscopy finding in COPD patients with gastro esophageal reflux symptoms. Mean standard deviation was computed for quantitative variables like age, smoking [pack year], solid fuel and tea consumption [cup/day]

Results: In this study of 100 patients 95 were males and 5 were female. Cough was the commonest symptom that was found in 85% patients followed by sputum production in 71% patients, retrosternal burning [68%], acid reflux [54%] and dysphagia [11%]

Gastro-esophageal reflux symptoms were observed in 54 patients. Out of these 54 patients who had GER symptoms, 33 [61%] patients had erosive gastro-esophageal reflux disease while 21[39%] patients non-erosive gastro esophageal reflux disease on upper GI endoscopy

Conclusion: Our study shows that higher proportion of Gastro esophageal reflux symptoms is present in COPD patients. Moreover, upper GI endoscopy can be normal in COPD patients with significant GERD symptoms

Total laryngectomy: an experience of 26 cases in a tertiary care hospital

OBJECTIVE: To determine the clinical features, diagnosis and complications of total laryngectomy at a tertiary care hospital

MATERIAL AND METHODS: This descriptive prospective study was conducted at the department of ENT, Head and Neck Surgery, PGMI/ LRH Peshawar from Janurary 2001 to December 2010. All patients were thoroughly evaluated and disease was staged according to TNM. After informed consent total laryngectomy was performed in all patients followed by chemoradiotherapy

RESULTS: A total of 26 patients underwent total laryngectomies for histologically confirmed laryngeal cancers. The age of the patients ranged from 38-72 years with mean age of 57.34 +S.D 9.6 years. Hoarseness was the commonest [100%] presenting feature. According to TNM staging system 15 patients [57.69%] had stage III and 11 patients [42.30%] had stage IV carcinoma larynx. There was wound infection in 6 patients [23.07%] and 4 patients [15.38%] developed pharyngocutanous fistula

CONCLUSION: The commonest presentation of laryngeal carcinoma was hoarseness, so any smoker patient having age greater than 40 years with persistent hoarseness must be investigated for laryngeal carcinoma

Pattern of causes and management of permanent loss of voice studied at a tertiary care hospital

To determine the frequency of causes of hoarseness leading to permanent loss of voice and discuss their management. This descriptive study was carried out at the department of ENT, Head and Neck Surgery, Lady Reading Hospital Peshawar from January 2009 to December 2011. All these patients were evaluated in terms of detailed history, thorough examination and relevant investigations. Biopsy from laryngeal mass was taken in case of tumours. Total laryngectomy was performed in patients with advanced laryngeal tumours provided with preoperative counseling regarding postoperative handicaps. The patients with laryngeal narrowing due to trauma were subjected to laryngeal stenting. The data was analyzed using SPSS 15. Out of 16 patients 10 were male and 6 were female with male: female ratio of 1.6:1. The ages ranged from 09-75 years with mean age of 43.68 +/- S.D 18.65 years. Majority of patients [68.75%] had low socioeconomic status. Main presentation of these patients was hoarseness [100%]. The commonest cause of change of voice was laryngeal carcinoma [n-6, 37.5%], followed by blast injury [25%].Endolaryngeal stenting was the commonest [43.75%] procedure performed for traumatic laryngeal stenosis followed by total laryngectomy. Most of the patients gained good esophageal speech. It is concluded that beside laryngeal cancer, trauma to the larynx is a common cause of permanent loss of voice resulting due to increased incidence of violence in our set up. Esophageal speech can be easily and successfully instituted in laryngectomized patients among other voice rehabilitative options

