Comparison of postoperative pain and hemorrhage in children after tonsillectomy with bipolar diathermy technique versus tonsillectomy with cold steel dissection and silk ligature

Objective: To compare post operative pain and hemorrhage in children after tonsillectomy with bipolar diathermy versus tonsillectomy with cold steel dissection and silk ligation to secure hemostasis

Study Design: Randomized controlled trial

Place and Duration of Study: Combined Military Hospital [CMH] Kharian from June 2012 to June 2013

Material and Methods: A total of 126 patients were included in the study through non-probability convenience sampling and randomly divided in two groups of 63 each. In group A patients were treated by tonsillectomy with bipolar diathermy and in group B patients underwent tonsillectomy with cold steel dissection and silk ligation to secure hemostasis. Results in terms of postoperative hemorrhage and pain based on Facial Pain Scale were observed

Results: A total of 126 patients were included in the study and randomly divided in two groups of 63 each. Average age in group A was 6.60 years [SD +/- 2.46] and in group B it was 6.31 years [SD +/- 2.48]. There were 33 males [52.38%] in group A while 37 males [58.73%] in group B. Both the groups are comparable with respect to gender [p=0.473] and age [p=0.522]. In group A, there were 5 [7.93%] cases of mild pain as compared to 15 [23.80%] in group B. Similarly there were 32 [50.79%] cases of moderate pain in group A and 39 [61.90%] in group B. In group A 25 [39.68%] had severe pain as compared to 9 [14.28%] in group B. It indicates that patients who underwent tonsillectomy with bipolar diathermy had significantly high frequency of severe pain than group A [p=0.03]. In both groups there was no incidence of primary hemorrhage. In group A, 3 [4.76%] patients had secondary hemorrhage and in group B, 1 [1.58%] patient had secondary hemorrhage however this was insignificant [p = 0.310]

Conclusion: Cold steel tonsillectomy technique with silk ligation to secure hemostasis is a safe method. It has significantly less postoperative pain as compared to bipolar diathermy technique. However there is no significant difference in post operative hemorrhage between the two methods

Multi drug resistance tuberculosis: pattern seen in last 13 years

Drug resistance in tuberculosis is a serious problem throughout the world especially, after the emergence of multi drug resistant TB strains. To estimate drug resistance in TB patients and compare it with previous studies to see the changing trends. The PMRC Research Centre receives sputum samples from all the leading hospitals of Lahore. This retrospective analysis was done from 1996 to 2008 on the multi drug resistant TB strains that were seen during these years. Five first lines tuberculosis drugs were tested on Lowenstein Jensen medium using standard proportion method. A total of 2661 confirmed isolates of Mycobacterium tuberculosis were seen over the past 13 years. Of the total, 2182 were pulmonary and 479 were extra pulmonary specimens. The patients comprised of those with and without history of previous treatment. These specimens were subjected to drug susceptibility testing. Almost half of the patient had some resistance; multiple drug resistance were seen in 12.3% and 23.0% cases without and with history of previous treatment respectively. overall resistance to rifampicin was 26.4%, isoniazid 24.1% streptomycin 21.6% ethambutol 13.4% and pyrazinamide 28.4% respectively. Statistically significant difference was seen between primary and acquired resistance. When compared with the reports from previous studies from the same area, there was a trend a gradual increase of drug resistance. Resistance to anti tuberculosis drugs in high. TB Control Program should start "DOTS Plus" schemes for which drug susceptibility testing facilities should be available for correctly managing the patients

Incidence of mitral regurgitation following first episode of myocardial infarction at 1[st] week

Frequency of mitral regurgitation [MR] after active MI in the first week. This comparative study, was carried out at the Department of Medicine, Unit-II, Services Hospital, Lahore from August 2000 to August 2001. A total of 50 patients were included in the study resented to emergency and admitted to CCU or other wards of the Services Hospital, Lahore. At presentation patients were examined fully and then daily at least for a period of 5 days. Patient underwent complete M mode and two dimensional echocardiography including plus wave, continuous wave and color flow maping. Incidence of MR at 1[st] week of post-MI was 24%. Higher incidence of mortality among MR patients [10%- as compared to non-MR patients [4%]. Mitral regurgitation is frequently seen after MI. It carries a bad prognosis. Every patient should undergo echocardiography for risk stratification and prognosis

Chronic maxillary sinusitis, an uncommon aetiological factor of headache

To emphasize that headache due to chronic sinusitis must be differentiated from all other forms of headache clearing the misconception of relating almost every headache with sinusitis. This is a descriptive study. The study was carried out at the department of ENT, PNS SHIFA Naval hospital Karachi from March 2002 to March 2004. This study was carried out on 100 patients who were selected from the OPD as convenient sampling. It included patients referred to otolaryngology department who were having radiological evidence of maxillary sinusitis on plain x-ray PNS and were being investigated for headache of more than one-month duration. All the patients underwent a detailed history, clinical and E.N.T. examinations. Bilateral antral washouts were performed. Patients were compared on the bases of various parameters for instance age, gender, duration, severity, type and location of headache, effects of treatment for chronic sinusitis in ameliorating headache. A follow up for a period of three months were carried out. After the study the collected data was processed, analyzed and the final results were made. Majority of the cases belonged to the age group of 21 to 35 years [70%]. A large majority of the patients were not sure about any aggravating conditions. 28% cases were unable to recognize any pain-relieving factor. Only 9% patients were severely affected. 23% patients were having structured problems e.g., deviated nasal septum, nasal polypi and enlarged turbinates. In 39% cases antral wash on one or both sides revealed mucoid discharge. 17% patients expressed that they were markedly improved with the treatment. 83% did not improve remarkably, revealing that chronic maxillary sinusitis was not the main cause of headache in those patients. It was concluded that although sinusitis is associated with headache in majority of the cases but headache is not a major symptom in chronic maxillary sinusitis. Patients primarily presenting with headache have chronic sinusitis in a few cases only. It is recommended that not all the patients of headache with hazy X-ray PNS should be subjected to only the treatment of chronic sinusitis to relieve headache