Head and neck squamous cell carcinoma in a tertiary care hospital

Background: Squamous cell carcinoma is the commonest head and neck malignancy which accounts for approximately 20% of the cancer burden in Asian countries. Frequencies and incidence rates of site specific head and neck squamous cell carcinoma have been reported regularly in different studies from various parts of the country

Methods: It was a descriptive study including 84 biopsy proven cases of squamous cell carcinoma from head and neck region reported to ENT unit-1 Allied Hospital Faisalabad by Pathology lab during January 2014 and December 2015. Data was acquired from hospital and pathology lab and analysed using SPSS version 18. Inclusion Criteria: Primary cases, mucosal disease. Exclusion criteria: congenital tumors, children, mentally retarded

Objective: The objective of the study was to identify the sites of cancer in head and neck along with their risk factors so that community education may be performed for better prevention of head and neck squamous cell carcinoma

Results: Mean age of the patients was 53.71 +/- 14.3 [median: 55] years. Mean age of females was 51 +/- 13.28 [median: 50] years. Mean age of male patients was 56 +/- 15.1 [median: 55] years. 53% of patients belonged to rural areas [n=53]. 37% [n=31] of patients came from urban areas. The commonest risk factor was smoking. The commonest site was hypo-pharynx

Conclusions: head and neck squamous cell carcinoma has a peak age incidence in 5th decade. Males and females are equally affected. Smoking is the commonest risk factor in Faisalabad. Most of the patients have moderately differentiated squamous cell carcinoma. Hypo-pharynx is the commonest site involved

Review of 300 cases of hoarseness of voice and its management in ENT department unit I, allied hospital Faisalabad

Objective: Aim of the study was to determine the prevalence and various management options of Hoarseness

Place and Duration of Study: 300 patients were selected from ENT OPD and casualty department of Allied Hospital, Faisalabad during January, 2013 to June, 2014

Materials and Methods: 300 patients were selected for study. The patients were assessed and a treatment plan formulated. Treatments were given depending on patients symptoms, vocal requirements and clinical findings

Results: In our study, majority of the cases, 116 patients [38.66%] were found to be suffering from Acute and Chronic Laryngitis, as the leading cause of Hoarseness. Acute Laryngitis was found in two peaks of age groups, one below 10 years of age, then the 2nd peak was found in age group between 10 to 20 years. In our study 46 patients of Tumors [15.33%] were the 2nd highest cause of Hoarseness. Tumors were found to be maximum in age group of 50 to 60 years. 49 patients were found to be suffering from Vocal Nodules [16.33%]. Vocal Nodules were found to be maximum in the age group between the 30 to 40 years. Vocal Cord Paralysis was found in 33 patients [11%]. Trauma, Blunt or Iatrogenic [injury to Recurrent Laryngeal Nerve following Thyroidectomy] was found in 27 patients [9%] as a cause of Hoarseness. Trauma was common in the age group between 10 to 20 years. 18 patients [6%] were found to have Vocal Polyps and the maximum age group was found to be between 30 to 40 years. Diphtheria was found in 8 patients [2.67%] and the maximum age group was below 10 years. All improved by timely ADS, Antibiotics and tracheostomy. Laryngeal Web was found in only 3 patients [01%] and the age group was again below 10 years

Conclusion: Our study concludes that acute and chronic laryngitis is the leading cause of hoarseness [42% of cases] and management plan varies according to its etiological cause from conservative voice rest and speech therapy to surgical intervention

Review of 300 cases of epistaxis

Objective: Aim of the study was to determine the etiology and management options of epistaxis admitted through emergency in our ENT Ward of Allied Hospital, Faisalabad

Place and Duration of Study: This study includes 300 cases of epistaxis admitted through emergency in our ENT Ward of Allied Hospital, Faisalabad from January, 2013 to September, 2014

Materials and Methods: All the patients in this series were admitted through Emergency of ENT Department, Allied Hospital, Faisalabad. Detailed history and thorough examination was done in all the patients. Investigations to measure Hemoglobin, total and differential Leucocyte Count, Platelet Count, Random Blood Sugar, Electrolytes and Serum Creatinine. Bleeding parameters like, Bleeding Time / Clotting Time [BT/CT], Prothrombin Time and Activated Partial Thromboplastin Time [APTT] should also be requested

