Diagnostic value of fine needle aspiration cytology in the diagnosis of solitary thyroid nodule

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

Patients and Methods: This study was conducted at the department of Ear, Nose, Throat, Head and Neck surgery at Postgraduate Medical Institute Lady Reading Hospital Peshawar. This was cross-sectional comparative study. The duration of the study was one year from June 17, 2010 to June 16, 2011. The sample size was 82 patients with solid solitary thyroid nodule, fulfilling the inclusion criteria. Fine needle aspirations were performed in all cases and compared with open biopsies taking as gold standard

Results: Our study included 82 cases consisting of 57 [69.51%] female and 25 [30.48 %] 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. Most of the patients presented in 3rd and 4th decade followed by the 5th and 2nd decade. The diagnostic yield of fine needle aspiration cytology [FNAC] in this study was accuracy 82.92%, sensitivity 88.09%, specificity 77.50% and positive predictive value was 80.43% that supported 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

Old is gold. topical clotrimazole remains an effective treatment of otomycosis

Introduction: Otomycosis also known as fungal otitis externa has typically been described as fungal infection of the external auditory canal. The prevalence of otomycosis has been reported to be as low as 9% of cases of otitis externa and as high as 30.4% in patients presenting with symptoms of otitis or inflammatory conditions of the ear. The most common fungal agents causing otomycosis are aspergillus niger [80%], candida albicans [second most common], actinomyces, trichophyton, aspergillus fumigatus and candida tropicalis

Methods: It was descriptive case series of six months duration done at department of ENT, Islamabad Medical and Dental College Islamabad. Sample size was 119, using 50%8 efficacy of topical clotrimazole, 95% confidence level and 9% margin of error under WHO software for sample size determination

Results: A total of 119 patients of otomycosis were included in the study. Male to female ratio was 0.61:1. Average age of the patients was 32.94 years +/- 5.24 SD with range 20-40 years. The efficacy of clotrimazole in treatment of otomycosis was observed in 112 [94.12%] while in 7 [5.88%] patients show no efficacy. Age and gender have no role in efficacy of clotrimazol in treatment of otomycosis

Conclusion: Topical clotrimazole is effective in the treatment of otomycosis

Disabling silicosis having grave prognosis: a preventable ancient malady still prevalent in modern era: a case report and review of the subject

This case describes a middle-aged man who developed an advanced disabling and irreversible fibrotic lung disease after occupational over-exposure to fine respirable crystalline silica in a poorly ventilated enclosure for nearly two decades. A few years ago, his brother died of a similar illness at a younger age with same occupational exposure. Unfortunately, no correlation between dusty occupation, clinical features and radiological findings was considered until irreversible interstitial pulmonary fibrosis had set in. We report this case to underscore the importance of a relevant work place exposures history in the genesis of a vigilant and early diagnosis for improved patient outcomes

Pulmonary function abnormalities in patients with metabolic syndrome

A cross sectional survey was conducted to evaluate for any deterioration in lung functions in patients having characteristics of metabolic syndrome. In a medical camp, study participants underwent blood pressure measurement, blood glucose and total cholesterol testing, anthropometry and waist circumference. A total of 42 non smoker subjects including 28 [66.6%] males and 14 [33.3%] females who were suffering from metabolic syndrome underwent spirometry using American Thoracic Society/European Respiratory Society [ATS/ERS] criteria. Out of 28 [66.6%] males, 19 [67.85%] had spirogram within normal limits, while 9 [32.14%] had abnormalities in pulmonary function testing including reduced PEF, FVC, FEV1 and FEF25-75, while out of 12 females, 7 [58.33%] had spirogram having all parameters within normal limits, while 5 [41.66%] had considerable spirometric abnormalities. Non smoker patients with metabolic syndrome have considerable abnormalities on pulmonary function testing which may have implications on their future respiratory health. Further larger studies for pulmonary functions evaluation are required in obese population

Captain of all these men of death - tuberculosis remains the commonest diagnosis - two years experience of bronchoscopy at Shaikh Zayed hospital, Lahore

A retrospective study of two years duration was conducted at the department of Pulmonology, Shaikh Zayed Hospital, Lahore, Pakistan to review our experience with bronchoscopy. Data was collected from145 patients who underwent bronchoscopy for different diagnostic and therapeutic indications. The study participants were having ages between 13 and 93 years. There were 85 male and 60 female patients. Bronchoscopy was performed for diagnostic purposes in 124 [85%] patients, for therapeutic purposes in 9 [6%] patients and for surveillance of airways in 13 [9%] patients. Bronchoscopy remained diagnostic in 74.19% patients. Tuberculosis was the commonest diagnosis in 34.6% patients followed by malignancy which was diagnosed in 16.1% patients. In 82% patients there was no complication during procedure, while mild haemoptysis occurred in 11.72%, 5.5% had wheezing [bronchospasm], 4.1% developed low grade fever and 1 patient died due to respiratory failure. It was concluded that bronchoscopy is found to be a useful procedure and can be used safely for diagnoses and treatment of different respiratory diseases

