Audit of various otorhinolaryngological diseases in Shangla valley

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

Comparison of chemical cautery versus topical vasoconstrictors in idiopathic pediatric anterior epistaxis

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

Knowledge, attitudes and practices of lady health workers regarding family planning program in tehsil muzaffargarh

Objective: To assess the knowledge, attitudes and practices of lady health workers [LHWs] regarding implementation of family planning program in Tehsil MuzaffarGarh

Study Design: Cross sectional study

Place and Duration of Study: It was carried out from December 2015 to May 2016 involving Lady Health Workers from 10 union councils of Tehsil Muzaffar Garh including both urban and rural areas

Material and Methods: The data were collected by interviewing 307 LHWs using a structured closed ended questionnaire

The data were entered and analyzed through SPSS version 22

Results: Lady health workers [LHWs] demonstrated a good knowledge ranging from 78% to 99% of different aspects of family planning. They were poorly informed regarding pregnancy complications, breast feeding and infertility. Almost all of them 305 [99%] showed positive attitude regarding job, trainings, compatibility of family planning with religion, although were unsatisfied with their salaries and monetary incentives

Conclusions: LHWs have a good knowledge and positive attitude towards family planning except knowledge about infertility, pregnancy complications and breast feeding. Family planning practices are difficult in rural areas because of low literacy rate and dominance of mothers in law, which needs attention

Polio immunization and awareness: a cross sectional study in shangla and swat districts,pakistan

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

Effect of military deployment in operational area on the trend of smoking among troops

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

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

Knowledge, awareness and practices of harmful effects of anabolic steroids among body builders in Rawalpindi and Islamabad

To determine the knowledge, awareness and practices of anabolic steroids amongst body builders of Rawalpindi and Islamabad. Cross sectional study. The study was conducted in various gyms and fitness centers in Rawalpindi and Islamabad from November 2013 to May 2014. A structured close ended questionnaire was filled from the body builders in various Gyms/fitness centers after taking informed consent. A total of 310 male body builders between age group of 15-35 years were interviewed by non-probability convenience sampling technique. Standard descriptive and analytical statistics were used to analyze the data. Data analysis was done including variables like age, education, legality, motivation, workout, side effects and withdrawal symptoms of steroids. Chi-square test was used to ascertain the association between categorical variables, 95% confidence intervals [95% CI] and p value less than 0.05 was considered significant. A total of 310 male adolescents were surveyed, 64% reported past or present use of anabolic steroids. Mean [SD] age of the body builders was 24.7 [+ 3] years and most [84%] of them were educated. More than 72% of all the body builders had the knowledge that the steroids are harmful for their health. About the side effects of steroid use, 37% knew about ham loss, acne 21%, aggression/hypertension 14%, and sterility/infertility 15%. Bodybuilders who were aware that steroid use is illegal was 62% but still they were using them [p<0.001] The withdrawal symptoms of steroids were not known to 64% bodybuilders [p<0.001]. Trainers and friends seemed to be the main motivationa2 forces [p<0.008] .Bodybuilders taking steroids were satisfied using them [p<0.000]. It was interesting to note that the bodybuilders who were themselves hooked onto steroids were not willing to recommend others to use them [p<0.001]. Mood swings were seen majority [61%] of bodybuilders. about 17% of the non-users of steroids were planning to start it in future. Steroids in the injectable from were used by 83% of the bodybuilders. Use of steroids in bodybuilders is rising and a large number of body builders are using anabolic steroids without proper knowledge of the adverse effects and withdrawal symptoms of steroids. People being aware that steroids are illegal, continue using them Trainers, peer pressure are main motivators for steroid use. Most of the body builders who are taking steroids seem pleased with its effect on the body. In addition, our study showed that there were unregulated sources of steroids in Rawalpindi and Islamabad from where the majority of the participants can have easy access, Media and health care professionals can play a vital role in the dissemination of knowledge

Are We Aware of Dengue Fever? A Community Based KAP Survey on Dengue Fever in Rawalpindi

To assess the knowledge, attitude and practices regarding dengue fever and its prevention in Rawalpindi. A Cross Sectional Survey. Community of Rawalpindi, from July to Sept. 2012. A total of 215 participants were selected through consecutive sampling echnique. A structured questionnaire was self administered after informed consent was obtained from all the participants. Knowledge of dengue was measured by asking questions related to disease symptoms and preventive measures. Association between knowledge and awareness at p<0.05 was accepted as significant. It was found that the knowledge of the community regarding Dengue fever was adequate [91%]. The respondents' awareness about preventive measures for dengue was also satisfactory [88%]. A significant association found between knowledge and awareness of dengue fever and preventive measures [P= 0.01]. Mass media was identified as an effective tool in raising awareness. However; adequate knowledge about prevention did not reflect in community practices [P=0.031]; factors identified responsible for it, were like water storage for domestic use due to water shortage and excessive load shedding. Local community is well aware about dengue fever and its prevention; however it was found that good knowledge doesn't necessarily lead to good practice. Health educational campaigns should be designed to improve behavior and practices of prevention and control measures against dengue fever

Vitamin d deficiency in patients with tuberculosis

To determine the frequency and association of Vitamin D deficiency in patients with tuberculosis. Case control study. Medical Department, Combined Military Hospital, Kharian, from July 2010 to June 2012. One hundred and five outdoor patients of tuberculosis were selected with 255 gender matched controls. Tuberculosis was diagnosed by presence of acid fast bacilli in sputum smears, positive culture for Mycobacterium tuberculosis or demonstration of chronic caseating granulomatous inflammation in tissue specimens. Controls were drawn randomly from general population. Serum 25 hydroxyvitamin D [25 [OH] D3] levels < 25 ng/ml was considered Vitamin D deficiency. The results were analyzed on SPSS version 17. Mean Vitamin D levels were 23.23 +/- 6.81 ng/ml in cases, 29.27 +/- 8.89 ng/ml in controls [p < 0.0001]. Vitamin D deficiency was found in 57% of cases and 33% controls [p < 0.0001]. Mean Vitamin D levels were significantly lower in females with tuberculosis [20.84 ng/ml] as compared to males [25.03 ng/ml, p = 0.002]. Mean BMI in patients of tuberculosis with Vitamin D deficiency were 19.51 +/- 1.77 kg/m2 and in patients with normal Vitamin D were 21.65 +/- 1.79 kg/m2 [p < 0.0001]. Mean Vitamin D levels in patients with multi-drug resistant tuberculosis was lower to a mean of 15.41 +/- 4.67 ng/ml [p < 0.0001]. There is significant deficiency of Vitamin D in patients with tuberculosis as compared to controls. This deficiency is more pronounced in females, individuals with low BMI, extra pulmonary and MDR tuberculosis.