Hematological profile and risk factors associated with pulmonary tuberculosis patients in Quetta, Pakistan

Tuberculosis [TB] is a chronic debilitating infectious disease affecting more than one third of the global population. This study was designed to investigate different peripheral blood parameters and risk factors in TB patients. A total of 600 [Male, 238 and Female, 362] aging 20-80 Years patients with clinical signs of prolonged cough, chest pain and fever, were evaluated for peripheral blood parameters using hematology analyzer. All the informations related to the disease were collected from the patients and recorded using predesigned questionnaire. Erythrocytic Sedimentation Rate [ESR], Hemoglobin [Hb] and lymphocytes were markedly changed in both sexes. Hemoglobin was recorded lower than normal value in 55% and 53% of male and female population respectively. Total leukocyte count was also lower than normal values in 8% and 6% of male and female respectively. Similarly neutropenia was observed in 5% and 8% cases, while neutrophilia was recorded as 60% and 64% in male and female patients respectively. Lymphocytopenia was also observed in 59% and 43% patients in male and female respectively. Illiteracy, smoking habits, overcrowding and living in shared houses were the main associated risk factors contributing in the enhancement of the disease. The disease was present significantly more in females and was relatively higher in older patients. Different hematological parameters like Erythrocytic sedimentation Rate [ESR], platelets and leukocytes work as hallmark and help the clinicians in early diagnosis of the disease. Malnutrition, smoking tobacco, living in shared houses, illiteracy and poverty were the common risk factors contributing to the dissemination of the tuberculosis in the target area population

Etiology and the role of proctosigmoidoscopy in patients with acute bloody diarrheas

To find out the etiology of acute bloody diarrheas in patients admitted to a tertiary care hospital. This descriptive study was conducted in the department of medicine, Lady Reading hospital from 2005 to 2008. A total of 50 patients were studied, comprising of 35 males and 15 females. Mean age of the sample was 32.66 +/- 15.4 years]. Patients who presented with acute bloody diarrhea of between 3-30 days duration were studied. Patients who had history of recurrent bloody diarrhea were also included. Patients below 12 years, severely dehydrated and seriously ill were excluded. All patients underwent fibreoptic proctosigmoidoscopy and rectal biopsy. Amebic colitis was confirmed on stool examination for Trophozoites of Entameoba histolytica, typical proctosigmoidoscopic findings and response to anti-amebic drugs. Thirty-two patients [64%] were having new onset bloody diarrhea, while 18 patients [36%] were giving history of recurrent bloody diarrhea. All patients had evidence of Procto-colitis on fibreoptic sigmoidoscopy. The most common conditions were ulcerative colitis in 25 [50%], bacterial dysentery in 15 [30%] and Amebic proctocolitis in 7 [14%]. Findings on proctosigmoidoscopy were mucosal hyperemia [50%], bleeding points [38%], ulcers [44%], pus [20%], pseudo polyps [4%] and mass [4%]. Fibreoptic Proctosigmoidoscopy is a simple and easier procedure to diagnose different causes of acute bloody diarrhea and should be considered in all cases except in seriously ill and dehydrated patients. The common causes of acute bloody diarrhea in our community are bacterial proctocolitis, amebiasis and ulcerative colitis

Removal of coins from upper oesophgus under local anesthesia

To know the safety of coin extraction from upper esophagus by using Magill forceps and laryngoscope, under local anesthesia. This prospective study includes four hundreds patients with coin stuck at the upper end of esophagus, referred to us from emergency department form Jan 2004 to Dec. 2004. We used both Magill forceps and Mackintosh Laryngoscope for coin extraction. A total of 400 patients were treated in one year, majority were children between 2-5 years of age. Males were 202 [50.5%] and females were 198 [49.5%]. Three hundred and forty patients [85%] presented with in 24 hours while 60 patients [15%] presented after 24 hours. At presentation, 360 [90%] had difficulty in swallowing and excessive salivation while remaining 10% had vomiting and cough. Out of 400 coins, 296 [74%] were of two rupees while remaining 105 [26.3%] included one and five rupees coins. Three hundred and twenty [80%] coins were removed in first attempt while 65 [16.2%] require more than one attempt. We failed in 15 [3.75%] cases. Minor complications occurred with this method in 19 [4.75%] while one child develop neck abscess [0.25%].Coin extraction from upper esophagus, using Magill forceps and laryngoscope under local anesthesia is a safe and effective method

