Frequency of Microalbuminuria in the middle age and older population of Peshawar City

Objectives: To determine the frequency of micro albuminuria in the middle age and older population of both genders in Peshawar city of Pakistan

Study Design: Random control study

Place and Duration of Study: This study was carried out from Jan 2017 to Feb 2017 in Khyber Teaching Hospital [KTH], Peshawar Pakistan

Material and Methods: The study was conducted on 118 subjects [Female: 48 and 70 male] aged 45-75 years. Spot urine sample from each subject was quantified for micro albumin and creatinine. The results for micro albuminuria were expressed as ACR [Albumin creatinine ratio/gram of creatinine]. Patients were categorized according to ACR results as norm albuminuria [ACR = 20 mg/g Cr], micro albuminuria [ACR = 30-299 mg/g Cr], or macro albuminuria [ACR >/=300 mg/ g Cr].

Results: The percentage of hypertensive [60 percent] and macro albuminuria patients [8.33 percent] were higher in female subjects than the male subjects [hypertensive; 25.71 percent] and macro albuminuria patients [2.86 percent]. The prevalence of micro albuminuria was higher in male [25.71 percent] than the female subjects [25 percent]

Conclusion: Micro albuminuria was found to be more prevalent in male than in female while macro albuminuria patients were higher in female than in male

Conservative and surgical management of otitis media with effusion in pediatric population

Objectives: The study was aimed to compare results of medical and surgical treatment of otitis media with effusion in terms of hearing improvement, determine recurrence of MEE and decide when to offer surgical treatment

Study Design: A descriptive study

Place And Duration: The study was conducted from June 2008 to December 2011 in ENT department of Khyber Teaching Hospital, Peshawar

Methodology: Sixty seven patients were selected for study. Every child with difficulty in hearing was examined with pneumatic otoscope for fluid level and tympanic membrane mobility. These children were investigated with tympanometry to confirm the middle ear effusion and pure tone audiometry for hearing threshold. X-Ray nasopharynx lateral view was performed to confirm the mass of adenoids. All of the patients were treated conservatively in the first phase. Those cases not responding to conservative treatment were treated with myringotomy and or adenoidectomy with and without ventilation tubes. Patients were followed for recurrence of MEE for 36 months

Results: Conservative treatment was tried in all patients. Middle ear effusion cleared in 71.5% [n.86] out of 120 ears. MEE showed no improvement in 28.5% [n. 34] ears. The failure was much less with ventilation tubes [5.0%]. The hearing level improved by 10 to 15 dB with ventilation tubes

Medical versus surgical management of otitis media with effusion in children

Otitis media with effusion [OME] is a leading cause of hearing difficulty in children. OME must be detected early and managed properly to prevent hearing and speech impairment in children. This study was aimed to compare results of medical and surgical treatments in terms of hearing improvement, recurrence of Middle Ear Effusion [MEE], time to offer surgical intervention. The study was conducted from June 2008 to December 2011. A performa was used to collect data. Every child having hearing difficulty was examined with pneumatic otoscope for fluid level and tympanic membrane mobility. These children were investigated with pure tone audiometry for level of hearing loss and tympanometry to confirm the middle ear effusion. X-Ray nasopharynx lateral view was taken to see if there were adenoids. All patients were treated conservatively in the first phase. Those not responding to conservative treatment were treated with myringotomy and adenoidectomy with or without ventilation tubes. Patients were followed-up for up to 36 months. Middle ear effusion cleared in 80 [71.5%] out of 112 ears. No improvement was noted in 32 ears for 9 months. Resistant and recurrent cases were managed with adenoidectomy and myringotomy alone or with insertion of ventilation tubes [VT]. Recurrence was noted more common with myringotomy alone than with ventilation tubes. Medical treatment failed in 32 ears. MEE recurred in 9 ears. VT was put in 41 ears. The hearing level improved with VT by 10-15 dB after first 3 months. All children with OME should be treated conservatively. It is cost effective and relieves MEE in about 70% of patients. The ears with OME that fails to resolve or recur should be managed with myringotomy and VT insertion or adenoidectomy.

Percutaneous image guided cutting needle biopsy of mediastinal masses: diagnostic yield and complications

To evaluate image guided cutting needle biopsy of mediastinal masses for diagnostic yield and complications. This was a descriptive study. Computed Tomography [CT] and ultrasound guided biopsies of mediastinal masses were performed in 30 patients. Tissue core obtained, were preserved in formalin and sent for histological examination. X-ray chest taken for evidence of pneumothorax and mediastinal widening. Hemoptysis, pneumothorax other complication were recorded. Definite histological diagnosis was obtained in all 30 patients. 70% [n=21] were malignant disease and 30% [n=9] were benign pathologies. Sensitivity and specificity, positive and negative predictive values were 100%. Pneumothorax occurred in 7% [n=2] cases. Hemoptysis occurred in 10% [n=3] cases. Chest intubation was not required in cases of pneumothorax. No hemodynamic instability occurred. There was no major complication. Image guided percutaneous transthoracic cutting needle biopsy in mediastinal masses is an accurate procedure for specific histological diagnosis and has a low complication rate

