Analysis of patients in otolaryngology department at Muzaffarabad hospitals

Objective: To assess the work load of the department in terms of individual disease

Study Design: Descriptive study

Place and Duration of Study: This study was conducted at Ear, Nose and Throat [ENT] Department of Shaikh Khalifa Bin ZayedAl Nahyan, Hospital Combined Military Hospital [CMH] Muzaffarabad from Jan 2011 to Jan 2012

Material and Methods: Total of 710 patients was admitted in ENT ward in one-year duration for various pathologies. For easy analysis, they were divided into groups according to the region involved by disease

Results: Two hundred and eighty-five cases [40.14%] were admitted with pathologies of nose and para nasal sinuses making the highest percentage among the groups. The second major group was otology comprising of one hundred and fifty-six [21.97%] cases. One hundred and three [14.50%] cases were from pathologies in oral cavity. Thirty [4.22%] cases from skull base, thirty [4.22%] pathologies of larynx, trachea and bronchi, forty [5.63%] cases were from hypopharynx and esophagus, twenty-four [3.38%] cases were from salivary gland pathologies. Twenty-one [2.95%] cases were from neck region. Tumors were 4[0.56%] and neurological cases were 11 [1.54%] of the total number of cases

Conclusion: Self-analysis/ audit at departmental level greatly enhances the working efficiency of a department and is essential for betterment of the patient and education of trainees as one gets a fair idea about the prevalence of disease in a community and can thus direct the resources accordingly

Nephroprotective property of Cinnamomum zeylanicum and its antibacterial activity in combination with gantamicin

Cinnamomum zeylanicum has strong antioxidant properties and has been presented to have nephroprotective effects. Present work was aimed to study the nephroprotective property of the plant extract through urinary enzymes excretion, to confirm its protective effects and to observe the antibacterial activities of gentamicin in combination with the plant extract. 200mg/kg/day of the plant extracts were administered alone and as co-therapy with gentamicin. Urinary lactate dehydrogenase [LDH] and Urinary alkaline phospatase [ALP] excretions were observed through reagents kits with the help of Power-Lab 300. Antibacterial activities were assessed for gentamicin alone and in combination with the extract. Present study showed that the plant extract have excess quantity of flavonoids, which may responsible for attenuating the excessive excretion of urinary LDH. However, Urinary ALP excretion was found remained same throughout the study period in all experimental groups; might be detected in acute damage. Further, the plant also proved to have no decreasing impact on the antibacterial activities of gentamicin

Screening outcomes of household contacts of multidrug-resistant tuberculosis patients in Peshawar, Pakistan

Objective To assess the profile of TB/multidrug-resistant TB (MDR-TB) among household contacts of MDR-TB patients. Methods Close contacts of MDR-TB patients were traced in the cross-sectional study. Different clinical, radiological and bacteriological were performed to rule out the evidence of TB/MDR-TB. Results Between January 2012 and December 2012, a total of 200 index MDR-TB patients were initiated on MDR-TB treatment, out of which home visit and contacts screening were conducted for 154 index cases. Of 610 contacts who could be studied, 41 (17.4%) were diagnosed with MDR-TB and 10 (4.2%) had TB. The most common symptoms observed were cough, chest pain and fever. Conclusions The high incidence of MDR-TB among close contacts emphasize the need for effective contact screening programme of index MDR-TB cases in order to cut the chain of transmission of this disease.

Screening outcomes of household contacts of multidrug-resistant tuberculosis patients in Peshawar, Pakistan

OBJECTIVE@#To assess the profile of TB/multidrug-resistant TB (MDR-TB) among household contacts of MDR-TB patients.@*METHODS@#Close contacts of MDR-TB patients were traced in the cross-sectional study. Different clinical, radiological and bacteriological were performed to rule out the evidence of TB/MDR-TB.@*RESULTS@#Between January 2012 and December 2012, a total of 200 index MDR-TB patients were initiated on MDR-TB treatment, out of which home visit and contacts screening were conducted for 154 index cases. Of 610 contacts who could be studied, 41 (17.4%) were diagnosed with MDR-TB and 10 (4.2%) had TB. The most common symptoms observed were cough, chest pain and fever.@*CONCLUSIONS@#The high incidence of MDR-TB among close contacts emphasize the need for effective contact screening programme of index MDR-TB cases in order to cut the chain of transmission of this disease.

