Comparison of analgesic efficacy of Systemic Lignocaine combined with Dexamethasone and Lignocaine infusion

Objective: To determine the analgesic efficacy of lignocaine combined with dexamethasone and lignocaine infusion in patients with advance cancer disease

Study Design: Randomized controlled trial

Place and Duration of Study: Pain centre Combined Military Hospital Rawalpindi, from Apr 2016 to Nov 2016

Material and Methods: Total 122 patients, 61 in each group, fulfilling the inclusion criteria were included in this study after approval of the ethical committee. The technique used was non probability consecutive sampling. Two groups were made; group-A received Lignocaine 2mg/kg and group-B Lignocaine 2mg/kg with dexamethasone 0.15mg/kg in continuous infusion over 30 minutes. Both regimen were administered twice weekly for a period of 12 weeks as an outdoor procedure. Numerical rating scale used to measure severity of pain. Baseline and outcome parameters of all patients' i.e. severity of persistent and breakthrough pain and percentage relief of pain were recorded and compared at 12 weeks. Mean +/- standard deviations were calculated for quantitative variables, while qualitative variables presented in frequency and percentages. Chi-square test used for qualitative variables while Independent sample t-test used to compare means. A p-value <0.05 was considered statistically significant

Results: When results of group-B compared with group-A, there was a significant reduction in severity of persistent pain from 5.68 +/- 2.08 to 2.83 +/- 1.01 [p-value <0.05], breakthrough pain from 5.90 +/- 2.07 to 3.06 +/- 1.09 [p-value <0.05]. The percentage relief of pain was 45.08 +/- 15.01 [ percent] when compared to baseline i.e. 23.35 +/- 8.55 [ percent] [p-value <0.05]

Conclusion: Lignocaine with dexamethasone has shown to be effective in reducing complex cancer related pain and disability when compared with Lignocaine alone

Comparison of analgesic efficacy of intra-articular and peri-articular sacro-iliac joint injection in patients with sacro-iliac joint pain syndrome

Objective: To compare the analgesic efficacy of intra-articular vs peri-articular sacroiliac joint [SIJ] injection in patients with sacroiliac joint pain syndrome. Study Design: Prospective, randomized control trial. Place and Duration of study: The study was conducted at the department of Pain Medicine, Combined Military Hospital [CMH] Rawalpindi, from Jul 2015 to Jun 2016

Material and Methods: Forty eight patients of sacroiliac joint [SIJ] pain syndrome were randomly assigned into two equal groups. Group A [n=24] received intra articular SIJ injection of local anesthetic with steroid [Triamcinol one 40mg] under fluoroscopic guidance [drug volume 2.5] and group B [n=24] received Periarticular SIJ injection of local anesthetic with steroid [Triamcinolone 40mg] using land mark technique [drug volume 10ml]. Pain score was assessed at 0 [Preprocedural baseline], 4, 8, and 12 week intervals after intervention by using numerical rating scale [NRS]

Results: Mean NRS pain score of group A was 7.5 +/- 0.99 and 3.1 +/- 1.6 at 0 and 12 week respectively. Mean NRS pain score of group B was 7 +/- 1.10 and 5.55 +/- 1.0 at 0 and 12 week respectively. A p-value <0.05 at 12 week between group A vs group B. There was a reduction in mean pain score from baseline to 12 week in both the groups but this reduction in mean pain score was statistically significant in group A as compared to group B

Conclusion: Pain relief score was found to be statistically significant in fluoroscopic guided intra-articular technique as compared to peri-articular landmark technique for sacroiliac joint pain syndrome at 12 weeks post procedure

Peri-anal surgery under saddle block anaesthesia comparing three different doses of hyperbaric 0.75% bupivacaine

Objective: To compare three doses of hyperbaric 0.75% bupivacaine and measuring time for home readiness after day care perianal surgery under saddle block anaesthesia

Study Design: Non randomized controlled trial

Place and Duration of Study: The study was conducted at the department of Anaesthesia, CMH Rawalpindi from Jun 2014 to Apr 2015