Removal of coins from upper oesophgus under local anesthesia

To know the safety of coin extraction from upper esophagus by using Magill forceps and laryngoscope, under local anesthesia. This prospective study includes four hundreds patients with coin stuck at the upper end of esophagus, referred to us from emergency department form Jan 2004 to Dec. 2004. We used both Magill forceps and Mackintosh Laryngoscope for coin extraction. A total of 400 patients were treated in one year, majority were children between 2-5 years of age. Males were 202 [50.5%] and females were 198 [49.5%]. Three hundred and forty patients [85%] presented with in 24 hours while 60 patients [15%] presented after 24 hours. At presentation, 360 [90%] had difficulty in swallowing and excessive salivation while remaining 10% had vomiting and cough. Out of 400 coins, 296 [74%] were of two rupees while remaining 105 [26.3%] included one and five rupees coins. Three hundred and twenty [80%] coins were removed in first attempt while 65 [16.2%] require more than one attempt. We failed in 15 [3.75%] cases. Minor complications occurred with this method in 19 [4.75%] while one child develop neck abscess [0.25%].Coin extraction from upper esophagus, using Magill forceps and laryngoscope under local anesthesia is a safe and effective method

Efficacy, safety and tolerability of streptokinase in multiloculated empyema

Empyema thoracis is a common illness with significant morbidity and mortality. Standard treatment of Empyema includes tube drainage and antibiotics. But the tube drainage often fails if the fluid is loculated. Intrapleural Streptokinase has been used in multiloculated empyemas with good success rate. We evaluated the efficacy and safety of intra-pleural Streptokinase in loculated empyemas. A total of 15 patients admitted in Pulmonology unit with multiloculated empyemas whose drainage via drainage tube was less than 100 ml during the last 24 hours were included in the study. Aliquots of 250,000 units of Streptokinase in 100 ml of normal saline were instilled into the pleural cavity and the tube clamped for 3 hours. Response was assessed by clinical outcome, measurement of drain output after unclamping and subsequent chest radiography and serial chest ultrasounds. Streptokinase enhanced drainage in all patients with complete resolution of Empyema in 13 patients. Two patients with thickened visceral pleura following empyema drainage were referred to thoracic surgeon for decortication. The number of instillations of Streptokinase per patient ranged from 1 to 3 and the volume of drained empyema fluid ranged from 60 ml to 600 ml per patient. Streptokinase was well tolerated in all patients. Intrapleural Streptokinase is a safe and effective means of increasing the tube drainage in multiloculated Empyema without causing systemic fibrinolysis

Somking and doctors a survey of trends and attitudes

The aim of this survey was to assess smoking trends and attitude towards smoking in doctors. Out of the total 86 doctors, 61[70.9%] males and 25[29.1%] females, the number of consultants and junior doctors was 21[24.4%] and 65[75.6%]. A total of 24[27.9%] doctors were smokers. Smoking was more popular among males 24[39.3%] and consultants 09[42.8%] than lady doctors [zero] and junior doctors 15[23.0%]. Other substance abuse was found in smokers only, 03[12.5%] among males smokers and zero among females while 01[11.1%] and 02[13.3%] in smoker consultants and junior doctors respectively. Among the smoker doctors 16[55.2%] and among the non-smoker doctors 27[47.4%] would always give their smoking patients a "stop-smoking" advice while the remaining doctors would, either sometimes or not at all, advise their patients to stop smoking. A supplementary question was included in another study, conducted by the same investigator on 275 university students to help assess doctors' contribution in reducing tobacco consumption in the community. The answers were analyzed in this study. Only 25% of the exsmokers gave up smoking on doctors' advice. Thus doctors don't have an accurate perception of smoking related diseases and so not only have high smoking rates but are also contributing insignificantly to reduce smoking in the community

Smoking trends in medical students: Are they influenced by difference in gender and financial status?

Smoking trends in medical students and the influence of gender and financial status difference was studied in a survey in Peshawar. Total study population was 154 with 101[65.6%] males and 53[34.4%] females while 78[50.6%] and 76[49.4%] were regular and self-financed students respectively. The total number of smokers was 49[31.8%]. Out of the male and female students 38[37.6%] and 6[12.8%] were smokers respectively. The number of smokers among regular and self-financed students was 15[19.2%] and 34[44.7%] respectively. Majority of the smokers [74.5%] smoked less than 10 cigarettes / day and only a small minority smoked more than 20 cigarettes/ day. Despite the fact that overall 93.6% students were aware of even passive smoking hazards; still only 74.7% and 69.8% male students would favour a ban on smoking at public placed and on cigarette ads., respectively while the corresponding number of female students was 94.1% and 80.4%, respectively. 15[39.5%] and 6[33.3%] among the male and female students respectively, first smoked during their school life

Inadequate postprandial compensatory tachycardia in elderly people

The effects of aging on cardiovascular and autonomic systems were evaluated through postprandial baroreceptor activity comparison between a group of young adults [n=20] and a group of elderly subjects [n=50.] through measurements of pulse rate, which is an indicator of baroreceptor activity. Significant rise of pulse rate was observed in the young adults at 15, 30, 45 and 60 minutes after meal, while similar postprandial compensatory tachycardia was not found in the elderly group. The mean differences in pulse rate in young adult group at 15, 30, 45 and 60 minutes after meal were 2.05 +/- 0.28, 5.90 +/- 0.37, 5.95 +/- 0.37 and 3.60 +/- 0.42 beats/minute respectively, while the same values at the same time intervals in elderly subjects were 0.48 +/- 0.31, 1.14 +/- 0.54, 0.06 +/- 0.34 and -0.36 +/- 0.26 beats/minute respectively. Highly significant differences [p< 0.001] were observed in the values at all postprandial time intervals between the two groups