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Objective: To assess cases of the spectrum of Kala Pathar poisoning in all age groups. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital [CMH] Bahawalpur and Bahawal Victoria Hospital [BVH], Bahawalpur, from January 2016 to April 2017
Methodology: All the cases of Kala Pathar [Paraphenylene diamine [PPD]] poisoning, admitted and treated at the study places during said period were included in the study. The assessed variable included gender, age, education status, socioeconomic status, reason of poisoning and mortality. Chi-square was applied for qualitative variables with p-value less than 0.05 was considered significant
Results: A total of 1,258 cases of PPD poisoning were included in the study; 814 [64.7%] females and 444 [35.3%] males. Their age ranged from 5 - 63 years, with median age 21 [IQR 4]. Sixty-six [5.2%] were children and the rest 1,192 [94.8%] were adults. In adults 1,125 [94.37%] cases of PPD poisoning were suicidal and 62 [5.20%] accidental cases; only 5 [0.42%] adults were intentionally poisoned. On the other hand, only one child took it with suicidal intent, 54 [81.81%] ingested it accidentally and 11 [16.66%] children were given poison deliberately with the intent to murder. The overall mortality was 24.08% - 22.81% in adults, and 46.96% in children
Conclusion: Kala Pathar [PPD] is a lethal substance when ingested. PPD poisoning is not limited to adults; many cases of pediatric poisoning are also being reported in Southern Punjab. Mortality due to Kala Pathar is high. Tracheostomy should be done immediately in all such cases; and high intensive multidisciplinary approach is required
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Objective: To assess the prevalence of various ear, nose and throat diseases in Shangla valley. Study Design: A descriptive cross-sectional study. Place and Duration of Study: Study was carried out in shangla. Duration of study was 3 months, from Jun 2014 to Aug 2014
Material and Methods: All the patients of any age group and both genders who reported with any ENT disorder and emergency were included in this study. Frequency and percentage of various ENT diseases among patients and emergency procedures performed were found
Results: A total of 2725 patients were included. The most common ENT disorder encountered was rhinosinusitis which was seen in 14.2% cases, followed by ear wax [impacted cerumen] in 13.4% and pharyngitis in 12.5% cases. Allergic rhinitis was seen in 10.4% cases, epistaxis in 7.4% and chronic suppurative otitis media in 6.4% cases. Among the emergency ENT procedures performed, anterior nasal packing was the commonest [done in 55 cases] followed by stitching of lacerations and foreign body removal from ear and nose
Conclusion: Ear, nose and throat diseases are very common in Shangla and their spectrum range from rhinosinusitis, impacted cerumen [ear wax] and pharyngitis to less common but potentially dangerous conditions like foreign body impaction in ear and nose
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Objective: To compare efficacy of chemical cautery with silver nitrate along with fucidin ointment versus topical vasoconstrictor spray [xylometazoline 0.05%] and fucidin ointment application in idiopathic pediatric anterior epistaxis. Study Design: Randomized controlled trial. Place and Duration of Study: Study was carried out at Combined Military Hospital [CMH] Bahawalpur from Jan 2016 to Dec 2016
Material and Methods: Total 112 patients fulfilling the inclusion criteria were selected from Ear Nose Throat [ENT] outpatient department at CMH Bahawalpur. They were randomly divided into two groups of 56 cases in each group. Group A individuals were treated by cauterization with 75% silver nitrate followed by fucidic acid ointment. Group-B individuals were treated with topical vasoconstrictor spray [xylometazoline 0.05% twice a day for one week] along with fucidic acid ointment. Efficacy was determined in terms of control of epistaxis, whether the procedure was effective in controlling epistaxis or otherwise i.e. patient again developed bleeding from same side of nose and needed further treatment to control epistaxis. All the cases were followed up for two months after procedure to check their efficacy
Results: There were total 61 [54.46%] males and 51 [45.54%] females among the cases. Mean age of patients was 8.27 [+/- 2.34] years. Both the groups were comparable as regards the gender [p=0.817] and age [p=0.749]. Group-A were treated with silver nitrate cauterization followed by fucidic acid ointmnet application and group-B were treated by vasoconstrictor nasal spray along with fucidic acid ointment. In group A [silver nitrate cautery], 87.5% cases had no rebleed during two months follow up and in group-B, 67.8% children had no rebleed during two months follow up period [p=0.022]
Conclusion: Chemical cauterization with silver nitrate along with fucidic acid ointment application was found to be more effective as compared to xylometazoline nasal spray and fucidic Acid ointment application in treating idiopathic pediatric epistaxis
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Teeth get weakened after endodontic treatment and these should ideally be crowned. However, few patients opt for crowns to preserve their teeth, whereas, many do not opt for crowning due to multiple reasons. The aim of this study was to explore how many patients take interest to preserve their teeth after endodontic treatment and to find out reasons for not opting for crowning. A data of 80 patients who had their root canal treatment done was collected during routine visit of various patients for dental treatment at 21 Military Dental Centre in Combine Military Hospital, Quetta. It was a questionnaire based cross sectional study. The collected data was analyzed to see frequency of patients who did or did not get their teeth crowned and possible reasons for not crowing after endodontic treatment. It was found that 36 % people had got their teeth crowned after endodontic treatment and 64% of patients did not opt for crowns. Majority of patients [29.4 %] who did not opt for crowns were found to be ignorant about the procedure, 19.6 % did not have time for their treatment, 15.7% were found to have financial limitation, non- availability of facility for treatment and lack of interest, whereas 3.9% did not opt for crowning due to previous bad experience. It was concluded that there is an absolute need for an educational campaign to create awareness among people to highlight importance of oral health and benefits of crowning of endodontically treated tooth for its longer survival. Government should make an effort to provide dental facility available to masses and introduce measures to provide affordable dental care