Results: In our study of 300 cases, 56 cases [18.67%] were of the maximum age group [51 to 60 years] and the minimum 30 cases [10%] were of age group between 1 to 10 years. 180 cases [60%] were males and 120 [40%] were females. Hypertension was the leading Etiological Factor in 83 cases [27.67%] in our study. Next was the Idiopathic group in 67 cases [22.33%]. Regarding treatment Anterior Nasal Packing was found to be sufficient in 123 cases [41%] in our study. 94 cases [31.33%] were required to be done Nasal Cautery. Only 09 cases [3%] required Posterior Nasal Packing. Arterial ligation or endovascular embolization was not required in any case

Conclusions: Our study concludes that hypertension is the leading cause of Epistaxis [27.67% of cases] in the age of group of 51 to 60 years [19% of cases]. Whereas, the most effective treatment is Anterior nasal packing [41% of cases]

Complications of emergency tracheostomy

Objective: To determine the complications of emergency tracheostomy in patients presenting to E.N.T emergency

Study design: Prospective type of study

Place and duration of study: Allied Hospital Faisalabad from 01-09-2012 to 31-05-2013

Methodology: This study includes 50 patients in which emergency tracheostomy was performed by the otorhinolaryngology department of Allied Hospital Faisalabad. Patients came from all over the province of Punjab either directly or referred cases from various BHUs. / RHCs or even DHQ

Results: Complications rate was 26% after emergency tracheostomy. The rate of immediate complications was 14%

Conclusion: Emergency tracheostomy, though lifesaving, is associated with definitive complications

Evaluation of etiology and management options of epistaxis in allied hospital Faisalabad

Objective: To determine the evaluation of etiology and management options of epistaxis in patients presenting to ENT ward Allied Hospital Faisalabad

Study Design: Cross-sectional study

Place and Duration of Study: Allied Hospital Faisalabad from July 2012 to December 2012

Methodology: Sixty patients of both sexes between the ages of 15-80 undergone this study. Detailed history taken and complete ENT examination done in all cases. Regular blood pressure monitoring done in all the patients. All the patients were fully investigated. Management included first aid measures [nose-pinching, ice-sponging, cold-saline gargles], anterior nasal packing, posterior nasal packing, and chemical cautery using silver nitrate

Results: In this study epistaxis was caused by hypertension in 27 cases [45%]. In 15 patients [25%], the cause was trauma. Anatomic lesions caused epistaxis in 6 cases [10%]. Chronic liver disease and pregnancy complications result in epistaxis in 3 cases [5%] each. While in 6 cases [10%], no cause was found. Patients were managed successfully with non-surgical methods [first aid measures, anterior nasal packing, posterior nasal packing, chemical cautery]. Anterior nasal packing was done in 45% cases [the most effective]

Conclusion: From the study, it is concluded that the commonest cause of epistaxis in this region of the Punjab is hypertension [45% of cases] and the most effective treatment option for epistaxis is anterior nasal packing [45% of cases]

Parent reported wheeze in school children of South Punjab, Pakistan

To find the prevalence of wheeze as reported by the parents in school children of Southern Punjab Pakistan. It was a cross sectional, questionnaire based survey of the children aged 3-18 years, in randomly selected primary and secondary schools, from October 2002 to March 2003. The data was analyzed using Statistical Analysis System. Of 6120 questionnaire sent to the parents/guardians, we received 3180 back [52%]. Of the 3180 respondents, 1767[56%] were for boys and 1413[44%] were for girls. The median age was 8.25 years. Around 71% of children were between 4 to 11 years of age. The parents reported wheeze in 222[7%] of their children with a slight predominance in boys 120[4%] than in girls 102[3%]. The wheeze was not reported in 14-18 years age group. Childhood wheeze was reported in children by 7% parents. Most of the time wheeze is not reported or disclosed rather denied. An extensive educational media campaign is required for creating awareness in masses regarding wheeze

Nocturnal asthma in school children of South Punjab, Pakistan

At the present time, the epidemiology of the childhood asthma is of considerable interest. There is an understandable concern that changes in the geographical area, lifestyle, and environment. This study was conducted to find the prevalence of nocturnal asthma, in school children of south Punjab, Pakistan. It was a cross sectional, questionnaire based, descriptive survey of the children aged 3-18 years, in randomly selected primary and secondary schools, from October 2002 to March 2003. The data was analyzed with Statistical Analysis System [SAS]. Of 6120 questionnaire sent to the parents/guardians, we received 3180 back [52%]. Of the 3180 respondents, 1767 [56%] were for boys and 1413 [44%] were for girls. The median age was 8.25 years. Around 71% of children were between 4 to 11 years of age. The parents reported nocturnal asthma in 177 [6%] of their children with an equal prevalence in boys and girls, i.e., [3% each, rounded off to nearest whole number]. Of these 177 children with nocturnal asthma, 99 [56%] were boys and 78 [44%] were girls. Of the 1767 boys and 1413 girls, the nocturnal asthma reported by parents was 6% each [99 and 78 respectively]. The nocturnal asthma was not reported in 14-18 years age group of females. The asthma is taken as a stigma in our society and as such is not reported or disclosed rather denied. An extensive educational media campaign is required for awareness of the masses

