Medical versus surgical treatment of nasal polyps

Objective: To compare medical versus surgical treatment of nasal polyps in terms of frequency of success and recurrence. Study Design: Randomized controlled trial. Place and Duration of Study: This study was conducted at the department of ear nose throat [ENT], Combined Military Hospital [CMH] Peshawar over 2 years' period, from Jan 2000 to Dec 2002

Material and Methods: During this period, 80 patients were diagnosed of nasal polyps. These patients were randomly divided into two treatment groups. Patients in group-A received medical treatment in the form of intra-nasal steroids while patients in group-B received surgical treatment depending upon the extent of disease. Outcome variables were frequency of successful resolution of nasal polyps after 1 month of treatment and frequency of recurrence upon 1 year follow-up

Results: The age of the patients ranged from 15 years to 40 years with a mean of 26.13 +/- 2.5 years. There were 49 [61.25%] male and 31 [38.75%] female patients in the study group giving a male to female ratio of 1.6:1. There was no significant difference between the two study groups in terms of gender [p=0.818] distribution. Bilateral intranasal polypectomy was the most frequently performed procedure [70.0%] followed by intranasal ethmoidectomy [12.5%], external ethmoidectomy [10.0%] and functional endoscopic sinus surgery [7.5%]. The frequency of successful treatment was significantly higher with surgery [100% vs. 52.50%; p<0.001] as compared to intra-nasal steroids at 1 month follow-up. However, over the long-term follow-up, the frequency of recurrence was significantly lower with intra-nasal steroids [4.8% vs. 30.0%; p=0.022] as compared to surgery. There was no complication in the patients treated with intra-nasal steroids. While crusting [15.0%] followed by infection [10.0%] were among the few complications observed in the surgical group-B

Conclusion: Though associated with significantly lower frequency of successful treatment, intranasal steroids were associated with significantly lower frequency of recurrence as compared to surgery. Moreover, their use was not associated with any complication as experienced with surgery. Due to these benefits and non-invasiveness, intra-nasal steroids become first line treatment of choice. It can be advocated on the basis of the present study, that patients with nasal polyps should receive a course of intra-nasal steroids and surgery should only be reserved for refractory cases

Duration of nasal packs in the management of epistaxis

To compare the efficacy of nasal packs for 12 and 24 hours in the management of epistaxis. Quasi experimental study. Combined Military Hospital, Nowshera and Heavy Industries Taxilla Hospital, from October 2012 to April 2013. A total of 60 patients presenting with epistaxis were selected and were divided into two groups of 30 patients each. Patients in both the groups were managed by nasal packs. In group-A packs were removed after 12 hours while in group-B after 24 hours. Symptoms of headache, lacrimation and recurrence of bleeding were recorded. SPSS 20 was used for data analysis and p-value less than 0.01 was considered significant. There was significant difference for headache between removal of nasal packs after 12 hours and 24 hours [p < 0.001]. There was significant difference for excessive lacrimation at 12 and 24 hours [p = 0.001]. No significant difference was observed for recurrence of bleed when nasal packs were removed at 12 and 24 hours [p = 0.317]. Duration in removal of nasal packs after 12 or 24 hours made a difference in the management of epistaxis. Symptoms of headache and excessive lacrimation were significantly higher when nasal packs were removed after 24 hours. It is recommended that patient could be managed with lesser duration of packs after episode of epistaxis to avoid inconvenience

Preference regarding technique selection for posterior composite restorations among the dentists in lahore

Bonding composites in deep posterior proximal cavities may be a challenge. The aim of the present study was to evaluate the preferences of dentists in selection of technique to prevent microleakage in posterior deep proximal composite restorations. One hundred questionnaires were randomly distributed to the dental surgeons working in hospitals and clinics in Lahore. The questionnaires were designed to elicit information regarding selection of technique for posterior composite restoration. Ninety two completed questionnaires were returned. Fifty eight general dental practitioners and thirty four specialists responded to the questionnaire. 62% dentists adopted sandwich technique using RMGIC, 60% used GIC in sandwich restoration with immediate composite placement, 39% usedflowable composite as a gingival increment, 4.4% used GIC with delay of 48 hours for composite placement and 4.4% reported to do restoration without using any liner. Difference was found among three groups of dentists in the selection of restorative technique but it was not significant. Sandwich restoration with RMGIC or GIC was the main preference among dentists in deep posterior proximal restorations followed by the use offlowable composite

Hepatitis C; association of interferon-ribavirin therapy with hearing loss

The objective of this study was to determine association of Interferon-Ribavarin therapy with hearing loss in patients suffering from Hepatitis 'C'. Quasi-experimental study. Otolaryngology Department Combined Military Hospital Rawalpindi from 09 June 2006 to 08 June 2007. Consenting sixty patients of Hepatitis C divided into two equal groups of 30 each, [group A receiving Interferon-Ribavarin therapy and group B, not receiving it] during the study period fitting the inclusion criteria were selected. Pure Tone Audiometery including both air and bone conduction performed as base line data at commencement of therapy and then at the end of therapy [after six months]. Patients were sampled by Convenience [non-probability] technique. The number of patients who were found to have defined hearing loss was 06 [20%] in Group A [n=30] and 05 [16.67%] in Group B [n=30]. Chi Square test was applied which showed a p-value of 0.739 which is highly insignificant. Interferon-Ribavarin Therapy does not have a significant association with hearing loss in patients of Hepatitis 'C