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Objective: To assess polio immunization coverage, awareness about polio and its vaccination and to find reasons of polio vaccination refusals in districts Swat and Shangla [the two conflict affected areas in recent past]
Methodology: This Cross-sectional descriptive study was carried out in Swat and Shangla districts, KPK, from January to July 2014. It was a door to door survey of 800 families selected by random sampling from four different localities of these two districts. Information gathered included educational status of both parents, number of children less than 5 years, polio vaccination history [both routine immunization and house to house approach] complete polio vaccination history, polio awareness level of parents and reasons of refusals to polio vaccination. Data collected was analyzed with SPSS version 21. Chi-square test was used to ascertain the association between various categorical variables and p value less than 0.05 was considered significant
Results: There were total 1775 children in age group 0-5 years in the 800 households under study. The children, who got vaccinated against polio, were 1392 [78 %]. Out of rest, 294 [16.5 %] had not been vaccinated against polio and the parents of remaining 89 [5%] children did not remember whether vaccination against polio was done or not. There was a significant association between educational status [minimum matriculate] of parents and polio vaccination [p=0.000]
Conclusion: The present day situation of polio vaccination is encouraging in areas under research. Law and order situation, illiteracy and misperceptions about the vaccine should be addressed along with the capacity building of the health care staff as soon as possible through sincere coordinated efforts for complete eradication of polio by all concerned institutions
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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
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To compare efficacy and discomfort in posterior nasal packing with Foley's catheters versus BIPP gauze packing in cases of posterior epistaxis. Randomized controlled trial. Combined Military Hospital [CMH] Kharian from October 2011 to October 2013. A total of 206 patients of posterior epistaxis were included in the study through nonprobability convenience sampling and randomly divided in two groups of 103 each. In group A patients were treated by posterior nasal packing with Foley's catheter and in group B patients were treated by posterior nasal packing with BIPP gauze and results in terms of control of epistaxis and discomfort during pack insertion, while the packs were in situ and pack removal, based on VAS [Visual Analogue Scale] were observed. Average age in group A was 52.64 years [SD=9.57] and in group B it was 50.27 years [SD +/- 10.13]. There were 71 [68.9%] males in group A while 67 [65%] males in group B. During posterior nasal pack insertion, the mean pain score in Group A was 6.21 [SD +/- I.13] and in Group B was 7.43 [SD +/- 1.19]. The mean pain score with the pack in situ was 4.27 [SD +/- 0.08] in Group A versus 4.76 [SD +/- 0.09] Group B. Similarly pack removal was also more painful in group B than group A [6.14 +/- 0.91 vs 6.89 +/- 1.09] [p =0.000]. In the group A, 31 [30.1%] patients had rebleeding after pack removal, out of which 9 [8.7%] had significant bleeding requiring repacking. In 22 [21.4%] cases there was mild bleeding which settled without repacking. In group B 22 [21.4%] patients had rebleeding after pack removal, out of which 5 [4.7%] had significant bleeding requiring repacking. It is concluded that posterior nasal packing with BIPP gauze pack is effective for controlling posterior epistaxis but causes more discomfort to the patients as compared to Foley's catheter packing
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To identify effect of military deployment in operational area on trend of smoking cigarettes among troops. Descriptive cross-sectional study. The study was carried out in an Army Brigade deployed in Operation Al-Mizan, Swat, from Jan to March 2014. Whole troops of an army brigade deployed in operation Al-Mizan, Swat were the part of present study. Total strength of brigade comprised of 1850 troops. Out of these 1850, officers constituted 53 [2.86%] and rest 1797 [97.14%] were Junior Commissioned officers [JCOs], noncommissioned officers [NCOs] and soldiers. All ranks other than officers were collectively termed as soldiers. All the individuals were given structured questionnaire to fill. The information was gathered on variables like age, rank, unit, education, duration of deployment in operational area, habit of smoking, intensity of smoking [number of cigarettes smoked daily] and change in the habit and intensity of smoking after being deployed in the operational area. Information was also gathered from the individuals about the reasons for change in the habit [starting or stopping smoking] and intensity of smoking after deployment in operational area. Forty nine individuals with less than 6 months duration in operational area were excluded. All the other officers and soldiers [1801] having served more than 6 months in the operational area were included in the study. There were total 1801 individuals included in the study. Officers constituted 52 [2.88%] of the total and rest 1749 [97.12%] were soldiers. The mean age of officers was 26.34 +/- 4.6 years and mean age of soldiers was 27.92 +/- 4.5 years. The overall frequency of smoking in officers and soldiers in the operational area came out to be 29.6%, however the overall frequency of smoking in these individuals before coming to operational area was 26.8%. There were 3 officers and 47 soldiers who started smoking in the operational area. There was an increased consumption of cigarettes among troops [p < 0.001]. The increased frequency of consumption of cigarettes in operational area was because of stress/increased combat activities, boredom, lack of recreational activities and monotony. It is concluded from the present study that operational activities increase the tendency of smoking in some troops and cause increased consumption of cigarettes by others mainly because of stress and peer pressure, which over the period of time can affect health, medical fitness and operational readiness of military personnel