Physician diagnosed asthma as reported by the parents in school children of South Punjab, Pakistan

To find the prevalence of doctor diagnosed asthma, as reported by the parents, in school children of South Punjab, Pakistan. It was a cross sectional, questionnaire based, descriptive survey of the children aged 3-18 years, in randomly selected primary and secondary schools, from October 2002 to March 2003. The data then was analyzed by the coauthor with Statistical Analysis System [SAS]. Of 6120 questionnaire sent to the parents/guardians, we received 3180 back [52%]. Of the 3180 respondents, 1767[56%] were for boys and 1413[44%] were for girls. The median age was 8.25 years. Around 71% of children were between 4 to 11 years of age. The parents reported asthma only in 129 [4%] of their children as was told to them by their doctor with almost equal distribution in boys [60] and girls [69] of 2%, respectively. Of these 129 children with doctor diagnosed asthma, 60 [47%] were boys and 69 [53%] were girls. Of the 1767 boys, the doctor diagnosed asthma as reported by parents was 3% [60]. Of the 1413 girls, the doctor diagnosed asthma as reported by parents was 5% [69]. The asthma was not reported in 14-18 years age. The asthma is taken as a stigma in our society and as such is not reported or disclosed rather denied. An extensive educational media campaign is required for awareness of the masses

Exercise induced asthma in school children of south Punjab, Pakistan

To find the prevalence of exercise induced asthma, in school children of South Punjab, Pakistan. It was a cross sectional, questionnaire based, descriptive survey of the children aged 3-18 years, in randomly selected primary and secondary schools, from October 2002 to March 2003. The data then was analyzed by the statistician with Statistical Analysis System [SAS]. Of 6120 questionnaire sent to the parents/guardians, we received 3180 back [52%]. Of the 3180 respondents, 1767[56%] were for boys and 1413[44%] were for girls. The median age was 8.25 years. Around 71% of children were between 4 to 11 years of age. The parents reported exercise induced asthma in 306[10%] of their children with an equal prevalence in boys and girls i.e. [5% each, when figures were rounded off to the nearest whole number]. Of this 306 children with exercise induced asthma, 159 [51%] were boys and 147[49%] were girls. Of the 1767 boys and 1413 girls, the exercise induced asthma reported by parents was 9% in boys and 10% in girls, [159 and 147 respectively]. The exercise induced asthma was not reported in 14-18 years age group of males. The asthma is taken as a stigma in our society and as such is not reported or disclosed rather denied. An extensive educational media campaign is required for awareness of the masses

Comprehensive HIV/AIDS prevention: focus on youth under threat

Prevention services are the mainstay of the response to AIDS, but are seldom implemented at a scale that would turn the tide of the epidemic. Effective, inexpensive and relatively simple HIV prevention interventions do exist but the pace of the epidemic is clearly outstripping most of the efforts towards effective prevention programming. Globally, less than one fifth of people who need it have any access to prevention services. This article is a review of comprehensive prevention of HIV/AIDS in youth. A variety of factors expose young people of HIV. These include lack of HIV information, education and services. Mass media can be used as a weapon against HIV/AIDS and targeted age-based approach can create awareness about AIDS. The message of ABCs combination prevention should be given to every vulnerable client in order to have sexual safety in youth. In Pakistan, National AIDS Control Programme has a important role in general pubic awareness about AIDS. The goals of the national strategic framework are to ensure multisectorial response to HIV/AIDS, to reduce risk of infections among high risk groups, to create awareness, to reduce transmission of sexually transmitted disease, to reduce vulnerability of young people to AIDS and to improve the quality of life for people living with HIV/AIDS through the provision of care and support and ensuring a secure environment for all people infected and/or affected by HIV/AIDS. This is a review article

Comparative analysis of associated complications of type-1 and type-2 diabetes mellitus

