Salivary gland tumours: a tertiary care hospital experience

To study demographic, clinical and histopathological features of salivary gland tumours in a tertiary care hospital. Prospective cross sectional study. This study was carried out in the Department of ENT, Head and Neck surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from June 2010 to May 2014. This prospective cross sectional study of 4 years was carried out in the Department of ENT, Head and Neck surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar. All the patients qualifying inclusion criteria were evaluated in terms of detailed history, thorough examination and relevant investigation. After performing required surgery specimen was examined for histopathology. In this study 123 patients were included with mean +/- SD age of 40 +/- 5.1 years [age range 7–76 years]. Males were 81 and females were 42 with male: female ratio of 1.9:1. Most of the patients presented in 4th decade [28.45%, 35]. Lump was the commonest clinical feature lasting for 1-5 years [66.66%, 82]. Among the tumours 77.23% were benign while 22.76% were malignant. Benign tumours were commonly noticed in parotid gland [53.65%]. Pleomorphic adenoma was the commonest benign tumour [65.04%, n-80], affecting parotid gland in 52.03%. Mucoepidermoid carcinoma is the commonest malignant tumour [12.19%] predominantly found in minor salivary gland of palate [6.50%]. Salivary gland tumours predominantly affecting middle aged male population. Benign tumours are the commonly occurring salivary gland tumours. Pleomorphic adenoma is commonly occurring benign tumour affecting predominantly parotid gland while mucoepidermoid carcinoma is the commonest malignant tumour of salivary glands

Interval tonsillectomies; comparison of per and post operative complications in patients undergoing early and delayed after peritonsillar abscess

Peritonsillar abscess is a common clinical problem faced by otorhinolaryngologist all over the world. There are different schools of thoughts regarding tonsillectomy after peritonsillar abscess due to its expected complications. This comparative study was conducted to know about frequency of complications in each of the techniques. To compare per and post operative complications in patients undergoing early and delayed interval tonsillectomy after peritonsillar abscess. This was randomized control trial. Department of ENT, Head and Neck surgery, PGMI/HMC, Peshawar. From Jan 2012 to Dec 2013. After taking detailed history, thorough examination, relevant investigations and informed written consent peritonsillar abscess was drained and then interval tonsillectomy was performed. The complications were noted on predesigned proforma. Chi square test was used to compare the complications in both the groups while keeping P < 0.05 as significant. Out of 60 patients males were 38 and females were 22 with male to female ratio of 1.31:1. Average age was 24.7 years + 7.63 SD with a range of 13-45 year in Group-A, while Group B has average age of 23.97 year + 7.07 SD with a range of 13-46 years. Findings of per-operative and post operative hemorrhage showed that there was insignificant difference in both the groups [P=0.601]. However pain and hospital stay in both the groups was significantly different with P value of 0.004 and 0.000 respectively. Early interval tonsillectomy is an easy and safe procedure for peritonsillar abscess

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.

Efficacy and safety of transradial approach in primary PCI for STEMI

To determine the efficacy and safety of transradial approach in primary percutanous intervention in acute ST segment elevation myocardial infarction. Descriptive study Emergency reporting [ER] department of Armed Forces Institute of Cardiology National Institute of Heart Diseases [AFIC/NIHD] from Dec 2011 to Dec 2013 Retrospective data of 354 patients had been collected through records. All the patients presented with acute myocardial infarction to emergency reporting [ER] department of Armed Forces Institute of Cardiology National Institute of Heart Diseases were included in the study. All the patients underwent primary coronary intervention through transradial route. All patients received IIB IIIA inhibitors bolus and infusion. The primary end points were procedure success and local access site hematoma and secondary end points were major bleeding requiring blood transfusion and door to balloon time. The mean age of the patient was 64 +/- 18 years, there were 251 [70.9%] males and female were 103 [29.1%]. Radial access site cannulation time was 194 +/- 22 sec and door to balloon time was 78 +/- 14 min. Procedural success was 349 [98.6%]. Forearm hematoma was noted in 4 [1.12%]. No major bleeding requiring transfusion was noted. Primary percutanous intervention [PPCI] via transradial [TRI] route in acute STEMI patients can be achieved with high success and low complications in our population. The clinical outcome is matching with local and international data

Role of aspiration thrombectomy in primary PCI for STEMI - myth or reality?

