Rho GTPase activating protein 15 [arhGAP15] siRNA effect apoptosis-induced by ethanol in bovine fibroblast cells

The Rho GTPases are the sub-group of Ras super family and identified in all eukaryotes. The Rho GTPases effect different cellular signaling pathways involved in a number of diseases such as cancer, neurological and cardiovascular disorders. Members of Rho GTPases including RhoA, RhoC and Rac1 play a major role in regulation of apoptosis in different kind of stress conditions. Here we investigated the Rho GTPase activating protein 15 [ArhGAP15] gene knock-down effect on apoptosis induced by ethanol in bovine fibroblast cells. The bovine Fibroblast cells were treated and transfected with two different concentrations [50 and 100 nM] of ArhGAP15 siRNA for 48 h respectively. Both concentrations of siRNA were effective and the results of RT-PCR revealed an efficient knock-down of ArhGAP15 mRNA in fibroblast cells. Further, the normal cells exposed to a 100 mM ethanol concentration showed a reduction in cell viability and induced the ratio of apoptosis related Bax/Bcl-2 proteins compared with ArhGAP15 siRNA transfected ethanol treated cells. Ethanol also increased caspase-3 expression in normal fibroblast cells compared with transfected cells. The ArhGAP15 knock-down cells treated with ethanol decreased Bax/Bcl-2 ratio and lower caspase-3 protein levels in ArhGAP15 knocked-down cells. Our results suggest that apoptosis induced by ethanol involves the activation of Rho GTPase activating protein 15 and silencing of the said gene protects apoptosis

Evaluation of auditory perception skills development in profoundly deaf children following cochlear implantation

Cochlear implant is a medical treatment option for individuals with severe to profound sensori-neural hearing loss on account of non-functioning cochlea or part thereof. Technology is ever evolving and the candidacy criteria are widening. Appropriate selection of patient, successful implantation of an appropriate device and adequate post-implantation rehabilitation protocol are the key factors that dictate the eventual outcome. Bilateral cochlear implantation in children and combined electro-acoustic stimulation are the new developments in this field of rehabilitation for the deaf. Pakistan Cochlear Implant Programme was started in year 2000 and one hundred and fifty subjects have undergone cochlear implant surgery so far at Karachi, Lahore and Peshawar since. This prospective study was designed to evaluate the development of auditory perception skills and language in children, over a twelve months period, following cochlear implantation. Twenty-one patients were enrolled in this evaluation. These were divided into three groups as per age factor. Group 1 included eleven children of ages less than five years, Group 2 included eight children of ages between five and nine years whereas, Group 3 included two eleven years old children. Furthermore, subjects in Group 1 and 2 were pre-lingual whereas those in Group 3 were post-lingual. The three groups were evaluated using "Evaluation of Auditory Responses to Speech" [EARS]. Improvement in performance on all measures was noticed in all the groups over a twelve months period following implantation. Dynamics of improvement in auditory skills suggested more and rapid development in younger age group. Children of varying ages, both pre and post lingual, did show improvement in the development of auditory perception skills, that was evident more in the younger age group

Analysis of tracheobronchial foreign bodies with respect to sex, age, type and presentation

Foreign body inhalation is one of the life threatening emergencies. It may happen at any age, however, most of these accidents occur in children especially below the age of five. This prospective study was done at Department of Otolaryngology, Head and Neck Surgery, Ayub Teaching Hospital, Abbottabad, from 1 January 2003 to 30 June 2005. a total of Eighty one patients, referred from the casualty and Paediatric unit with suspicion of tracheobronchial foreign body were included in the study. Eighty one were studied. Fifty [61.7%] were male and thirty one [38.3%] were female. Sixty three [77.8%] were below five years, thirteen [16%] were between five and fifteen years and five [6.2%] were above fifteen years. Sixty seven patients [82.7%], presented mainly with chocking, while fifty nine patients [72.8%] had stridor and forty five patients [55.6%] had cough at initial presentation. Seventy two [88.9%] patients had decreased air entry and forty two [51.9%] had wheeze on auscultation, whereas cyanosis was noticed in five [6.2%] patients. Peanut was the commonest foreign body, retrieved in forty five patients [55.6%]. Other foreign bodies were whistle [18.5%], maize seed [13.6%], bean seed [6.2%], nuts [2.55], sewing needle with thread, dice and denture [1.2%] each. Foreign body inhalation is more common in male patients, mostly below five years of age. Chocking is the commonest symptom and decreased air entry on auscultation is the typical examination finding. Peanut has been found to be the commonest type of foreign body

