Frequency of three complications [bleeding, laceration of external auditory canal and perforation of tympanic membrane] in patients with aural foreign bodies

To determine the frequency of three major complications of the foreign body in the external auditory canal i.e. the haemorrhage, the laceration and the perforation of the tympanic membrane. Cross sectional study. This study was conducted in the Department of ENT, Bahawal Victoria Hospital, Bahawalpur from 25-12-2012 to 24-09-2013. Total 284 cases that presented during nine months of duration were included in our study. General anaesthesia was used not only when initial attempt under direct visualization was unsuccessful, but also for those having history of previous attempts, and uncooperative patients. 25% of patients developed haemorrhage, 13.8% were having laceration while none of the patient presented with tympanic membrane perforation. Cotton bud was found to be the commonest foreign body [33.7%] and bleeding was associated with it. In this study, the cotton bud was found to be the commonest foreign body in external auditory canal. Use of cotton bud although is easy for cleaning of ears but if it is broken inside the external auditory canal, can cause serious complications like bleeding and laceration as found in this study. Public should be educated about this preventable medical emergency

Trauma research in Qatar: a literature review and discussion of progress after establishment of a trauma research centre

A structured research programme is one of the main pillars of a trauma care system. Despite the high rate of injury-related mortalities, especially road traffic accidents, in Qatar, little consideration has been given to research in trauma. This review aimed to analyse research publications on the subject of trauma published from Qatar and to discuss the progress of clinical research in Qatar and the Gulf Cooperation Council countries with special emphasis on trauma research. A literature search using PubMed and Google Scholar search engines located 757 English-language articles within the fields of internal medicine, surgery and trauma originating from Qatar between the years 1993 and 2013. A steep increase in the number of trauma publications since 2010 could be linked to the setting up of a trauma research centre in Qatar in 2011. We believe that establishing a research unit has made a major impact on research productivity, which ultimately benefits health care.

Tonsillectomy under local anesthesia: is it safe, feasible and practicable?

Background: Tonsillectomy is one of the most common ENT surgeries

Objective: The study was done to evaluate the feasibility of tonsillectomy under local anesthesia

Subjects and Methods: A total number of 80 consecutive patients whose tonsillectomy was performed under local anesthesia with systemic analgesic injections were included in this cross- sectional study. Peroperative difficulties and problems were noted. Similarly in post-operative period, the rate of complications was noted to conclude upon the feasibility of tonsillectomy under local anaesthesia

Results: A total of 80 patients were included in this study, with 36 females. Following complications were noted, Trismus [5%], difficult dissection [10%], primary hemorrhage [3.7%], reactionary hemorrhage [2.5%] and throat pain [10%]

Conclusion: We concluded that the procedure is safe, feasible and practicable but should be done with certain precautionsi

Infectious diseases in the aftermath of monsoon flooding in Pakistan

Pakistan is ranked 9th in terms of flood-affected countries worldwide. In the summer of 2010, the northern province of Khyber-Pakhtunkhwa received more than 312 mm of rain in a 56 hour period. This resulted in over 1 600 deaths across the region. In addition, over 14 million people were directly affected by this record-breaking deluge. Flood affected regions serve as ideal breeding grounds for pathogens, leading to the spread of diseases. The poor standards of hygiene in camps set up for individuals displaced by the floods also contribute to this. It is essential that those involved in relief efforts are aware of the epidemiology of diseases that have historically seen a sudden upsurge after natural disasters. Keeping this in mind, we conducted a simple review of literature. An extensive literature search was conducted using the PubMed data base and online search engines. Articles published in the last 20 years were considered along with some historical articles where a background was required. Seven major diseases were identified to increase substantially in the aftermath of natural disasters. They were then classified into acute and sub-acute settings. Diarrhea, skin & eye infections and leptospirosis were identified in the acute setting while malaria, leishmaniasis, respiratory infections and hepatitis were identified in the sub-acute setting.

A case of cellulitis of the hands caused by a predatory bird attack

Many species have been drastically affected by rapid urbanization. Harris's hawks from their natural habitat of open spaces and a supply of rodents, lizards and other small prey have been forced to change their natural environment adapting to living in open spaces in sub- and peri-urban areas. Specific areas include playgrounds, parks and school courtyards. The migration of this predatory species into these areas poses a risk to individuals, and especially the children are often attacked by claws, talons and beaks intentionally or as collateral damage while attacking rodent prey. In addition, the diverse micro-organisms harbored in the beaks and talons can result in wound infections, presenting a challenge to clinical management. Here we would like to present a case of an 80-year-old man with cellulitis of both hands after sustaining minor injuries from the talons of a Harris's hawk and review the management options. We would also like to draw attention to the matter that, even though previously a rarity, more cases of injuries caused by birds of prey may be seen in hospital settings.