The objective of the study was to determine the outcome of thrombus aspiration in Primary coronary intervention [PCI] for ST elevation myocardial infarction [STEMI]. Case Series The study was carried out in Armed Forces Institute of Cardiology - National Institute of Heart Diseases [AFIC-NIHD] over a period of twelve months from January 2013 to December 2013. Data of 30 patients who underwent aspiration thrombectomy during primary PCI for STEMI by the transradial approach was collected. Inclusion criteria were chest pain suggestive of myocardial ischemia lasting longer than 30 min accompanied by ST- segment elevation or new left bundle branch block on the ECG within 12 h of symptom onset. Patients with previous CABG, cardiogenic shock or requiring TPM placement were excluded from this study. A 6F sheath was placed inside the radial artery, and cardiac catheterization was performed. Angiographic and electrocardiographic signs of myocardial reperfusion were assessed. Study endpoints included TIMI III flow and ST-segment resolution at the end of the procedure. Mean age of the patients was 52 years [range 37-77 yrs] and 63% [n= 19] were males and 37% [n=11] were females. The right radial artery was used in 90% of cases. Thrombus aspiration catheter used was 6 F Thrombuster II [70%] and Hunter [30%].There was significant improvement in markers of myocardial reperfusion with achievement of ST-segment resolution and TIMI 3 flow in 28 patients [93%]. No case of vascular complications such as major access site bleeding, vascular perforation, radial artery occlusion, forearm ischemia, compartment syndrome or MACE was observed. Thrombus aspiration [TA] is applicable in the majority of patients undergoing primary PCI for myocardial infarction with ST-segment elevation, and it improves early markers of myocardial reperfusion

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

Transformative education, school textbooks and gender

Textbooks constitute a vital part of curricular material in gender education. To maximize the benefits of education, textbooks need to be gender-balanced in representation and role identification and assignment. This research study attempts to measure the transformative aspect of knowledge contained in school textbooks in the context of gender. The study is based on the survey of English textbook [grade 10[th]] taught in public schools of Punjab, Pakistan from where data is collected both quantitatively and qualitatively. The findings of the study indicate that the textual content suffer from gender disparity in presentation, gender role identity and assignment. It also concludes that the textbook needs revision to render it more progressively transformative

An audit of tracheostomy at a tertiary care hospital

To determine the indications and complications of tracheostomy in a tertiary care hospital. This descriptive study was conducted at the department of ENT, Head and Neck surgery, Lady Reading Hospital Peshawar from January to December 2010. This study included 160 patients fulfilling inclusion and exclusion criteria. All these patients were properly evaluated. After taking well informed consent tracheostomy was performed in all the patients as emergency or elective procedure depending upon the clinical condition of the patient. The data was collected on a prof or ma and it was analyzed using SPSS version 10. A total of 160 patients underwent tracheostomy who constituting 110 male and 50 female, with male: female ratio of 2.2:1. The age of the patients ranged from 01-75 years with mean age of 37.61 +/- S.D 19.99 years. Tracheostomy was performed in 148 cases [92.5%] as emergency and in 12 cases [7.5%] as elective procedure. The commonest indication for tracheostomy was trauma [65.62%] followed by infection [26.25%]. Elective tracheostomy was performed for inoperable tumours. The early complications were 37.5% while late complications were 7.5%. It is concluded that the common etiology of tracheostomy in our part of the world is airway obstruction due to trauma and complications of tracheostomy can be minimized by improving the postoperative care of tracheostomized patients

Non opaque foreign body aspiration in children: should we be more vigilant and proactive?

