Yield and safety profile of ultrasound guided fine needle aspiration cytology [FNAC] of lymph nodes

Objective: To determine the re-biopsy rate, positive yield and safety profile of ultrasound guided fine needle aspiration cytology [FNAC] in cervical lymph nodes in terms of its complications and repeat procedures

Study Design: An analytical study

Place and Duration of Study: Department of Vascular and Interventional Radiology, Dow University Hospital, Dow University of Health Sciences, Karachi, from June to December 2013

Methodology: Eighty neck swellings, which were found to be lymph nodes on ultrasound, underwent ultrasound guided FNAC, from outpatients. Lymph nodes which were included in the study were those that were not easily palpable, located near major blood vessels, where patient refused of direct palpation and wanted image guided FNAC, those directly sent by physician for image guided FNAC and where blind biopsy remained inconclusive. Patients who refused on explanation or did not give consent were excluded. Complications and repeat biopsy were noted

Results: This study consisted of 80 cases, of which 51 cases [63.75%] were female and 29 cases [36.25%] were male. Repeat biopsy was required in 1 case [1.6%]. There were no procedure-related complications. A total of 44 cases [55%] revealed evidence suggesting or confirming the existence of tuberculosis. Rest of the others showed other benign lesions, reactive lymphadenopathy and malignancy

Conclusion: Ultrasound guided FNAC is a safe procedure with low re-biopsy rate that aids diagnosis. The predominant cause of cervical lymphadenopathy in this study was tuberculous lymphadenitis

Early hearing aid fitting - key to better education for school going special children with hearing impairment

INTRODUCTION: 10% of the world population has hearing impairment. The most common association for this neurological impairment is considered to be consanguineous marriages. Our study aim is to find the Impact of late advice and fitting of hearing aid on the level of schooling of special children and the rate at which consanguinity is related to congenital hearing loss

MATERIALS and METHODS: This is a cross sectional survey conducted on special children participating in a free ENT examination camp conducted for the special children. 50 children with hearing impairment as the single disability were selected for the questionnaire based survey

RESULTS: Fifty six percent children were fitted with hearing aid at the ages of 1-2 years, only twelve percent [6 participants] were able to communicate verbally; this is when speech therapy was also received along with a hearing aid. This had a p-value of 0.001. They also had the most age appropriate school years.Thirty eight of the participants gave a history of consanguineous marriage which is seventy six percent

CONCLUSION: The children who had the diagnostic workup completed and hearing aid fitted at 2-4 years, not only did well in developing verbal communication. They also did better at school

Another important factor in speech development is speech therapy after the fitting of Hearing Aid. Without speech therapy the maximum benefit cannot be achieved from the hearing aid device

The frequency of hearing impairment being associated with consanguineous marriage in our study is seventy six percent which is even higher than the regional figures for this problem

Complications and technical errors of tube thoracostomy and its underwater seal system

To find out the complications and technical errors of tube thoracostomy and its underwater seal system in a tertiary care hospital. Descriptive case series. Department of Thoracic Surgery Jinnah Postgraduate Medical Centre Karachi, from March 2010 to January 2012. All patients above the age of 12 year who were admitted directly or those referred from other centres were included in this study. Indications of chest tube insertion included both traumatic and non traumatic conditions. Data collection included both technical errors as well as complications related to the procedure. There were total of 144 patients managed during study period. This include 102 [70.8%] males and 42 [29.9%] females. The mean age of the patients was 32.2 year. Of total patients, 123 [85.45%] were referred from other hospitals while 21 [14.5%] were admitted directly in the ward. The most common complication related to insertion of chest tube was lung injury, [n=19, 13.19%] which resulted from the use of trocar or due to inadequate separation of the lung from the chest wall. Diaphragm injury occurred in 4 [2.78%] patients. The technical error frequently encountered was kinking of chest tube [n=25, 17.36%], followed by use of small chest tube [n=15, 10.41%]. Tube thoracostomy resulted in number of complications of which lung injury was most common. This occurred mainly due to trocar used for insertion. Kinking of tube was the most common technical error in the series

Gender and stress perception based differences in BMI, hormonal response and appetite in adult Pakistani population

To evaluate and compare the gender based variations in stress perception induced changes in leptin, cortisol and serotonin [5-HT] trends, appetite and Body Mass Index [BMI]. An analytical comparative study. Neurochemistry Laboratory, University of Karachi, from January to August 2013. Appetite, BMI and serum leptin, cortisol, and 5-HT were measured in 100 men and women of aged 30 - 60 years, working in teaching institutes of Karachi, to evaluate gender based, stress perception induced variations. The samples were identified by stratified random technique. The chemical variables were estimated through ELISA. Results were analysed using one-way ANOVA and multivariate general linear model using SPSS version 17. Mean stress perception, BMI and serum leptin levels were significantly more in women [p < 0.05]. Serum cortisol and 5-HT were found significantly reduced in women [p < 0.05]. BMI, serum cortisol and leptin were found to be increased with increasing level of stress perception [p < 0.05]. VAS for hunger and desire to eat as the measure of appetite was significantly higher in men [p < 0.05]. Stress perception attenuates the positive effect of cortisol and negative effects of leptin and 5-HT on appetite through changes in their circulatory levels. Women perceive more stress and exhibit significantly attenuated changes in hormonal levels and appetite which may be the contributing factor towards obesity. Increased BMI in women despite decreased appetite merits more studies

Radiographic patterns in HIV associated pulmonary tuberculosis

To compare the radiologic patterns in HIV positive patients with pulmonary tuberculosis with non-HIV positive patients of pulmonary tuberculosis. Descriptive study. The study is a carried out in the Department of Medicine at Dow University Hospital from July, 2010 to July, 2011. The admission records of 54 HIV-positive patients were analyzed. A total of 30 patients out of 54 presented with pulmonary symptoms, which were further evaluated by sputum smear for acid-fast bacilli and chest radiographs. These 30 patients were compared with 30 non-HIV, smear positive for acid-fast bacilli patients. Out of 30 HIV seropositive patients, 29 were male and 1 was female with the mean age +/- SD 33.9 +/- 95 years. Sputum staining for acid-fast bacilli was positive in 10 patients [33.3 %]. Frequent radiographic patterns included normal 12[40%] and apical infiltrates 5[16.6%]. Cavitatory lesion was observed in 1 patient. Dominant symptoms were weight loss 29[93.3%] and fever 24[80%]. Out of the 30 non-HIV seropositive pulmonary tuberculosis patients, 20 were male and 10 were female of mean age +/- SD 33.9 +/- 95 years. Sputum staining for acid-fast bacilli was positive in 30 patients [100%]. Frequent radiographic patterns were apical cavitations 12[40%], apical infiltrates 5 [16.6%], bronchopneumonia 6[20%], interstitial infection3 [10%].Dominant symptoms were weight loss 29[93.3%] and fever 24[80%]. Majority of HIV seropositive patients with pulmonary tuberculosis were male. Common radiographic patterns were normal radiographs and apical infiltrates. Atypical radiographic presentation is particularly related in advance stages of immunosuppresion. Cavitatory lesions and pleural effusion were rare findings. Non HIV seropositive pulmonary tuberculosis patients were both male and female. Common radiographic patterns were apical cavitatory lesions, bronchopneumonia, interstitial infiltrations and pleural effusion. This radiographic presentation is particularly related to delayed hypersensitivity reaction