To analyse the associated complications of Type-1 and Type-2 diabetes mellitus in two tertiary care hospitals of Peshawar. A comparative cross sectional observational study was conducted at Khyber teaching hospital and Lady Reading hospital, Peshawar from January 2004 to February 2005. A total of 532 diagnosed patients of diabetes mellitus who had developed further complications were included. Patients were interviewed according to a pre-designed questionnaire. Out of 532 patients, 437 [82.1%] were Type-2 diabetics and 95 [17.9%] were Type-1 diabetics. Two hundred and seventy eight [52.25%] were females and 254 [47.74%] were males. Two hundred and seventy six [60.33%] patients had more than 10 years of duration of diabetes. The common complications in type-2 diabetics were coronary artery disease [CAD] in 268 [49.81%] cases, cerebrovascular accidents in 61 [11.46%] cases and diabetic ulcers in 59 [11.09%] cases. In type-1 diabetics, common complications were cardiovascular diseases in 38 [7.14%] cases, surgical ulcers in 16 [3%] cases, neuropathies in 15 [2.81%] cases and nephropathy in 9 [1.69%] cases. Type-2 diabetes coexists with hypertension in 112 [36.60%] cases of CAD and 31 [46.26%] cases of CVA cases. The frequency and morbidity of Type 2 diabetes is more common than Type 1 diabetes in our selected patients

hospital based study on stratification of risk factors of stroke in Peshawar

To determine the risk factors of stroke in Peshawar. Prospective observational study. Medical Wards of Khyber teaching hospital Peshawar from January 2004 to June 2005. A questionnaire was prepared in accordance with the objectives of the study. Questionnaire contained detailed history, general physical examination, and neurological examination. Association of risk factors with stroke was also studied. Two hundreds and eleven patients with established diagnosis of stroke were selected. Sixty-six patients [31.27%] had more than one risk factors. The age range of patients was from 27 to 91 years with mean age of 59 years. Out of 211 patients 126[59.71%] were males and 85[40.28%] females. Risk factors distribution was: Hypertension [55.45%] diabetes [32.70%] hyperlipidemia [19.43%], smoking [10.90%], ischemic heart disease [9.00%], Atrial fibrillation [3.31%] and history of oral contraception use [0.94%]. Hypertension, diabetes, hyperlipidemia and smoking are major modifiable risk factors of stroke, which require proper management and counseling of patients

Complications of barium studies

The objectives of our study were to know the frequency and type of complications of Barium contrast study. Material and This study was conducted in surgical unit of Postgraduate Medical Institute Hayatabad Medical Complex Peshawar. It was a descriptive study including all those patients who had some form of barium contrast studies for gastrointestinal diseases from January 2001 to December 2003. Total number of patients was 290. Patients who developed complications were only 13 [4.17%]. Referral from other centre was 75% among the complicated cases. Different types of complications noted in this study were intestinal obstruction 1.05% [n=3], failure of ileastomy/colostomy closure 2.42% [n=8], and perforation of hollow viscera 0.69% [n=2]. Overall mortality rate was 0.69% [n=2]. Frequency rate of complications in our study is higher than international studies. Complications rate can be reduced by following a standard approach to deal with acute/chronic abdomen. Barium study should be avoided in cases where there are signs of eminent intestinal obstruction or perforation

Right atrial Myxoma - A rare diagnosis in pediatrics

A three and-a-half years old baby girl was presented with intermittent, high grade fever and generalized dull abdominal pain of two months duration. The respiratory difficulty was progressing since fifteen days. Her growth and development was normal prior to her illness. She had taken multiple antibiotics in high dosages without any sustained improvement. On examination, she was pale and dyspnoeic with nasal flaring, intercostal and subcostal recessions. The respiratory rate was 72/min, pulse 160/min, temperature 101oF and blood pressure 110/70 mm of Hg. The jugular venous pressure was raised. The precordium was hyperdynamic with multiple visible pulsations. The apex beat was in fifth intercostal space without any particular character. The first and second heart sounds were normal. There was a pan-systolic murmur, best audible at the tricuspid area. There was bronchial breathing at the left lower chest and diminished breath sounds in the right lower lung. The liver was tender, pulsatile and 12 cm palpable in the right mid clavicular line. The spleen was 10 cm palpable in it's longest axis and tender. Due to prolonged illness as well as non- specific symptoms and signs a provisional diagnosis of congestive cardiac failure due to congenital heart disease or infective endocarditis was made. The hemoglobin was 5.6g%. The total leukocyte count was 15,200/mm3, with 79% neutrophils and 15% lymphocytes. The serum electrolytes and renal parameters were normal. The slide for malarial parasite was negative. Three samples of blood were taken for culture, from different sites and at different times. These were sent to different laboratories, but none of these showed any growth of microorganisms. The chest x-ray revealed increased vascular markings without cardiomegally. The electro-cardiography showed right axis deviation and right ventricular hypertrophy. The ultra-sonography revealed right pleural effusion, ectopic left kidney and a mass in the right atrium adherent to the tricuspid valve. On echocardiography the diagnosis of right atrial myxoma was confirmed. The child was promptly referred for the surgery but the parents refused to undertake surgery