To study the frequency of symptoms, composition and complications of clinically suspected non radio-opaque foreign body aspiration; which is a difficult diagnostic challenge resulting in delayed referral for bronchoscopy. This descriptive analysis of 400 cases of foreign body aspiration was done in the department of ENT and Head and Neck surgery. Lady Reading Hospital Peshawar from 2003-2006. One hundred cases were selected with presumptive diagnosis of foreign bodies in tracheobronchial tree. The inclusion criteria were not witness and non radio-opaque foreign bodies. We reviewed their hospital record to ascertain history diagnosis and treatment. Age, sex, location in tracheobronchial tree, witnessed or un-witnessed events, symptoms, radio graphic findings, anatomical abnormalities noted at endoscopy and complications were recorded. Radio opaque foreign bodies were excluded from the study. A total of hundred cases were included. Age range was from 2-5 years. Males were 70% and females were 30%. Delay in presentation was from 10 days to 4 years. Common symptoms at presentation were cough 55% and asthma 20%. Radiological findings were abnormal in 90% of cases. Upon bronchoscopy 70% were positive for foreign body and 30% were negative. Peanuts [30%] and whistles [28%] were the commonest foreign bodies. No death occurred in this study and minor complications of the procedure were only 15%. Aspiration of foreign bodies in children can lead to serious morbidity if not recognized and treated in time; hence early referral is essential

Angiofibroma of middle turbinate

We report a rare case of angiofibroma of middle turbinate. A man of 17 years presented to out patient department [OPD] of ENT, Head and Neck Surgery Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan with presenting complaint of progressive obstruction of right side of nasal cavity for last 3 months. On ENT examination there was a reddish fleshy mass in the right nasal cavity. It was firm on probing, arising from the middle turbinate of lateral wall of nasal cavity and was sensitive on touching. On CT scan the mass was limited to lateral wall of right side of nasal cavity which was iso-dense with no bony erosion. The mass was removed in toto intranasally and specimen was sent for histopathology study. The histopathology report was angiofibroma. The patient is followed regularly and he is disease free so far

Association and pattern of diastolic dysfunction in patients of metabolic syndrome

Diastolic dysfunction is important predictor of morbidity and mortality in patients with metabolic syndrome. This prospective study is to evaluate an association and pattern of diastolic dysfunction in patients of metabolic syndrome in our population. This cross-sectional study was performed at Armed Forces Institute of Cardiology Rawalpindi for a period of 6 months from 20[th] November 2007 to 20[th] April 2008. One hundred eligible and consenting patients having metabolic syndrome reporting in the OPD were registered. Inclusion criteria included patients of metabolic syndrome with negative ETT and normal systolic function. Exclusion criteria were patients with age above 60 years and valvular heart disease. Data was collected by a structured clinical interview with a physician, ECG and a transthoracic M-mode, 2D and TDI echocardiogram. The metabolic syndrome was defined according to International Diabetes Federation. There was a positive association between the degree of the metabolic syndrome-assessed as number of concurrently present components-and parameters of cardiac structure and function, with a consistent and statistically significant trend for all cardiac variables considered [p=0.000]. There was also a positive association between each parameter and the cardiac diastolic dysfunction grading, e.g., systolic blood pressure [p=0.000], diastolic blood pressure [p=0.005], waist circumference [p=0.004], fasting blood sugar [p=0.008], triglycerides [p=0.006], HDL cholesterol [p=0.001]. Several cardiac functional abnormalities regardless of symptoms increased progressively with increasing degree of metabolic syndrome

Deployment of inferior vena cava filters; efficacy and safety

Objective: to study the patient's profile, indications and procedural success of placement of Inferior Vena Cava [IVC] filters at AFIC/NIHD Rawalpindi, Pakistan

Design: a retrospective observational study

Place and Duration of Study: the patients were studied in the department of Interventional Cardiology of AFIC/NIHD from May 2004 to Jun 2005

Material and Methods: 16 patients of either sex who revealed clinical and investigative evidence of recurrent pulmonary embolism [PE] due to deep vein thrombosis [DVT] of lower limbs were selected. All efforts including history, physical examination and laboratory investigations were carried out in order to ascertain the etiology. A note was made of the associated conditions, past and family history of DVT and PE. IVC filter was deployed through femoral vein in all patients as a lifesaving treatment modality. The procedure was uncomplicated and all patients had smooth post procedural recovery

Results: through femoral vein, IVC filters [Trap Ease Cordis J and J] were successfully deployed below the renal veins. In one patient, another filter was deployed immediately below the tricuspid valve

Conclusion: IVC filter placement is a simple, safe and effective procedure in stabilizing patients who have recurrent pulmonary embolism