Clinicians approach to euthanasia in the province of Khyber Pakhtunkhwa

Objective: to determine the knowledge of clinicians and their opinion about legalization, obstacles in practicing euthanasia and factors that may compel them to practice euthanasia

Methodology: a questionnaire based descriptive study was conducted at public and private hospitals of Khyber Pakhtunkhwa. A questionnaire was distributed randomly to 540 doctors of different specialties and general practitioners. Questions were related to their knowledge, views about legalization, factors and obstacles in practicing euthanasia. The questionnaire was collected from the doctors who filled the form and consented to participate in the study

Results: the response rate was 55%, among them 79% were males. Only 61% [185] knew the meaning of euthanasia, whereas 36% [109] knew about its guidelines and 2% [6] had no knowledge of euthanasia. Amongst clinicians who knew about euthanasia, 84% did not and 16% agreed with its legalization. Reasons mentioned for disagreement with its legalization were religion 95%, moral 61%, ethical 44%, emotional 41% and social 37%. Of those clinicians who agreed with its legalization, 90% would and 10% would not practice it on their patients. Out of them 40% would adopt no resuscitation method, 40% would administer lethal drugs and 20% would withhold or withdraw the treatment

Conclusion: majority of responding clinicians were not aware of euthanasia and any related guidelines. They disagreed with the practice as well as legalization of euthanasia

Comparison of efficacy of lignocaine anesthesia of vocal cords by [spray as you go] through a bronchoscope with lignocaine injection through the cricothyroid membrane

To assess and compare the efficacy of lignocaine anesthesia of vocal cords by [spray as you go] through a bronchoscope with lignocaine injection through the cricothyroid membrane. Quasi experimental study. This study was done in Combined Military Hospital Peshawar form May 2009 to June 2010. Thirty patients in each group were given local anesthesia to the vocal cords. With lignocaine either via intratracheal instillation through the cricothyroid membrane or through a fibreoptic bronchoscope [spray as you go]. A cough score was calculated by recording the number of coughs as the bronchoscope was advanced through the cords into the trachea. A twenty point unpleasantness score was marked by the patient 2 hours after the procedure. Cough score and unpleasantness score was compared among the two groups using SPSS version 19. Median unpleasantness score was 6 [Inter quartile range [IQR] 4-8] whereas median cough score was 2[IQR 0-3]. The difference was statistically significant among the two groups for both cough and unpleasant scores [p < 0.001 and p < 0.001 respectively]. Intratracheal injection of lignocaine is more comfortable for the patient. It induces much less cough and irritability to the patient than the [spray as you go] technique

Frequency of meningitis in newborns presenting with sepsis to Nishtar hospital, Multan

To determine the frequency of meningitis in newborns presenting with neonatal sepsis to Nishtar Hospital, Multan. Descriptive study. This was carried out in the Department of Paediatric Medicine, Nishtar Hospital, Multan from January 2012 to December 2012. A total of 73 newborns were included in the study conducted at Nishtar Hospital, Multan. Out of 73 newborns with sepsis, 20 [27.4%] were diagnosed to have meningitis. Majority of the neonates with sepsis [52.1%] were between 1-7 days of their life, however, mean age of all cases was 10.49 +/- 7.79 days [range 2-25 days]. There were 39 [53%] male, 34 [47%] female babies. 36 [39.3%] neonates having low birth weight [1.5-2.5 kg] however mean weight was 2.55 +/- 0.39 kg [range 1.8-3.6 kg]. Higher rate of meningitis [27.4%] diagnosed in present study shows better diagnostic facilities and on the other hand alarm us to take prompt measures to prevent it

Clinical presentation and aetiological agents of urinary tract infection in children