Polymicrobial community acquired pneumonia with occult lower lung field tuberculosis: a case report and review of the subject

A middle aged diabetic male was admitted with a respiratory infection having right middle and lower zones pneumonic infiltrates on chest radiograph. He had no response to the broad spectrum antibiotics [non responding pneumonia] and therefore underwent bronchoscopy for bronchoalveolar lavage [BAL] which showed unusual polymicrobial community acquired pneumonia [Staphylococcus aureus, Pseudomonas aeruginosa, and Aspergillus fumigatus] along with smear positivity for Mycobacterium tuberculosis. The lower lung field involvement is unusual for mycobacterium tuberculosis which typically involves the upper lung zones. His pneumonic infection was treated with culture specific antibiotics and lower lung field TB was managed with conventional antituberculous regimen resulting in excellent response

diagnosis of exclusion: idiopathic pulmonary arterial hypertension presenting as intractable shortness of breath - a case report and review of the subject

A 35 year old house wife was evaluated for gradual onset and progressively worsening dyspnea. She had normal vitals, but raised JVP, loud P2, normal vesicular breathing in chest and normal systemic examination. Her chest radiograph showed cardiomegaly and echocardiography was consistent with severe pulmonary hypertension of non cardiac origin. Extensive investigations to find any cardiovascular, respiratory or systemic disorders were negative ruling out an underlying cause of occult pulmonary hypertension and she was finally diagnosed as having idiopathic pulmonary hypertension [IPAH]. She responded well to treatment with pulmonary vasodilator drugs and was advised regular follow ups in pulmonary out patients department

Frequency of Angiotensin Converting Enzyme Inhibitor [ACEI] induced cough

The objective was to assess the frequency of ACE inhibitor induced cough in our patients. The study was prospective open labeled one centre, in and out patients of cardiology department Sheikh Zayed Hospital, Lahore 2011. 200 patients using six different types of ACEI were used. Preference was given to patients to whom ACEI were prescribed for the first time. Patients with chronic respiratory diseases were excluded. Patients were follwed up on fortnightly basis for three months. On each visit besides recording their blood pressure, they were not specifically inquired about occurrence of any cough. Patients themselves came with the complaint of cough. The dry cough frequency with different ACEI was 17%, ranging from almost 20% with Enalopril, 16.6% with Captopril, 10% with Lissinopril and Ramipril, 15% with Qurinapril and Perindopril. The dry cough was moderate in the majority of our patients and they were not willing to continue their ACEI, although their blood pressure was well controlled with it. They were switched over to other group of anti hypertensive drugs. Incidence was almost same in males and females. ACEI have a relatively high frequency of dry cough and our patients don't want to take it if cough occurs

Frequency of clot in left atrium [LA] in patients of severe mitral stenosis [MS] with atrial fibrillation [AF]

To determine the frequency of clot in left atrium [LA] in patients suffering from tight mitral stenosis [MS] with atrial fibrillation. A cross-sectional descriptive type study at two centers was performed. A total of 50 adult patients with tight MS and AF were included. A 12 leads electrocardiography was performed once for each patients to look for AF after transthoracic echocardiography [TTE] and clinical examination features revealed tight MS. Patients with AF were selected and TTE was done to detect clot in LA. Tran esophageal echocardiography [TEE] was performed whenever clot could not be detected with TTE. Among 50 patients studied. There were 20 males and 30 females, TTE was done of all patients and LA clot were detected in 10 patients [20% of total] and TEE were performed in remaining 40 patients [80% of total] and additional 12 patients [24% of total] with clot in LA were detected. Therefore total of 44% of patients had LA clot. Among them 4% had clot in LA body and 40% had in LA appendage. LA dimension was found to be relevant [P value = 0.004] with the presence of clot in patients of severe MS with AF. LA spontaneous echo contrast [LASEC] was found in all patients. LA clot was present in 44% patients with tight MS and AF. Larger LA diameters is a strong predictor- of presence of LA clot in severe MS with AF

Knowledge of family physicians about the fundamental diagnostic modality for chronic obstructive pulmonary disease

The adequate knowledge of primary health practitioners about spirometry being the best test for the diagnosis of chronic obstructive pulmonary disease [COPD] is essential because of high prevalence and sustained global rise in COPD population

Methods: A cross-sectional survey of family physicians by a questionnaire [data interpretation] was conducted to assess the existing status of knowledge about the spirometric diagnosis for COPD. This was undertaken on the occasion of two scientific presentations as well as by directly approaching them at their clinics

Results: A total of 150 questionnaires were given and 148 were returned with a response rate of 98.66%. Sixty three participants [42.56 %] selected the correct answer [spirometry: FEV1, FVC and FEV1/VC ratio] while 57.44% opted for the wrong answers for COPD diagnostic strategy given in the clinical scenario. More senior family physicians [P- value 0.076] and more educated physicians [P- value 0.022] had a better knowledge regarding the correct answer of performing spirometry