Reconstruction of nasal alar defect; use of nasolabial skin flap

To assess the outcome of nasolabial flap for ala plasty in patients with alar defect. Descriptive study. Department of E.N.T, Head and Neck Surgery Postgraduate Medical Institute [PGMI] Lady Reading Hospital [LRH] Peshawar. January 2006 to December 2007. In this study we included 35 patients. A detailed history and thorough physical examination regarding general condition of the patient and specifically E.N.T of the patient with emphasis on the alar soft tissue deformity, both from cosmetic and functional aspect was recorded on preformed proforma. Pre-operative and post-operative photographs were taken after taking written consent from all the patients. All procedures were carried out under local infiltrative anesthesia and were covered by intravenous prophylactic antibiotics. These patients were followed at one month, six month and one year intervals. Our study included 35 patients of nasal ala plasty with superiorly based nasolabial flap. Out of 35 patients 26 [74.29%] were males and 9 [25.71%] were female with female to male ratio of 1:2.8. Males dominated nasal deformity as males are more exposed to trauma. Average age in males was 47 years [range 24-70 years] and in females it was 48.5 years [range 27-70 years]. The patients presented with nasal alar deformity in the age range from 25 to 70 years, while 19 patients [54.28%] presented during 31 to 50 years of age. Trauma was dominated [n=28, 80%] among the causative factors for alar soft tissue loss in these 35 patients. Twenty-eight [80.00%] patients were fully satisfied both cosmetically and functionally, 04 patients [11.42%] were partially satisfied only cosmetically and 03 patients [8.57%] were not satisfied with their nasal cosmetic improvement and functional results. Nasal ala plasty with superiorly based nasolabial flap provide good cosmetic result with minimal complications

Rare foreign bodies [pellets] migrating through the gastrointestinal tract spontaneously. report of 2 cases

Foreign body ingestion or insertion in children is a common clinical condition. Foreign body may cause number of complications if not detected and treated in time. Firearm injury is not uncommon. Injury by air gun may cause pellets to retain inside human body. Here we present two cases of air gun injury where pellets entered the esophagus and passed through gastrointestinal tract spontaneously without causing any complication

Diagnostic yield of fine needle aspiration cytology in diagnosis of thyroid nodule and its comparison with national and international studies

OBJECTIVE: To determine the diagnostic value of fine needle aspiration cytology in the diagnosis of solid solitary thyroid nodule

STUDY DESIGN: This was cross-sectional comparative study

PLACE AND DURATION OF STUDY: This study was conducted at the Department of Ear, Nose, Throat, Head and Neck surgery, Post Graduate Medical Institute, Lady reading Hospital, Peshawar. The duration of the study was one year from June 17, 2010 to June 16, 2011

METHODOLOGY: The sample size was 82 patients with solid solitary thyroid nodule, fulfilling the inclusion criteria. After taking detailed history and thorough examination, relevant investigations were performed. Informed consent was taken from all the patients and Fine needle aspirations were carried out in all cases and compared with open biopsies taking as gold standard

RESULTS: Our study included 82 cases consisting of 57 female and 25 male, with female: male ratio of 2.28

1.The age of the patients was ranged from 16-65 years with mean age of 42.56 + S.D 11.60 years. The FNAC diagnostic accuracy was 82.92% along with a sensitivity of 88.09% and specificity 77.50%. The positive predictive value was 80.43% that supports our hypothesis

CONCLUSION: FNAC is a primary diagnostic tool for solitary thyroid nodule because it is simple, safe, quick, reliable, minimally invasive, and cost effective

Etiological profile and sensitivity spectrum of isolates from chronic suppurative otitis media at a tertiary care hospital

Background: Chronic suppurative otitis media [CSOM] is choronic inflammation of middle ear, which represents with recurrent ear discharge and is prevalent worldwide

Objective: To determine the etiological profile and sensitivity spectrum of microorganisms of chronic suppurative otitis media in a tertiary care hospital

Material and Methods: This descriptive study was conducted at outpatient department, Ear, Nose, Throat, Head and Neck Surgery, Postgraduate Medical Institute Lady Reading Hospital Peshawar from June 20 10 to June 2011. This study included 285 patients who had discharging ears more than 3 months. The swabs were plated on Mac Conkey agar, Blood agar and Chocolate agar and incubated for 24 to 48 hours at 37[degree]C. Identification of bacterial strains was done by colonial morphology on selective and differential medium. Minimal inhibitory concentrations [MIC] of these antibiotics were monitored according to the guideline of National Committee for Clinical Laboratory Standards [NCCLS]. The data was analyzed using the SPSS version 17

Results: This study included 285 cases constituting 184 male and 101 female, with male: female ratio of 1.8:1. The age of the patients ranged from 08-46 years with mean age of 39.91 +/- S.D 15.27 years. In majority of patients [73.68%] single organism was isolated. Among the isolates Pseudomonas aeruginosa was the commonest [46.31%]. The antibiotic susceptibility profile of the bacterial isolates revealed that ciprofloxacin had highest sensitivity against pathogens isolated from CSOM

Conclusion: It is concluded that Pseudomonas aeruginosa is the commonest etiological agent in chronic suppurative otitis media in our set up and ciprofloxacin is the antimicrobial agent with highest sensitivity