Material and Methods: In this study 90 patients who presented for perianal day care surgery, were divided in three equal groups. Group A received 7.5 mg, group B 6.0 mg and group C 4.5 mg of hyperbaric 0.75% bupivacaine. Intrathecal injection was given in L4-5 space by 25 G spinal needle in sitting position. Lithotomy position was made after five minutes. After surgery patients were monitored in recovery room. After fulfilling ambulatory and discharge criteria patients were allowed to go home with attendants. Time of intrathecal injection, assessment of above criteria and time of discharge were noted and analyzed

Results: Male patients were 85.6% and females were 14.4%. Mean time of surgery was 48 +/- 10.59 min. Mean time of discharge in minutes for group A was 235.86 +/- 49.38, for group B 217.7 +/- 42.49 and for group C 205.76 +/- 32

Time of discharge was significantly different between group A and group C [p=0.02]

While it was not significantly different between group A and group B [p=0.29] and between group B and group C [p=0.819]

Conclusion: Lower dose of hyperbaric bupivacaine can reduce the time for home readiness compared to higher dose. Time of discharge is mainly dependent on time to micturate after saddle block anaesthesia

Unilateral spinal anesthesia for major lower limb surgery in patients with cardiac failure

Objective: To determine the safety of unilateral spinal anesthesia in elderly patients with cardiac failure undergoing major lower limb surgery

Study Design: Prospective, quasi- experimental study

Place and Duration of Study: Department of Anesthesiology, Combined Military Hospital Rawalpindi, during the period of October 2012 to December 2013

Material and Methods: In this study, 20, American Society of Anesthesiologists [ASA] III and IV patients with different severities of heart failure due to previous myocardial infarction [MI], aged between 60-110 years undergoing unilateral lower limb orthopaedic surgery were included by non probability consecutive sampling. All patients received unilateral spinal anesthesia using hyperbaric 0.75% Bupivacaine 7.5mg. They were given preload of 2ml/kg colloid. Patients were placed in the lateral position with fractured limb on lower side and kept in this position for 10 minutes. Haemodynamic variations were monitored and recorded for the whole duration of procedure. Dobutamine, Ephedrine and Atropine were used as vasopressor/inotropic agents

Result: In this study 20 patients were included. Sixteen [80%] were male. Mean age of group was 80.8 +/- 12.5 years. The mean duration of surgery in our patients was 63.55 +/- 16.47 minutes. Ephedrine was needed in 12 patients, atropine in 4 patients. One patient required Dobutamin infusion and one patient required norepinephrine infusion for 15 minutes. Two patients did not require inotropic or vasopressor support. The average percent fall in mean arterial pressure from prespinal value was 20.59%. The block remained unilateralin all cases. Motor blockade was adequate in the limb to be operated

Conclusion: Unilateral subarachnoid block with hyperbaric bupivacaine does not produce adverse hemodynamic changes. Under controlled setting and meticulous monitoring elderly patients with variable degree of heart failure can be safely given unilateral spinal anesthesia for major lower limb orthopaedic surgery. Unilateral subarachnoid block with hyperbaric bupivacaine does not produce adverse hemodynamic changes. Under controlled setting and meticulous monitoring elderly patients with variable degree of heart failure can be safely given unilateral spinal anesthesia for major lower limb orthopaedic surgery

Survival of a malignant hyperthermia patient

Malignant hyperthermia is an inherited autosomal life threatening skeletal muscle disorder usually triggered by certain general anesthetic drugs like volatile anesthetics and depolarizing muscle relaxants [succinylcholine]. Only early recognition and prompt accurate treatment can save life in an otherwise fatal situation. We present a case of a young boy in whom malignant hyperthermia was recognized within 10 minutes of induction of anesthesia and life was saved by prompt treatment even in the absence of dantrolene

Increased concentration of circulating visfatin associates with post-challenged hyperglycaemia and insulin resistance in IGT subjects

Objectives: The cytokine visfatin is increased in obesity and type 2 Diabetes; however, its role in the development of diabetes is still unsettled. The present study aimed to investigate the serum visfatin levels in prediabetic subjects