Comparative study of different samples of Unani preparation Itrifal ustukhuddus with a reference standard sample for physicochemical standardisation

Before the advent of modern medicine, the majority of folks relied on the drugs of plant origin for the treatment of common ailments. An appreciable number of these herbal drugs have been scientifically analysed and a lot of them are under such appraisal at present in the research laboratories, however very few attempts have been made to analyse the poly-pharmaceutical preparations especially in the case of Unani Murakkabat [Compound formulations]. Reference may be made to the standardization of Khamira Abresham Hakeem Arshad Wala [Siddiqui, 1964] and the standardization of Jawarish-e-Jalinoos [Israili 1971] and Itrifal Mulayyin [Israili, 1972]. Since the Unani system of medicine uses herbs, animal products as well as minerals, it is necessary to evolve the standards for single as well as poly-pharmaceuticals. To satisfy the present day scientific world it is all the more important to lay down minimum standards of quality and purity for indigenously developed drugs to ensure their uniform effectiveness against disease. In view of these factors an attempt has been made in the present study to standardise constituents of "Itrifal Ustukhuddus," a well-known Unani preparation making use of modern methods of analysis. Itrifal Ustukhuddus is a reputed poly-pharmaceutical preparation of Unani system of medicine. It is extensively used with great success in the treatment of chronic sinusitis, a very common disease causing great discomfort. It is a time-tested drug in Unani system of medicine, and has gained positive reputation due to its wide and divergent actions on different systems of human body. It purifies the body from the waste products and relieves obstruction in the flow of body fluids. It gets rid of toxic substances [metabolites] from major organs like heart, brain, liver, spleen and kidney. It is also useful in epilepsy, melancholia and insomnia [Siddiqui, et al., 1991]. Keeping in view the beneficial effects of Itrifal Ustukhuddus in the nervous and respiratory disorders and its frequency of usage, an attempt has been made to find out the analytical characteristics of this Unani preparation which may prove prelude to fix the chemical standards for this preparation

Analytical study of compound Unani drug Habb-e-Mudir

The drugs used in Unani Medicine consist of materials from plant, animal and mineral origin that are either used single or in combination with other drugs as poly-pharmaceuticals. Habb-e-Mudir is a poly-ingredient formulation comprising Sibr [Aloe species], Zafran [Crocus sativus] and Hira Kasees [Ferrous Sulphate], in the ratio of 2:1:1 [NFUM I] indicated for the treatment of amenorrhoea. Present study is aimed to standardize the formulation for quality control purpose. Standard sample of the formulation was prepared in laboratory following the NFUM methodology [National Formulary of Unani Medicine]. Separate studies were undertaken for each ingredient in respect of pharmacognostical characters, physico-chemical constituents and HPTLC profile. Standard formulation was subjected to chemical analysis viz. extractive values, ash values, etc. including chromatographic profile in line with standard pharmacopoeial protocols. The results may ensure the quality of Habb-e-Mudir through determining the genuineness and quality of ingredients as well as the manufacturing process

step by step approach to prevent lodinated contrast-media induced acute kidney injury [ICI-AKI] in hospital inpatients

Chronic kidney disease is one of the biggest health threats facing the world, the State of Qatar being no exception. In Qatar the annual incidence of end-stage renal disease is approximately 200 per million of population. This figure is expected to rise further, reflecting the global epidemic of Type 2 diabetes and the ageing of the population. Advances in medical care have led to an increased number of iodinated contrast media [ICM] based radiographic studies and interventions. In the last few years, there has been an intense focus on Nephrogenic Systemic Fibrosis and consequently the medical community has almost abandoned the use of gadolinium based radio contrast agents in patients with advanced renal impairment. Hence, ICM remain the mainstay for diagnostic and interventional radiological procedures. As kidney disease and diabetes are major risk markers for iodinated contrast media induced acute kidney injury [ICI-AKI], one can predict that the burden of ICI-AKI will increase. A practical step-by-step management algorithm is presented which is intended to promote safe administration of intravascular ICM in hospital inpatients at risk of ICI-AKI

Role of ICT malaria immunochromatographic test for rapid diagnosis of malaria

To evaluate the sensitivity and specificity of immunochromatographic test [ICT] malaria p.f/p.v using microscopy as the gold standard diagnosis. Five hundred and sixty patients of both sexes and all age groups with clinical suspicion of malaria were studied. Venous blood was collected for microscopy and ICT. Thick and thin films prepared and stained with Leishman's stain were examined. ICT malaria test was performed and interpreted according to manufacturer's instructions. Data was analyzed using Epi-6. A total of 560 cases were studied, 339 males and 221 females with age ranges between 2 to 73 years. Seventy two [12.85%] cases had parasitaemia [with or without sexual forms]. On microscopy 65 [11.6%] cases had asexual-stage parasitaemia and 7 [1.25%] cases had P. falciparum gametocytes only. Thirty two cases were infected with P. falciparum, 29 with P. vivax and 4 had mixed infection. For P. falciparum the ICT was 97.0% sensitive, 98.3% specific, with positive predictive value [PPV] of 78.0% and a negative predictive value [NPV] of 99.8%. For P. vivax the sensitivity was only 89.7%, specificity 97.9%, PPV was 70.3% and NPV 99.4%. Our results are in concordance with previous studies. Rapid tests though expensive are simple to perform and effective diagnostic tools of malaria. They can be used selectively, though microscopy remains the gold standard diagnosis, economical and accurate if performed by skilled technologists

Emerging drug - resistance and guidelines for treatment of malaria

The increasing prevalence of multi-resistant Plasmodium falciparum malaria worldwide is a serious public health threat to the global control of malaria, especially in poor countries like Pakistan. In many countries choloroquine-resistance is a huge problem, accounting for more than 90% of malaria cases. In Pakistan, resistance to choloroquine is on the rise and reported in up to 16-62% of Plasmodium falciparum. Four to 25% of Plasmodium falciparum is also reported to be resistant to sulfadoxine-pyrimethamine and several cases of delayed parasite clearance have been observed in patients with Plasmodium falciparum malaria treated with quinine. In this article we have introduced the concept of Artemisinin-based Combination Therapy [ACT] and emphasize the use of empiric combination therapy for all patients with Plasmodium falciparum malaria to prevent development of drug resistance and to obtain additive and synergistic killing of narasite