Diagnostic value of fine needle aspiration cytology [FNAC] in cervical lymphadenopathy

The aim of this study was to evaluate the diagnostic value of fine needle aspiration cytology [FNAC] in head and neck lymph nodes and in differentiating malignant from benign diseases. This prospective study was conducted in the ENT Department of PGMI HMC and LRH Peshawar from 1st April 2003 to 30th March 2004. A total of 42 patients were studied. After thorough history and examination, FNA biopsy was obtained with the help of experienced cytopathologist using 21G needle and the results compared with final histopathological diagnosis. FNAC findings in this series were metastatic [42.85%], tuberculosis adenitis [26.19%], reactive hyperplasia [16.66%], lymphoproliferative disorder [9.52%] and lymphoma [4.76%]. In terms of differentiating malignant from non-malignant lesions; diagnostic accuracy, sensitivity, speciflcity, positive predictive value and negative predictive value of FNAC were 95.23%, 95.83%, 94.44%, 95.85% and 94.44% respectively. FNAC has been found to be a useful diagnostic tool in the evaluation of patients presenting with neck nodes and should be considered before performing open biopsy

surgical treatment of pharyngeal pouch

Objective: to determine the anatomical results and complications associated with the surgical treatment of the pharyngeal pouch

Material and Methods: this study was conducted in ENT department of Postgraduate Medical Institute Lady Reading Hospital from the period of 1997 to 2001. All Ten patients were suffering from dysphagia and the diagnosis was confirmed by barium studies. Most of the patients were above the age of 55 years not associated with any co morbidities . All patients were subjected to open exploration with removal of the pouch and crico pharyngeal myotomy

Results: all patients treated by external approach were asymptomatic as compared to inversion and suspension procedure. 2% patients developed complications associated with this procedures. The postoperative radiological appearance of all these patients showed no evidence of any residual pouch

Conclusion: the study shows that excision of the pharyngeal pouch with crico pharyngeal myotomy treats the patient symptoms effectively and is associated with low recurrence rate

correlation of clinical appearance of nasopharyngeal carcinoma with tumour staging

To correlate the clinical appearance of nasopharyngeal carcinoma with tumour staging. Patients And This study was conducted in the ENT department of Postgraduate Medical Institute, Lady Reading Hospital, Peshawarfor the duration of seven years from March 1994 to March 2001. The number of cases in this study was ninety which include endophytic or submucosal to advanced stage tumour. Tumour staging was undertaken according to computerized tomography scan finding. The female to male ratio was 2.5:1. The age of patients was ten years to eighty five years with average of forty five years. Seventy patients [77.8%] had obvious malignant lesion. Almost 25% of the patients with nasopharyngeal carcinoma had tumour which appeared inconspicuous in the post nasal space and these tended to be in patients with early tumour. Such cases have excellent prognosis if diagnosed and treated early

Current status of presentation and prognosis of retinoblastoma in Pakistan

To determine the current presentation pattern and prognosis of retinoblastoma in Northern Pakistan, we reviewed 26 retinoblastoma cases [13 boys and 13 girls] admitted to the Department of Ophthalmology, Lady Reading Hospital, Postgraduate Medical Institute, Peshawar between April 1985 and November 1988. Of these patients, 25 were children ranging in age from eight months to seven years, and one was a woman of 22. The tumor was unilateral in 15 patients and bilateral in 11. The presenting signs were fungating mass in 10 [38.36%] patients, proptosis in seven [26.92%], leukokoria in five [19.26%], orbital cellulitis in one [3.85%], loss of vision in one [3.85%], strabismus in one [3.85%], and quadriplegia in one [3.85%]. Because of nearly universal late presentation, the mortality rate in our cases was 88.46%, which is similar to retinoblastoma with biopsy proven orbital extension. The only treatment suited for a great majority of our patients was enucleation followed by external beam radiotherapy [EBR]. One female patient's elder sister was known to have suffered from retinoblastoma, but their parents were clinically free of the disease. Finally, although some improvement has been made in the treatment of retinoblastoma, no noticeable progress in public health education regarding this tumor has occurred in the past decade in Pakistan