Methods: Seventeen subjects with Impaired Fasting Glucose [IFG], 44 Impaired Glucose Tolerant [IGT], 16 IFG-IGT and 51 healthy subjects were recruited. Fasting insulin and visfatin were measured using enzyme-linked immunosorbent assay [ELISA] techniques. The Insulin sensitivity Homeostasis Model Assessment [HOMA%S] and B-cell secretory capacity [HOMA%B] were estimated using HOMA-CIGMA software

Results: HOMA%B was significantly lower in IFG [p = 0.0001] and IFG-IGT [p = 0.001] subjects. HOMA%S in IGT [p = 0.0001] and IFG-IGT [p = 0.001] subjects were significantly lower compared to controls. The fasting serum visfatin [ng/ml] level was significantly higher in IFG [5.08 +/- 2.16, p = 0.0001], IGT [4.75 +/- 2.81, p = 0.0001] and IFG-IGT subjects [4.33 +/- 2.68, p = 0.013] compared to controls [2.60 +/- 1.2]. In binary logistic regression analysis, visfatin has found significantly associated with IFG [B = 0.198, p = 0.040], IGT [B = 0.162, p = 0.043] and IFG-IGT [B = 0.188, p = 0.044]. Visfatin was also found significantly correlated with postprandial serum glucose and blood pressure in IGT subjects. Frequency of IFG, IGT and IFG-IGT subjects increased with increasing visfatin concentrations

Conclusions: Serum visfatin appear to be associated with IFG, IGT and IFG-IGT. Postprandial serum glucose and blood pressure are positively associated with visfatin levels in IGT subjects

Post operative nausea and vomiting [ponv]: comparison of timing of administration of antiemetics in prolong surgeries

The objective of this study was to compare the timing of administration of Ondansetron and Dexamethasone in terms of prevention of postoperative nausea and vomiting when given at induction verses thirty minutes before the end of prolong surgeries. Randomized control trial. The study was conducted in Main Operation Theatre of Combined Military Hospital Rawalpindi over a period of six months from 17 Apr 2009 to 16 Oct 2009. Cases were selected from OPDs, emergency and also by referral. Total 120 patients were included in this study [60 patients in each group] Group A patients received Ondansetron 4 milligrams and Dexamethasone 8 milligrams intravenous at induction and group B patients received Ondansetron 4 milligrams and Dexamethasone 8 milligrams thirty minutes before reversal of neuromuscular blockade at the end of surgery. Mean age was observed 41.7 +/- 3.7 and 39.9 +/- 1.9 in group-A and B, respectively. Comparison of pre-induction and 30 minutes before end of surgery at 0-6 hours reveal nausea and vomiting in 11 [18.3%] in group-A and in 3 [5.0%] patients of group-B. Results were statistically significant [p=0.022]. At 7-12 hours results were also statistically significant when comparison was made between group-A and B [p=0.051], while at 13-24 hours difference between two groups was statistically non-significant [p=0.314]. It is therefore established that administering a combination of Inj. Ondansetron 4mg with Inj. Dexamethasone 8mg, was more efficacious in reducing post-operative nausea and vomiting at 0-6 hours when administered 30 minutes before the completion of surgery

Serum vaspin levels are associated with decreased insulin sensitivity in newly diagnosed type 2 diabetes mellitus in Bangladesh

The present study aimed to explore the relationship of circulating vaspin levels with insulin sensitivity and anthropometric factors. This study was conducted with 65 newly diagnosed type 2 diabetes mellitus [T2DM] patients with age-matched 65 healthy controls. Serum glucose was measured using glucose-oxidase method, lipid profiles by enzymatic end-point methods, and fasting insulin and vaspin levels were assessed with ELISA techniques. Homeostasis model assessment for insulin sensitivity [HOMA%S] and insulin secretory capacity [HOMA%B] were estimated from the fasting glucose and insulin levels using HOMA-CIGMA software. Fasting serum insulin [micro U/ml] was higher in the diabetic group than controls [16.0 +/- 7.9 vs. 10.9 +/- 3.3, respectively, p=0.0001]. The mean [ +/- SD] HOMA%S of the diabetics was significantly lower than that of the controls [48 +/- 31 vs. 76 +/- 55, respectively, p = 0.001]. The HOMA%B of the T2DM group was nearly 50% of that of the controls [71 +/- 40 vs. 131 +/- 46, respectively, p = 0.001]. The T2DM group exhibited significantly lower serum vaspin [ng/ml] levels than the controls [0.62 +/- 0.26 vs. 0.83 +/- 0.28, respectively, p = 0.001]. Vaspin levels were negatively correlated with waist circumference [r = 0.17, p = 0.043] and positively correlated with HOMA%S [r = 0.243, p = 0.007] among all of the participants. The association of serum vaspin with diabetes remained highly significant [p = 0.008] in binary logistic regression analysis performed after adjusting for the effects of confounders. Serum vaspin level is positively associated with insulin sensitivity and negatively correlated with serum glucose, BMI and waist-height ratio