To describe the clinical presentation and to identify the aetiological agents causing urinary tract infection. Descriptive study. This study was carried out in the Department of Paediatric Medicine, Nishtar Medical College/Hospital, Multan from January 2013 to December 2013. A total of 50 children were included in the study conducted at Nishtar Medical College/Hospital, Multan. Out of 50 children, 38 were female and 12 were male. 28 children were from 1-3 years age group and 22 were of more than 3 years. Most common clinical presentations were fever, urinary symptoms, vomiting and pain abdomen. Aetiological agents in study were Escherichia coli, klebsiella, proteus, staphylococcus saprophyticus, streptococcus fecalis or pseudomonas. four cases of UTI [3 females, 1 male] were associated with nephritic syndrome. Four cases were associated with malnutrition. It is concluded from study that UTI is more common in females between the age of 2-4 years mostly due to problems in their toilet training

Nephroprotective potentials of Citrus aurantium: a prospective pharmacological study on experimental models

Citrus aurantium is traditionally used in various kidney problems like burning of urine, urinary hesitancy and renal colic. The main objective of the present work was to evaluate the protective role of Citrus aurantium against gentamicin induced renal damage, due to its free radical scavenging properties to present experimental facts for their traditional use. 200 mg/kg/day of ethanolic extract of the plant employed in combination with the toxic doses of gentamicin for twenty-one days. The group GC-au [animals treated with co-administration of Citrus aurantium and gentamicin] protected renal damage expected with gentamicin, assessed by known functional and morphological parameters, significantly different from group G [animals treated with gentamicin]. All the renal functioning parameters including; Blood urea nitrogen, Serum creatinine, Serum uric acid, Creatinine clearance, Serum electrolytes, Body weight, Urinary volume, Enzyme excretions, Urinary protein excretions and histological examination was performed for each and every group animals. The plant extract proved to have nephroprotective potentials may because of its known flavonoid contents and antioxidant properties.

Effect of postoperative dexamethasone on pain, emesis and haemorrhage in tonsillectomy by dissection method

To compare the effect of postoperative intravenous dose of dexamethasone on morbidity in patients undergoing tonsillectomy. Randomized control trial. This study was conducted in ENT Department Shaikh Khalifa Bin Zayed Al Nahyan Hospital [CMH] Muzaffarabadfrom 10[th] Jan 2010 to 15[th] Feb 2011. After getting informed consent, a total of 60 patients who fulfilled the inclusion criteria were selected and tonsillectomy by dissection method was carried out. They were divided into two groups of 30 eachusing a random numbers table. Group A received 0.25 mg/kg body weight [maximum 20 mg] of Dexamethasone postoperatively intravenously for 03 days while group B [control group] did not receive any steroid. In group A, 80% patients had mild pain, 16.7% had moderate pain and 3.3% had a severe pain while in group B, 30% patients had mild pain, 6.7% had moderate pain and 63.3% had severe pain [p< 0.05]. In group A, 76.7% patients had mild emesis while in group B, 86.7% had moderate emesis [p< 0.05]. There was an insignificant difference in secondary hemorrhage. Dexamethasone given postoperatively significantly reduces the morbidity that is pain, episodes of emesis thus early recovery to a normal lifestyle with no effect on secondary hemorrhage in patients undergoing Tonsillectomy by dissection method

Determine the prevalence and pattern of killings in Quetta, Balochistan

Homicide is defined as Human life slaughter of a human being by the conduct of another human being. This study was conducted to determine the pattern of killing in Quetta. Observational study. All medico-legal autopsy reports conducted in Civil Hospital Quetta, by Department of Forensic Medicine, Bolan Medical College, Quetta, from 1[st] January, 2009 to 31[st] December, 2010 and police in quest reports of the respective cases were studied. All police inquest reports of the respective medico-legal autopsies were also made part of this study. Preformed were used to record Medico-legal case number, date, day and time of arrival of dead body and autopsy, brought by police or relatives cause of death, type of weapon used, type and site of injuries, place of occurrence, mode, manner and cause of death. A total of 200 cases of medico-legal autopsies were studied, out of which 113 were declared as homicidal deaths. The most common weapons used for homicide were Automatic firearm weapons. The most affected age group was 31 to 40 years followed by 21 to 30 years and 11 to 20 years. The cases of homicide in district Quetta are mostly by firearm weapons. Male are affected more than females. The most common age group affected is 31 to 40 years