Conclusion: There is inadequate knowledge among family physicians about the fundamental diagnostic modality [spirometry] of COPD

Correlation between amount of smoking and decline in lung function among urban male population

A cross sectional study of six months duration was conducted at the Department of Pulmonology, Shaikh Zayed Hospital, Lahore to compare the lung function decline [percentage of predicted forced expiratory volume in one second with amount of smoking in different groups of subjects according to pack years of smoking. Data was collected from four hundred current smokers meeting inclusion and exclusion criteria collected by arranging free spirometry camps by non-probability purposive sampling. The study participants were having ages between 20 and 67 years with mean age of 38.1 +/- 12.2. It was found that cases in group up to 5 pack years of smoking had highest average FEV[1] 98.0+/-5.3 and FEV[1] decreased smoothly as number of pack years escalated. It was 96.0+/- 10.9 in 6-10 pack year group, 90.0 +/- 9.8 in 11-15 pack years group, 85.3+/-7.2 in group 16-20 and it was 71.9 +/- 16.2 in group 21 and above pack years of smoking. In our study we also found that 79 [19.75%] participants had FEV[1] between 80-50% of predicted out these 58 [73.41%] were in group 21 and above pack years of smoking whereas 08 participants had FEV[1] less than 50% of predicted. It was concluded that the prevalence of undetected persistent airflow obstruction was high and more frequent in smokers having history more than 21 pack years of smoking

Pulmonary nocardiosis presenting as bilateral round pneumonia in a patient having idiopathic thrombocytopenic purpura a case report and review of the subject

Nocardiosis is an uncommon Gram positive bacterial infection having predilection for lung and central nervous system. It is typically regarded as an opportunistic infection, but approximately one-third of infected patients are immunocompetent. This patient while using corticosteroids for immune thrombocytopenic purpura developed fever and respiratory symptoms consistent with lower respiratory tract infection. Her chest radiograph revealed bilateral atypical perihilar rounded shadows which on bacteriological evaluation of bronchial washings turned out to be nocardia pneumonia that responded well to appropriate treatment

Adjunct prednisolone versus anti tuberculous drugs alone for treatment of tuberculous pleurisy

To determine the effect of adjunct prednisolone therapy, a randomized controlled trial was conducted involving 46 hospitalized patients having biopsy proven tuberculous pleurisy and were followed till the end of treatment. Patients were divided into two groups; one group was treated with standard anti tuberculous treatment while the other [group 2] was assigned adjunct prednisolone with anti-tuberculous drugs. Fever and constitutional symptoms disappeared faster in group 2 [P value <0.001]. After one month, there was a significantly greater reduction in the size of pleural effusion in group receiving adjunct prednisolone, but after 4 and 8 months the difference was not statistically significant. It was concluded that adjunct prednisolone alleviates symptoms and effusion earlier than anti tuberculous drugs alone but does not reduce the development of pleural thickening

ghost in the closet. Allergic sino bronchopulmonary aspergillosis without bronchial asthma: a case report and review of the subject

Allergic bronchopulmonary aspergillosis [ABPA] is a complex hypersensitivity reaction, often in patients with asthma or cystic fibrosis [CF], which occurs when there is colonization of airways by Aspergillus species. In the absence of bronchial asthma, the diagnosis of ABPA is questionable but the reported patient had no features of bronchial asthma and presented with multifocal radiological shadows in both the lung fields which on further exploration revealed obscure ABPA

Misconceptions of young males regarding shisha smoking

This study was intended to assess the misconceptions about contents and hazards of shisha [water pipe] smoking as well as practices of shisha smokers. Sixty young males between 16 to 26 years of age, smoking shisha regularly or occasionally were interviewed through a questionnaire based performa. The level of misconceptions regarding contents and harms of shisha smoking was high as majority [76%] perceived shisha very safe and insisted for its contents to be fruit flavors only while forty [66.6%] considered it absolutely harmless. Thirty two percent became active cigarettes smokers after starting shisha smoking and there was minimal parental inhibition towards shisha smoking. It is concluded that there is high level of misconceptions and poor information about the traumatic effects of shisha smoking among young urban males in Lahore

Primary ciliary dyskinesia-kartagener's syndrome: a case report and review of the subject

Primary ciliary dyskinesia [PCD] is a heterogeneous group of inherited disorders in which cilia in the body are dysmotile/immotile due to their structural defectes. Fifty percent of patients with PCD who have situs inversus have Kartagener's syndrome. Our patient had history of recurrent upper and lower respiratory tract infections and infertility. He was admitted this time with features of hepatitis related to congestive hepatomegaly. He was diagnosed as a case of Kartagener's syndrome when on further work up, he was found to have situs inversus along with immotile cilia and spermatozoa