ringing bells: perspective of Karachiites regarding noise pollution

To identify the awareness regarding noise pollution and its adverse effects on human health in the people of urban areas of Karachi. Cross-sectional survey. Urban areas of Karachi, from September to October 2012. A survey was conducted with 50 selected subjects of urban areas of Karachi with their informed consent. The questionnaire covered aspects of noise pollution. Descriptive analysis was done with percent responses. All [100%, n=50] subjects admitted to be suffering from noise pollution. The source of noise pollution was vehicles in 64% [n=32]. There was 90% [n=45] agreement for laws and regulations regarding noise pollution to be in place. Awareness sessions need to be conducted for the public regarding the effects of noise pollution on health with formulation of laws and regulations

Association of serum free IGF-1 and IGFBP-1 with insulin sensitivity and insulin secretory defects in Bangladeshi type 2 diabetes mellitus

Serum free insulin like growth factors-1 [IGF-1] and insulin like growth factor binding protein-1 [IGFBP-1] may have an association with insulin resistance and B-cell secretory dysfunction. Present study is undertaken to explore the independent association of IGF-1 and IGFBP-1with two basic defects in type 2 diabetic patients in a Bangladeshi population. Sixty eight type 2 diabetes mellitus [DM] subjects are studied along with age-, sex- and BMI-matched 61 healthy controls without family history of diabetes or prediabetes. Insulin, free IGF-1 and IGFBP-1 are measured by the standard ELISA method. Insulin secretory capacity [HOMA B] and insulin sensitivity [HOMA S] are calculated using fasting glucose and fasting insulin by HOMA-CIGMA software. Fasting free IGF-1 and IGFBP-1 levels are not significantly different between the study groups. But the level of free IGF-1 is significantly higher [p = 0.03] in type 2 DM subjects compared to controls in the low BMI group [BMI

Tracheal intubation; direct laryngoscopic oral intubation vs fiberoptic bronchoscopic nasal intubation haemodynamic response

Haemodynamic response to direct laryngoscopy and tracheal intubation has always been concern especially in cardiac patients. The use of fiberoptic bronchoscope for endotracheal tube placement may reduce the haemodynamic changes associated with intubation. To compare haemodynamic changes [pulse and mean arterial pressure] following tracheal intubation, using direct laryngoscopic technique with fiberoptic bronchoscopic technique. Randomized Controlled Trial [RCT]. Department of Anaesthesiology, Intensive Care and Pain management Military hospital Rawalpindi. The study was of six months duration starting from April 2008 to October 2008. ASA-I and II patients [n=160] undergoing surgery meeting the inclusion and exclusion criteria.Informed consent was taken from all the patients undergoing the study. Patients were divided in two groups. Patients assigned to Group A got endotracheal intubation through direct laryngoscopic technique and Group B through fiberoptic bronchoscopic technique after induction of general anaesthesia. Pulse and Mean arterial pressure were recorded before induction of anaesthesia and three minutes after the intubation. One hundred and sixty patients were studied. Eighty patients intubated through direct laryngoscopy [Group A] and eighty patients intubated through fiberoptic bronchoscope and it was observed that fiberoptic bronchoscopic intubation is haemodynamically safer as compared to conventional laryngoscopic intubation. The study concluded that bronchoscopic intubation provides better haemodynamic stability than direct laryngoscopic intubation