Influence of size of tympanic membrane perforation on outcome of myringoplasty

The objective of this study was to determine the influence of size of central tympanic membrane perforation on outcome ofmyringoplasty. Descriptive-Interventional Study. ENT Department PNS SHIFA Karachi. The study was completed in seventeen months from 22nd August 2009 to 22nd Jan 2010. The study consists of 60 cases. Non-Probability Convenience Sampling. After obtaining informed consent sixty patients undergoing myringoplasty at PNS SHIFA Karachi during the study period fitting the inclusion criteria were selected. Patients were examined and the size of tympanic membrane perforation was recorded. Perforation up to two quadrents was labeled as small perforation, three quadrents as large perforation and four quadrents labeled as subtotal perforation. The patients were managed by myringoplasty using Endaural incision with underlay technique to place the graft harvested from Temporalis fascia under General Anesthesia. All surgeries were performed by second author [senior consultant surgeon]. After undergoing myringoplasty patients were followed in ENT OPD on 2nd week to check the status of ear after removal of BIPP and eight weekly interval to check complete healing of graft for final result.:After 8wks 100% [n=20] patients with small perforation, 85% [n=17] with large perforation and 60% [n=12] with subtotal perforation had perfect healing and graft was intact. Smaller perforations have a greater chance of healing after surgery

Sensitivity and specificity of ultrasonography in diagnosis of maxillary sinusitis as compared to antral lavage

To compare the sensitivity and specificity of ultrasonography in the diagnosis of maxillary sinusitis as compared to antral lavage. Validation study. Otolaryngology Department Combined Military Hospital Rawalpindi from 1st march 07 to 28th February 2008. Consenting 60 patients diagnosed clinically as a case of sinusitis, presenting in ENT OPD during the study period fitting the inclusion criteria were selected. Ultrasonography of maxillary sinuses focusing on fluid level was done of all the patients. After ultrasonography all the patients had an antral lavage with isotonic saline to look for mucopurulent discharge. Sensitivity and specificity of ultrasonography was evaluated in diagnosis of maxillary sinusitis. The sensitivity of ultrasonography in diagnosis of maxillary sinusitis taking antral lavage as Gold Standard was very low 35.89%. The specificity of ultrasonography in diagnosis of maxillary sinusitis taking antral lavage as Gold Standard is good i.e. 80.95%.Ultrasonography has low sensitivity but high specificity in diagnosis of maxillary sinusitis.

Intermitted feeding attenuates clinical course of experimental autoimmune encephalomyelitis in C57BL/6 mice

Multiple Sclerosis [MS] is an automimmune inflammatory, demyelinating disease of human central nervous sytem. Experimantal Autoimmune Encephalomyelitis [EAE] is the commonly used animal model of MS. Calorie restriction has been found to reduce inflammation and autoimmune responses and promote neruoprotection. In this study we evaluated the effects of intermittent feeding protocol of the calorie restriction in a mouse model of EAE. Fifty four female mice [C57BL/6] were used in this study. The animals were divided into two dietary groups: ad libitum [AL] [n=25] with access to food on alternate days. After 8 weeks, EAE was induced in animals by immunization with MOG antigen [hooke labs, Lawrence, MA, USA] subcutaneously. AL and IF groups were then further divided into two groups each: AA [ad libitum until the end of study] [n=16] and Al [subjected to intermittent feeding regimen after immunization day] [n=13]. The IF group was divided into II [continued intermittent feeding regimen until the end of study] [n=13] and IA [changed to AL regimen after immunization day][n=12]. All the animals were behaviorally monitored for 35 days after immunization and observed daily for the signs and severity of disease with EAE scoring scale [0.5] and cumulative disease index [CDI] score. Intermittent feeding significantly reduced the incidence of EAE in IF groups [Al 0%, II 18.5%, IA 22.2%, p<0.05]. In addition, intermittent feeding significantly delayed the onset of EAE in Al group [p<0.05] and also, intermittent feeding significantly reduced the severity of disease in II and IA groups [AA vs. II, p<0.05 and AA vs. IA p<0.05] groups. The CDI was also significantly reduced in intermittent feeding fed groups [Al, II and to compared to AA group [p<0.05, <0.01, <0.05 respectively]]. Intermittent feeding regimen protocol of the calorie restriction significantly suppressed EAE incidence, induction, and severity. The results of this study suggest possible role of intermittent feeding in the treatment of Multiple Sclerosis patients

Small bowel obstruction in children due to persimmon phytobezoars

To present the clinical picture of small bowel obstruction caused by Persimmon phytobezoars in children of Hazara [Northern Pakistan]. Design: Descriptive case series. Place and Duration of Study: Three general surgical units of Ayub Teaching Hospital, Abbottabad from November 1998 to March 2003. Patients and Nineteen children were managed for small bowel obstruction due to persimmon phytobezoars. The age, gender, season at the time of presentation, history of persimmon ingestion, symptoms, signs, site of obstruction, operative procedure and outcome were analyzed. There were 15 males and 4 females with ages ranging from 4-11 years [mean 7 years]. All presented in winter with a positive history of persimmon ingestion. All had signs and symptoms and evidence of small bowel obstruction on plain abdominal x-rays. At laparotomy, ileum was the commonest site of obstruction. Milking of bezoars into caecum was performed in 17 patients while 2 patients required enterotomy for removal of bezoars. Complications occurred in 4 patients. There was no mortality.Small bowel obstruction in children due to persimmon phytobezoars is uncommon. However, it should be considered pre-operatively as a possible cause of intestinal obstruction in winter in children who have access to the fruit. Laparotomy should be performed for persistent obstruction or signs of strangulation