Neonatal resuscitation impact of neonatal resuscitation programmes on birth asphyxia, the actual situation

Each Year Billions of dollars have been spent on the various programmes for Maternal and child health services in collaboration with international organizations and hundreds of doctors and thousands of skilled [SBAs] birth attendants and lady heal workers have been trained. To evaluate the impact of neonatal resuscitation programs on the prevalence of birth asphyxia in a hospital which drains a large population of Punjab. Cross sectional. Department of Paediatric Medicine, Nishtar Medical College and Hospital, Multan from January 2008-December 2008. All newborns with a H/o failure to initiate or sustain respiration at birth or H/o associated convulsions who were admitted [referred or hospital based] with the diagnosis of Birth Asphyxia and a weight > 1.5 kg were included, still born and those with lethal congenital malformations were excluded. A questionnaire was designed after extensive review of literature and data recorded. The data of past 10 years for Birth Asphyxia was also collected from the hospital record and compared with the present results. In year 1998 a total of 722 Newborns were admitted our neonatal unit out of which 210 [29.0%] were diagnosed as Asphyxia Neonatorum. This number has progressively increased over the past 10 years with a total of 846 out of total 2079 newborns [40.78%] admitted in 2008 with a diagnosis of asphyxia. Out of the total 8461 patients, there were 69% Male and 31% Female with a M:F ratio of 2.2:1.46% were delivered by SVD [17.39% in Nishtar Hospital 15.21% by dais, 32.6% by Private doctors and 34.78% by LHV] and 54% were delivered by caesarian section, out of which 46.29% were delivered in Private hospitals and 54% in Nishtar Hospital. Overall 65% deliveries were in the private sector or at home and 35% in the government hospitals 60% babies had come from Multan and 40% from other town or cities. A H/o one or more antenatal visits was present in 68% of others. Out of total cases of B.A. 26% were in B.A Grade-159% in Birth Asphyxia Grade-II 15% in B.A Grade-lll. Out of this total 45% expired. As we are moving towards the 4[th] MDG and Pakistan strives to improve its health indicators and we claim to decrease the infant mortality, neonatal and perinatal mortality rate. The incidence of birth asphyxia rises with increased burden of, morbidity. Even though the principles of NRPs are recommended for international application, this program widely used in the developed world has not been properly disseminated in communities in the developing countries, especially Pakistan

Valsalva manouevre; efficacy in the treatment of eustachian catarrh

To assess the efficacy of Valsalva maneuver in the treatment of Eustachian catarrh. Quasi Experimental Study. Frontier corp Hospital [Quetta] and Sheikh Khalifa Bin Zayad Al Nahyan Hospital [Muzzafarabad] from December 2010 to May 2011. Total of sixty patients of Eustachian catarrh were randomly assigned to two treatment groups. Group A was given Antibiotics, Antihistamine, systemic and nasal decongestants and group B was advised Valsalva maneuver in addition to the above mention treatment. Relief in aural fullness [assessed through tympanometry] and hearing improvement [assessed through audiometry] were compared between these two groups at the end of three weeks of treatment. Audiogram done after three weeks of treatment showed statistically significant hearing and middle ear pressure improvement [assessed through audiogram and tympanogram respectively] in group B

Unrecognised peripartum cardiomyopathy will have dire consequences

We report an undiagnosed case of Peripartum cardiomyopathy [PPCM] in our tertiary care hospital, who presented for an elective cesarean section [CS] with cough and orthopnea in her late gestational period. She was treated for upper respiratory tract infection; whereas her heart failure leading to pulmonary edema causing cough and orthopnea, remained unidentified and thus uninvestigated. The disease was only diagnosed during the postoperative period when she suffered from cardiac arrest and had to be ventilated mechanically. She was effectively managed after correct diagnosis; weaned successfully off the ventilator and transferred to the Obstetrics/Gynecology ward in a stable condition