Pattern of intestinal obstruction in children - a review of 200 consecutive cases

To identify the various causes of intestinal obstruction in children. Retrospective study. Department of Paediatric Surgery, Allied Hospital, Faisalabad from July 1995 to June 2009. The record of all children, between the age of 1 to 14 years, who presented with intestinal obstruction during the study period was reviewed. Two hundred children presented with intestinal obstruction. It was not an uncommon cause for admission from the emergency department [12.1%] and constituted 7.4% of the children operated in the unit. They were predominantly males [75%]. Average duration of symptoms was 3 days. The commonest causes were adhesions [31%], Meckel's diverticulum with band [15.5%], volvulus [12%] and incarcerated inguinal hernia [11.5%]. Wound infection [11%] and wound dehiscence [4%] were the common complications. Mortality rate was 2.5%. Intestinal obstruction is seen not infrequently in children and is associated with significant morbidity. Adhesions especially post operative have emerged as a leading cause. Early recognition and prompt treatment are needed

Pancytopenia: megaloblastic anemia is still the commonest cause

To find out the frequency of the different causes of Pancytopenia and also to specifically detect the percentage of vitamin B12 deficieny amongst these patients. It is a prospective study carried out in Medical Unit I [Ward 5] of Jinnah Postgraduate Medical Centre Karachi from March to August 2007. A total of 88 patients were included after a detailed history and examinations the information was recorded on Proforma. Findings of aspiration and trephine biopsies were interpreted in the light of history, clinical examination and peripheral blood findings. Out of 88 patients suffering from Pancytopenia, a large number [40.90%] were diagnosed as Megaloblastic Anemia, out of which 77.77% had vitamin B12 deficiency. Aplastic anemia was found in 28 [31.88%] patients followed by other less common causes. Megaloblastic anemia was found in largest number of patients who were found to have Pancytopenia on initial investigations and majority of such patients were found to be deficient in Vitamin B

Malarial hepatopathy in falciparum malaria

To evaluate the clinical, biochemical and sonographic changes in patients with falciparum malaria and jaundice. A case series. This study was conducted at Medical Unit-1 [Ward 5], Jinnah Postgraduate Medical Centre, Karachi, from January 2006 to November 2007. A total of 62 adult patients, regardless of age and gender, with peripheral blood film evidence of falciparum malaria, who had jaundice, were included. Any patient with evidence of infection with Plasmodium vivax or other causes of liver disease [e.g. viral hepatitis, cirrhosis, portal hypertension, amoebic liver abscess, unexplained hepatomegaly, ascites, history of alcoholism, taking hepatotoxic drugs, past history of jaundice] was excluded on the basis of history, relevant clinical examination and investigations. Age of the patients ranged from 13-48 years [mean 26.04 +/- 8.33]. All patients were febrile and icteric, with pallor in 67.7%, hepatomegaly in 30.6%, splenomegaly in 70.9% and impaired consciousness in 20%. Serum bilirubin levels ranged from 3 to 24 mg%. Thirty two [51.6%] had serum bilirubin 3-6 mg%, 20 [32.2%] had 6-10 mg% and 10 [16.1%] had >10 mg%. ALT levels ranged from 20-870 IU/L and AST levels 24-1210 IU/L respectively. INR ranged from 1-1.3. Twenty eight patients [45%] had predominantly conjugated or mixed hyperbilirubinemia and serum transaminases were more than three times normal. Ultrasonography revealed hepatomegaly with decreased echogenicity in 22 [35.4%], splenomegaly in 48 [77.4%] and both hepatomegaly and splenomegaly in 16 [25.8%]. Gallbladder wall thickness was increased in 5 [8.06%] patients. There was no evidence of biliary dilatation. A significant percentage of patients having falciparum malaria with jaundice fulfill the criteria for malarial hepatopathy. It should be considered in patients presenting with acute febrile illness with jaundice so that specific treatment can be given