Evaluation of efficacy of management protocol in allergic rhinitis

Allergic rhinitis represents a global health issue affecting between 10% to 25% of the world population, with increasing prevalence, resulting in a significant impact on quality of life, multiple comorbidities and the considerable socio-economic burden. Majority of the patients are younger than 30 years and it may be inherited. Symptoms typically occur as a result of exposure to dust, dander or certain seasonal pollen. Lack of standardized management protocol is one of the major factors responsible for poor control of this condition. This study was designed to evaluate the patients suffering with allergic rhinitis and manage them with a protocol based on the pathogenesis of the condition. Method: This prospective study was conducted in the Department of Ear, Nose and Throat and Head and Neck Surgery, Ayub Teaching Hospital, Abbottabad, over a period of two years [2005-2006], to assess the efficacy of a standard protocol of treatment developed and followed in the department. 1167 patients, clinically diagnosed as suffering with allergic rhinitis, were evaluated and managed. Age ranged from 08 months to 64 years. All the patients were prescribed medical treatment, divided into initial phase of 10 days to two weeks duration followed by a maintenance phase, and a regular follow-up schedule was maintained upto two years. 634 [54.32%] patients were male and 533 [45.67%] were female. Age ranged from 08 months to 64 years, 85% being between 05 and 45 years. 91% of patients had symptom duration of 06 months to 03 years. 96% of the patients were getting treated on as required basis, whereas 98% had no educational sessions with the treating doctor, especially regarding preventive measures. Typical presentation in most of the patients was nasal obstruction, runny and itchy nose, post nasal drip and bouts of sneezing. 90.57% patients reported improvement in symptoms. 53.21% patients had a relapse of symptoms at some stage during the study period. 37.53% patients had surgery done for associated pathologies, mostly a DNS. Compliance regarding medication was more than 90% in the initial phase of treatment that dropped to 50% in the maintenance phase. 93% of the patients tolerated the treatment well. Allergic rhinitis is a growing problem worldwide. Optimal treatment protocol is still lacking especially in the developing countries. Patient's education on avoidance of allergens must be stressed. Associated problems that may need surgical treatment. Regular follow-up must be ensured to monitor the progress of treatment as well as to identify patients who might be candidates for immunotherapy. Newer modalities of treatment need to be further explored. A team approach is mandatory in the presence of symptoms related to lower respiratory tract

Evaluation of safety of bipolar diathermy tonsillectomy

Tonsillectomy is a common operation in both children as well as adults, performed by a variety of techniques that have evolved over the years to ensure the safety of the procedure. Cold dissection and electrodissection are the two mostly used techniques. Bipolar diathermy tonsillectomy was evaluated for its safety and postoperative morbidity. This study was conducted over a period of two years, in the Department of Ear, Nose Throat and Head and Neck Surgery at Ayub Teaching Hospital, Abbottabad, Pakistan. Two hundred and forty-six were enrolled; however, 238 patients completed the full evaluation as the technique had to be modified in 8 patients. All the procedures were performed by the first author thereby ensuring the same expertise level. Operating time, intraoperative blood loss, postoperative algesia, feeding status and time taken getting back to school/work and episodes of secondary bleeding were recorded. Time taken by the procedure ranged from 10 to 20 minutes. Intraoperative blood loss ranged between 2 to 5 ml. Postoperative pain averaged around 3-5 on a 1-10 point scale in 75% of patients. 80% of patients were back to normal diet by day 3 postoperative. Nine [3.6%] patients had a secondary haemorrhage that was managed conservatively and did not need surgical intervention. Bipolar diathermy tonsillectomy is an effective and safe technique, especially in children population. Adequate experience with the technique is mandatory to achieve the desired goals

Significance and cost effectiveness of pre-operative routine laboratory investigations in young healthy patients undergoing elective ear, nose and throat surgery

Pre-operative preparation is an important component of surgical workup. Adequate clinical assessment to determine fitness for anaesthesia and surgery and to outrule possibilities of existing disease or risk factors against the procedure would suffice in elective surgery on healthy young patients. Still routine investigations are carried out following a protocol, that does not offer added benefit and is not cost effective. We evaluated one hundred and fifty young healthy patients planned for elective surgery, to compare adequate clinical assessment with results of routine investigations in such patients, in terms of significance and cost effectiveness. Significant co-relation was demonstrated between clinical assessment and routine investigations. Only 03 abnormal results were reported following 600 laboratory investigations on 150 patients. Thorough clinical assessment is mandatory for successful outcome of surgery. There is significant co-relation with routine investigations in elective Ear, Nose and Throat [ENT] surgery. Investigations should be restricted to where indicated by clinical assessment. Such policy will significantly reduce the costs and workload, thereby improving quality of health care system

Foreign body inhalation - site of impaction and efficacy of rigid bronchoscopy

Foreign body inhalation is a relatively commonly encountered emergency in otolaryngology. Foreign body can get lodged at any site from the supraglottis to the terminal bronchioles. Rigid bronchoscopy is one of the well established methods of removing inhaled foreign body with fewer complications. This prospective study was conducted in the Department of ENT, Head and Neck Surgery, Ayub Teaching Hospital, Abbottabad, from January 2003 to June 2005. The total number of patients was eighty one. Patients in whom a foreign body was retrieved, were included in the study. Foreign body was found in the right main bronchus in sixty patients [74.1%], left main bronchus in seventeen patients [21%], terminal bronchioles in two patients [2.5%] and one patient [1.2%] each in trachea and laryngeal inlet. Foreign body was successfully removed in seventy-nine patients [97.5%]. Nineteen patients [23.5%] had postoperative airway edema, one [1.2%] had trauma to the false cord and laceration of the posterior pharyngeal wall. It was concluded that the right main bronchus is the most common site of impaction of inhaled foreign body. Rigid bronchoscopy is very effective procedure for inhaled foreign body removal with fewer complications