Frequency of lung cancer diagnosed bronchoscopically in a tertiary care chest facility

To evaluate various types of lung malignancies diagnosed through bronchoscopy, and their presentations. This descriptive study was based in a tertiary care chest facility in Peshawar. Duration of the study was from June 2005 - June 2009. The material was obtained from the bronchoscopy record in the chest clinic. All the patients bronchoscoped from June 2005 - June 2009 were studied for their outcome. This study included 425 patients, 306 [72%] were males and 235 [55.3%] of patients were between 31-60 years age. Ninety two [21.6%] patients were diagnosed with lung cancer; of which 73 [79.5%] patients were males and 19 [20.5%] were females. Sixty five [70.7%] of the 92 patients initially presented with shadow on the Chest radiograph, 9 [9.80%] patients had superior vena caval obstruction, 8 [8.70%] patients presented with lung collapse, 6 [6.52%] with haemoptysis, and 4 [4.35%] patients with hoarseness of voice. Forty three [46.7%] patients were diagnosed with squamous cell carcinoma, 29 [31.5%] with adenocarcinoma, 17 [18.5%] with small cell type carcinoma and 3 [3.30%] patients had large cell type carcinoma. Fifty four [58.7%] patients of the 92 were smokers or had a history of smoking, Anthracosis was found in 45 [10.6%] patients out of all the 425 patients. Commonest type of lung cancer in this study was squamous cell [46.7%] followed by adenocarcinoma [31.5%] and small cell carcinoma [18.5%]. Squamous cell carcinoma was strongly associated with cigerrete smoking as compared to adenocarcinoma in this study

CNS stimulant activity of Qurs saffron [a herbal medicine] in experimental animal models

To confirm the safety and efficacy of the product for human health due to its wide use and to explore its effects on CNS. Experimental and observational. This study was conducted at Frontier medical college Abbottabad Pakistan in March 2011. Thirty rabbits divided into five groups were administered Qurs saffron at the dose of 50, 100 and 200 mg/kg, Caffeine 100mg/kg orally and the last group was taken as control group, received normosaline. The animals were observed for behavioral changes at 30 min intervals. At 50mg/kg of the drug were found to have mild stimulant activity, while 100mg/kg were found to have a moderate CNS stimulant properties same like caffeine at a dose of 50mg/kg. While at a dose of 200mg/kg_Qurs saffron were found to have a strong stimulant properties. From the current study it can be concluded that the product have dose dependent CNS stimulant effects

Effect of preoperative dexamethasone on postoperative pain, emesis and haemorrhage in tonsillectomy by dissection method

To compare the effect of single preoperative intravenous dose of dexamethasone on postoperative morbidity that is pain, episodes of emesis, and hemorrhage in patients undergoing tonsillectomy by dissection method with those who do not receive dexamethasone. Randomized control type. ENT Department Combined Military Hospital Rawalpindi, from Feb 2006 to Feb 2007. After getting informed consent a total of 60 patients who fulfilled the probability sampling. Group A received 0.25 mg/kg body weight [maximum 20 mg] of dexamethasone intravenously 10 minutes before start of operation while group B [control group] did not receive any steroid. Pain control had significant difference in both groups with better control rates in group A. Similarly, emesis control was significantly better in group A. There was no significant difference in secondary haemorrhage in the two groups. Single dose of dexamethasone given preoperatively significantly reduces the postoperative morbidity that is pain, episodes of emesis with no effect on secondary hemorrhage in patients undergoind tonsillectomy by dissection method

Influence on visual deficit after transsphenoidal hypophysectomy for pituitary adenomas

Background: Transsphenoidal surgical exision of pituitary tumor in widely used route

Objective: To determine the effects on visual symptoms after transsphenoidal hypophysectomy for pituitary adenomas

Patients and Methods: This retrospective study was conducted in the department of neurosurgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar. All patients from January 2006 to January 2011, who underwent transsphenoidal surgery for pituitary adenomas, were included for visual deterioration