Pericardial cyst: a rare congenital anomaly

Pericardial cyst is an uncommon congenital abnormality that can occur in the middle mediastinum. The clinical presentation is variable and can range from asymptomatic patients in whom the diagnosis is incidental to those cases with complaints such as pain or heaviness in chest, difficulty in breathing or cough. These cysts can lead to cardio-pulmonary complications such right main stem bronchus obstruction, ventricular outflow obstruction, pulmonary artery stenosis, arrhythmias or cardiac temponade which can prove fatal. Due to the variable nature of patients' complaints and grave complications associated with pericardial cyst, a detailed work-up is necessary to reach a diagnosis. We present this case in a middle-aged man who presented with feeling of heaviness in chest. He underwent thorough work-up in order to detect a pericardial cyst

Nutritional iron deficiency in women of child bearing age- what to do?

Iron deficiency is the most common aetiology of anaemia worldwide and has several risk factors. Although iron deficiency anaemia [IDA] can occur at any age, women from reproductive age group are particularly vulnerable to develop IDA due to increased nutritional demand during pregnancy. Objective was to determine the frequency and nutritional risk factor of iron deficiency anaemia in women of child bearing age. This descriptive, cross sectional study was conducted from October 2005 to March 2006 at the Department of Medicine, Ward-5, and out-patients department of Jinnah Postgraduate Medical Centre, Karachi. Two hundred non-pregnant females of child bearing age were included in the study; 100 with no previous pregnancy and remaining 100 with at least one prior history of pregnancy. All the relevant information, i.e., demographic and socioeconomic was collected through a questionnaire. Two hundred patients with signs and symptoms of anaemia were recruited. Out of them 89 patients were found to be having iron deficiency anaemia in various age groups. Results also showed that dietary habit of patients was one of the causative factors leading to iron deficiency anaemia. To overcome iron deficiency anaemia a thorough and comprehensive strategy is required, i.e., educating the subjects to consume food rich in iron, community based program, monitoring severely anaemic cases and their treatment

Comparative efficacy of intravenous methylprednisolone versus intravenous hydrocortisone in acute severe asthma

To compare the efficacy of intravenous methylprednisolone versus intravenous hydrocortisone in acute severe asthma It was a quasi-experimental interventional study, conducted on 60 patients of acute severe asthma, presenting to the emergency department of MH Rawalpindi. Military Hospital Rawalpindi from Jan 2001 to Dec 2002. Patients fulfilling the criteria were divided into two groups of 30 patients each by convenience sampling. Group-I received intravenous methylprednisolone sodium succinate 125 mg as a single dose within half an hour of admission while group-2 received intravenous hydrocortisone 200 mg bolus followed by three doses of 100mg at six hours interval for next 24 hours. In addition, both the groups received nebulized salbutamol 2.5 mg diluted with 5 ml of distilled water at an interval of 30 minutes for first hour then 4 hourly along with oxygen at a rate 4-5 liters /minutes. Pulse rate and peak expiratory flow rate [PEFR: best of three attempts] were recorded on admission and subsequently at interval of six, twelve, eighteen and twenty-four hours of admission. Significant improvement in pulse rate was defined as its fall below 100 per minute and that of PEFR as its rise above 65% of predicted. Out of sixty patients, 41 were males and 19 were females. Their mean age was 38 years [range 19-50 years]. Significant improvements in pulse rate and PEFR were noted at interval of 24 hours in both groups, and this improvement was more marked in gropu-2. Target reduction [< 100/minute] in mean pulse rate was seen in 70% of patients in group-2 versus 26.7% in group-1. Target mean PEFR [> 65% of predicted] was achieved in 86.7% [group-2] and 40% [group-1]. The differences of mean pulse rate and PEFR at 24 hours were statistically significant. Intravenous hydrocortisone is more effective than intravenous methylprednisolone, at the dosages selected, in setting of acute severe asthma

experience of percutaneous tracheostomy in twenty obesity patients with short neck in a tertiary care hospital in Pakistan