Poliomyelitis as an etiology of acute flaccid paralysis and its epidemiology

According to confirmed total polio cases in the world the incidence in Pakistan has decreased from 20% in 1997 to 6% in 1998. To find out the relative incidence of the poliomyelitis and to assess its epidemiological variables, a prospective open clinical study of acute flaccid paralysis [AFP] was carried out. A total of 44 patients with AFP were admitted to the Paediatric Medicine-II, Nishtar Hospital, Multan, during April 95 to August 96. Thirty of these patients completed the study and their stool samples were sent for the isolation of polio virus. Only 12 of these were positive for polio virus. It was P-1, wild type virus. The 6 of polio virus excretors were completely vaccinated, 3 partially vaccinated and 3 non-vaccinated. As a whole 25 [83%] were vaccinated [13 complete and 12 partial] and 8 [27%] of these had taken polio drops only on National Immunization Days [NIDs]. The cases mostly occurred during early and late summer. The maximum of cases were under 5 years [93%] and half of the total were less than 1.5 years. The majority belonged to male, lower socioeconomic and urban group

Effect of fluvastatin on dyslipidaemia associated with type 2 diabetes mellitus

Type-2 diabetics suffer from lipid abnormalities. Even though these are mild in most patients, they contribute to the increased cardiovascular morbidity and mortality seen in this disease, especially in South Asians. We report the effect of HMGCoA reductase inhibitor, FLUVASTATIN in lowering lipid levels in type 2 diabetes mellitus in urban Pakistanis from Punjab. Such data does not exist before. Type 2 diabetes with stable disease were entered into the study if the level of lipids remained elevated following period of 8 weeks on diet placebo oral medications. They entered into the next phase [week 0] only if they demonstrated a persistently raised total cholesterol [250 mg/dl] despite the lipid lowering diet. In phase 2, the subjects received FLUVASTATIN 40 mg per day for twelve weeks, lipid levels were estimated at week 0, 6, 12. Monitoring for side effects both clinical and biochemical, was carried out. 50 out of 85 patients were found to have a total cholesterol of less than 250 mg/dl after 8 weeks on a lipid-lowering diet. 35 patients [9 male, 26 female] entered phase two. Their mean age was 46.7 years and mean body mass index 28.6 kg/m[2]. After 12 weeks of treatment with FLUVASTATIN there was no change in fasting blood glucose. However mean total cholesterol was reduced from 313.3 mg/dl to 233 mg/dl [-34.3%]; LDL cholesterol fell from 185.2 mg/dl to 160.6 mg/ dl [-15.4%]. The mean HDL cholesterol level increased from 46.6 mg/dl to 56.1 mg/dl [+17.2%]. Side effects were insignificant. FLUVASTATIN effectively and safely lowers total cholesterol, LDL cholesterol, triglycerides in urban Pakistanis suffering from type 2 diabetes mellitus, presenting at Mayo Hospital, diabetic clinic. It also increases the level of HDL cholesterol

Polioimmunizations status and acute flaccid paralysis at Multan

A prospective, cohort, open clinical study was carried out to assess the immunization/ vaccination status of children presenting with acute flaccid paralysis [AFP]. A total of 44 patients with acute flaccid paralysis were admitted to the Pediatric Medicine-Il, Nishtar Hospital, Multan during April 95 to August 96. Thirty of these patients were labelled as "Probable Poliomyelitis" and their stool samples were sent for isolation of polio virus. Polio virus type-I was isolated in 12 patients. Four [33.33 percent] of these were fully vaccinated while three [25 percent] were partially vaccinated; three cases [25 percent] were nonvaccinated and 2 [16.66 percent] bad taken polio drops on the National Immunization Days [NID] for polio eradication. Necessary measures have been suggested to improve the Immunization situation