Evaluation of aetiology and efficacy of management protocol of epistaxis

Epistaxis is one of the commonest medical emergencies. It affects all age groups and both sexes. The cause may be local or systemic but in majority it is spontaneous and idiopathic. Trauma is considered to be a major aetiological factor. Various treatment protocols are utilized to control epistaxis derpending upon the type, severity and cause of bleeding. This descriptive study was designed to evaluate the aetiology and efficacy of management protocol of epistaxis in a tertiary care setting. 313 patients underwent prospective evaluation by consultant and non-consultant doctors with considerable experience in Ear, Nose and Throat [ENT] emergencies management. Standard principles were followed in the management. This study demonstrated a bimodal distribution with incidence peaks in below 25 years and above 50 years of age. Males were affected twice more than the females [2.15:1.04]. Anterior nasal bleeding was noted in majority of the patients. Anterior nasal packing was the most effective method of controlling anterior epistaxis. While posterior bleeding was controlled by posterior nasal packing with Foley's catheter. The most common cause was found to be trauma, followed by hypertension. It may be concluded from this study that epistaxis is the most common ENT emergency, affecting all age groups. It has a bimodal age presentation and affects males twice more than females. Anterior bleeding is more common than posterior bleeding. Epistaxis may be controlled with chemical/electro-cautery if the bleeding point is visible. In case of failure to localize or access a bleeding point or profuse bleeding, anterior nasal packing can effectively control majority of epistaxis. Foley's catheter is a good option that can be used for posterior nasal packing. Gelfoam may be used for controlling epistaxis in cases of bleeding disorders, when there is mucosal ooze

Management outcome of secretory otitis media

Secretory otitis media is a common otological manifestation, that most of the time is left undiagnosed on account of unawareness and negligence in seeking early medical attention for trivial ailments. Untreated, it might end up in serious consequences in the form of poor speech and intellectual development and permanent anatomical disabilities within middle ear cleft, The objectives of the study were to determine most affected age group, the common etiological factors, to access the efficacy of medical and surgical treatment and finally to find out the complication associated with the surgical procedures. This study was conducted in the ENT, Head and Neck Surgery department of the Ayub Teaching Hospital, Abbottabad from January 2001 to December 2003.Only the diagnosed cases of SOM were included in the study. After detailed history, clinical examination, routine investigations and special investigations such as pure tone audiogram and tympanometry were carried out to confirm the diagnosis of SOM. All patients were initially treated by medical therapy. In cases of failure, underwent myringotomy with or without ventilation tube insertion and where indication present adenotonsillectomy and antral lavage was done. Follow up of cases was carried out from 18-24 months. It included 87 patients, 58 were males [66.6%] and 29 females [33.3%]. Majority of the patients were between 5-8 years [62%]. The most common aetiological factor was rhinosinusitis [36.7%] followed by hypertrophic adenoids [34.5%]. All patients were initially given medical treatment. Out of 87 patients,30 patients [34.4%] improved and 57 patients [65.5%] had no response and underwent surgery. Surgical procedures included myringotomy with and without ventilation tube insertion, adenotonsillectomy and antral lavage. It is concluded from this study that conservative treatment has a definite role and should be tried before any surgical step is taken however surgery is the treatment of choice in more resistant cases

Lemierre's syndrome: a forgotten complication of oropharyngeal infection

Lemierre's syndrome [postanginal sepsis] usually complicates an oropharyngeal infection as septicemia. septic thrombophlebitis of the internal jugular vein, and metastatic lesions, most frequently in the lungs. Fusobacterium necrophorum is the usual etiologic agent. Lemierre's syndrome is not widely known by clinicians. This study aims at creating awareness amongst the clinicians of existence of this potentially fatal but curable clinical entity. All the patients admitted in the ENT department of Ayub Teaching Hospital, during the period of January 2000 to December 2002, for the treatment of acute oropharyngeal infection, were critically assessed by consultants, for features of Lemierre's syndrome, and investigated further. accordingly. 156 patients were admitted with acute oropharyngeal infection. Two patients [1.28%] had features suggestive of Lemierre's syndrome. A male and a female, 25 and 28 years old respectively, had a history of a preceding sore throat for a variable duration followed by complications. Attempts were made to make the diagnosis of Lemierre's syndrome and they were treated appropriately, as per recommendations, to a successful outcome. Conclusions: Widespread use of antibiotics for pharyngeal infections has significantly reduced the incidence. Rare and a forgotten complication, Lemierre's syndrome is potentially fatal. Early diagnosis and prolonged treatment with appropriate antibiotics are usually curative. A high degree of clinical suspicion is necessary for diagnosis. Modern day clinician should be aware of this potentially life threatening clinical entity that may complicate a trivial oropharyngeal infection