Diagnosis of adult chronic rhinosinusitis: can nasal endoscopy predict intrasinus disease?

To define the role of endoscopic evaluation of middle meatus in adult patients clinically diagnosed to have chronic rhinosinusitis and its ability to predict intra-sinus mucosal involvement as compared to CT scan. This prospective analytical study was conducted on consecutive patients with diagnosis of chronic rhino-sinusitis who were symptomatic and fulfilled the American Academy of Otolaryngology - Head and Neck Surgery Task Force criteria. The patients were enrolled prospectively and were subjected to rigid diagnostic nasal endoscopy and classified as defined by the revised Sinus Allergy Health Partnership Task Force criteria. The patients then underwent non contrast CT sinuses on the same day. Results were analyzed as a diagnostic test evaluation using CT as a gold standard. Among the 75 study patients with symptom based chronic rhino-sinusitis, nasal endoscopy was abnormal in 65 patients [87%]. Of these patients, 60/65 [92%] showed positive findings on CT scan. Ten patients had normal endoscopy, of these 6/10 [60%] had abnormal CT scan. Sensitivity and specificity of diagnostic nasal endoscopy against CT scan were 91% [95% CI: 81-97] and 44% [95% CI: 14-79], respectively. The likelihood ratio for positive nasal endoscopy to diagnose chronic rhino-sinusitis was 1.6 and the likelihood ratio to rule out chronic rhino-sinusitis when endoscopy was negative was 0.2. Nasal endoscopy is a valid and objective diagnostic tool in the work up of patients with symptomatic chronic rhinosinusitis. When clinical suspicion is low [<50%] and endoscopy is negative, the probability of rhino-sinusitis is very low [<17%] and there is no need to perform a CT scan to reconfirm this finding routinely. Endoscopy alone is able to diagnose chronic rhinosinusitis in >90% of patients when clinical suspicion is high [88%] as defined in this study by AAO-HNS Task Force criteria. Negative endoscopy, however, does not totally exclude the sinus disease in patients fulfilling task force criteria. CT scan may be needed on follow-up if there is clinical suspicion in 10% of these patients who are negative on endoscopy if symptoms persists. It is thus possible to reduce the number of CT scans if patients are carefully selected based on clinical criteria and endoscopy is done initially as part of their evaluation.

change in trainee physicians' knowledge and comfort levels with obstetric emergencies following ALSO training

The Advanced Life Support in Obstetrics [ALSO] is a course in emergency obstetrics to help physicians and other health care providers develop and maintain the knowledge and skills to effectively manage potential obstetric emergencies. This course was held for the first time in Pakistan at the Aga Khan University in September 2003. This study was conducted to evaluate the improvement in knowledge and comfort level of physicians-in-training [interns, family medicine, obstetric and emergency room residents] in dealing with emergency obstetrics after undergoing the course. After informed consent, study subjects were administered a written test and asked to complete a questionnaire 10 days before and immediately after taking the ALSO course. Level of comfort in handling obstetric emergencies was assessed using a three-point Likert scale. A total of 38 trainees participated in pretest, ALSO course and subsequent post-test. Eleven were males and 27 were females. The comparison of the pre-test and post test showed a significant increase in the knowledge. The mean difference between the scores was 24 and the paired t-test done showed there was a highly significant difference between the scores [t=18.8, p= <0.001]. There was also a significant improvement in the comfort level for handling emergency obstetrics. Following the ALSO course all participants said they would recommend the course to others. The ALSO course is a valuable teaching intervention that improves not only knowledge but also perceived comfort levels of emergency obstetrics among interns and residents in a developing country

Diagnosis and management of allergic rhinitis in adults

Allergic Rhinitis is a common condition seen in family practice, though prevalence data from Pakistan is lacking. Classification is based on severity of symptoms. Patient education and medications such as oral anti-histamine and intranasal corticosteroids are the mainstay of treatment. Medications like pseudoephdrine help with nasal congestion but have to be used with caution in people with heart disease

Evaluating and managing cancer pain guidelines using the world health organization analgesic ladder approach

Pain relief has been recognized as an important but neglected public health issue in both developing and developed countries. In 1986, the World Health Organization released a set of guidelines under the title of 'Cancer Pain Relief'. The second edition of these guidelines was published in 1996. Due to its importance, an abridged version of these guidelines is being presented in this article

Distribution of lower urinary tract symptoms [LUTS] in adult women

To determine the distribution of lower urinary tract symptoms in adult women and the frequency with which the women consulted a health care provider for their symptoms. Design: Cross-sectional analytical study. Place and Duration of Study: Community Health Center of Aga Khan University Hospital from November 1st to 30th, 2002. Subjects and A trained interviewer administered a structured questionnaire to women patients or attendants aged 18 years and older coming to the center. Fifty-two% of the study subjects reported having at least one or more urinary complaints in the past. Stress incontinence was the highest reported complaint [38.4%] followed by burning [34.4%], frequency [26%], painful micturition [20.4%], urge incontinence [18.8%], incomplete emptying of bladder [14.4%], dribbling [12.4%] and poor stream [8.4%]. Forty-three% of the women with LUTS never consulted a health care provider for their problem. Although the distribution of LUTS among females was found to be high, the patients did not consider it important enough to consult a health care provider. There is a need to create awareness among females regarding LUTS and the need to consult a health care provider for their problems