Results: During the five years time a total of 65 patients were operated for transsphenoidal adenomas. Four patients were excluded due to various reasons. There were 44 [72.13%] male and 17 [27.87%] female patients. The age ranged from 31 years to 62 years. The mean age was 44 years. There was improvement in visual symptoms in 39 [63.93%] patients immediately after surgery, 13 [21.31%] patients showed improvement in four weeks time, while there was no improvement in 9 [14.75%] patients

Conclusion: The improvement in visual symptoms occurs in majority of the patients after transsphenoidal hypophysectomy. There are several factors which influence the outcome, like duration and size of the lesion

Brachiobasilic fistula with anterior transposition, a workable solution in difficult clinical situations

This study was undertaken to assess the role of brachio-basilic fistulae with anterior transposition in patients with unsuitable veins for formation of conventional AV fistulae or after failure of multiple fistulae. Descriptive study. Armed Forces Institute of Urology and Military Hospital Rawalpindi, from November 2007 to October 2009. Patients of CKD with unsuitable veins for the formation of conventional AV fistula and those with failed Radiocephalic and Brachiocephalic fistulae in whom Brachio-basilic fistula was formed, were included in the study. Patients unfit for general anesthesia and those with upper arm Prosthetic grafts were excluded. The patients were interviewed, examined with particular attention to vascular access and a complete data about their hemodialysis and previous vascular access was collected. Transposed Brachio-basilic fistulae were created in 38 patients of End Stage Renal Disease [ESRD] during study period; out of which 1 patient was lost during followup and the rest 37 were followed prospectively. The median duration of follow-up was 13.56 months [SD +6.03] with a range of 3 to 23 months. In 92% of cases transposed Brachio-basilic fistula was created after failure of one or more conventional fistulae. Complications were noted in 16.2% cases which included primary failure, wound infection, arm swelling and distal ischemia as a result of steal phenomena [Table]. Three patients died during this period. Life of fistulae ranged from primary failure to as long as 23 months. Transposed brachio-basilic fistula is a viable option for patients who do not have suitable vasculature for formation of conventional fistula but especially for those after failure of fistulae at other sites

Hyperkalemia - frequency in a group of hypertensive diabetics

To evaluate the frequency of hyperkalemia in a cohort of hypertensive diabetic patients. A prospective analytical cohort study. The study was carried out in department of medicine [nephrology] Military Hospital [MH] and Armed Forces Institute of Urology [AFIU] Rawalpindi from Jun 2007 - Jun 2009. A total of 110 hypertensive, middle aged diabetic patients attending medical OPD in MH and AFIU. Rawalpindi were followed over two years from Jun 2007 - Jun 2009 for development of hyperkalemia and monitored for changes in eGFR, Serum Urea, creatinine and blood glucose random besides changes in blood pressure and ECG findings. SPSS version 13 was employed for statistical analysis. During the course of study 9 patients were lost to follow up. There were 7 deaths among study subjects before the end of study after about ten to twelve months. Out of the 94 patients followed up mean Serum Urea at the end of study was 13.50 mmol/l against a serum creatinine level of 2.26mmol/l and an estimated GFR of 21.08 ml/ min. The frequency of raised serum Potassium of 5.1-6.0 mmol/l was 46.08% and 26.59% of the patients had serum Potassium of 6.1-7.2 mmol/l at the end of study. This was against an initial level of 4.5-5.0 mmol/l in 100% of the study subjects. Paired sample t-test revealed significant changes in each variable studied but a borderline positive correlation of 0.619 was observed only between serum potassium and change in eGFR at the end of study. The mean blood glucose random dropped from 16.14 mmol/l to 10.41 mmol/l. at the end of study mean systolic BP was 122mm Hg and diastolic BP 80.2mm Hg. The ECG revealed tall T waves in 64.9% of cases while at the start of study all subjects had their electrocardiograms within normal limits. There was a trend of increase in frequency of tall T waves with the rise of serum potassium levels. Raised serum potassium is a significant potential complication among long standing diabetics with covert nephropathy treated with ACE inhibotrs, ARBs, potassium sparing diuretics or a combination of these drugs. Co morbidities and development of this complication must therefore be considered by physicians when dealing with such patients