To evaluate the success rate, procedure time and per-operative complications of percutaneous dilational tracheostomy in obese patients with short neck. Case series, descriptive study. Military Hospital Rawalpindi, from Jan 2006 to July 2007. Twenty obese patients with short neck were referred from intensive care unit [ICU] to operation theatre for open surgical tracheostomy [ST]. Before doing open procedure, all the patients were reassessed and an attempt was made by a team of experienced ENT surgeon and anaesthetist, to do percutaneous dilational tracheostomy [PDT] as first option. The success rate, procedure time and per-operative complications were noted. Data was collected over a period of one and half year. Twenty patients [12 F and 8 M], mean age 53 [34-80] years, mean body mass index [BMI=40] [34-45] were studied. The successful PDT was performed in 18 patients and in two patients procedure was converted to open surgical tracheostomy. Average time taken was 15 min. per-operative complications noted were, false passage, bleeding and leakage of air due to cuff puncture. In obese patients with short neck, if percutaneous dilational tracheostomy is performed by an experienced operator, in operation theatre [OT] with full preparation, good light and proper positioning, the procedure can be performed with in 15 min, the success rate is high with little complications

clinical study of papular urticaria

To determine the clinical features and demographic profile of the patients having papular urticaria. A case-series. Dermatology Department of Combined Military Hospital, Abbottabad from January to December 2006. Individuals of all age groups and either gender either suspected of or having definite history of insect bite were included in the study. A specially-designed proforma was filled for each patient separately. The proforma included demographic features, information regarding clothing and sleeping habits, personal or family history of atopy and clinical patterns of the lesions. Computer programme SPSS 10 was used to manage and analyze the data. Out of 280 patients, 201 [71.8%] were children upto 12 years of age, 178 [63.6%] were males, 91[32.5%] had atopy, 194 [69.3%] were non-locals, 212 [75.7%] came from urban/pen-urban areas and 173 [61.8%] presented during May-August. Lesions were present over exposed parts of the body in 36 [12.9%], arranged in groups in 152 [54.3%] and were papular urticaria in 185 [66.1%] patients. Children, adult males, non-locals and those belonging to urban/peri-urban areas are more vulnerable to papular urticaria in a particular region. Papular and urticarial lesions arranged in groups over both exposed as well as covered body parts of a single patient is the most common clinical pattern

Microbiology of Chronic suppurative otitis media - experience at Bahawalpur

To determine the aerobic microorganisms involved and their antibiotic sensitivity pattern in patients with chronic suppurative otitis media [CSOM] to provide a guideline for making a protocol for empirical antibiotic therapy. Descriptive study. The study was conducted from Sept 2005 to April 2007 at the department of ENT and Microbiology, Combined Military hospital Bahawalpur. A total of 178 patients with unilateral or bilateral active chronic suppurative otitis media attending the outpatient clinic were included in the study. All the patients were evaluated through detailed clinical history and clinical examination. Pus samples were collected from the discharging ear[s] and sent to microbiology section of hospital laboratory where aerobic cultures were done. Antibiotic sensitivity testing was done with standard antibiotic discs using Kirby-Bauer disk diffusion method as per National Committee for Clinical Laboratory Standards recommendations. From the clinical specimens of 178 patients enrolled in the study, microbiological culture was yielded from 130 [73%] specimens. There were 116, [89%] bacterial isolates and 14, [11%] fungi. Pseudomonas aeruginosa 58 [45%] was the most common isolate, followed by Staphylococcus aureus 52 [40%] including two isolates of Methicilliresistent Staphylococcus Aureus [MRSA]. Antibiotic sensitivities of Pseudomonas aeruginosa showed that 100% isolates were sensitive to Piperacillin/Tazobactam, where as 86% isolates were sensitive to ceftazidime and 83% to ciprofloxacin. Only 45% of Pseudomonas aeruginosa isolates were sensitive to gentamicin and 48% to amikacin. For Staphylococcus aureus [other than MRSA], 100% isolates were sensitive to cloxacillin, 80% to ciprofloxacin and 68% to gentamicin. Only 60% isolates were sensitive to chloramphenicol and 32% to cotrimoxazole. Pseudomonas aeruginosa was the most common isolate followed by Staphylococcus aureus. More than 80% of the two organisms were sensitive to quinolones. It is therefore concluded that the topical preparation of quinolones should be included in the formulary to cover the most common aerobic isolates involved in CSOM