Comparison of graft uptake by underlay and overlay technique in myringoplasty.

BACKGROUND: About 80% of tympanic membrane tears consequential of middle ear infections or trauma restore spontaneously. Myringoplasty is the procedure to fix the perforation which fails to heal. It is of two types; overlay and underlay techniques. In former technique graft is placed lateral to the fibrous sheet of the tympanic membrane while in underlay technique the graft is placed medial to the tympanic membrane remnant. The published success rates of underlay and overlay myringoplasty varied. This study was conducted to evaluate the effectiveness of graft uptake by underlay and overlay technique in patients undergoing myringoplasty. METHODS: This randomized control trial including 80 patients was carried out at Otorhinolaryngology department of Combined Military Hospital, Rawalpindi from April 2016 to September 2017. Patients going through myringoplasty for tympanic perforations were randomly allocated into two groups. Group-A underwent underlay while Group-B underwent overlay myringoplasty. RESULTS: The age of the patients ranged from 20 to 40 years with a mean of 29.58±5.92 years with a male to female ratio of 1.2:1. Hearing improvement was significantly higher (97.5% vs. 77.5%) in patients undergoing underlay versus overlay myringoplasty. The frequency of effectiveness in terms of graft uptake was significantly higher in patients undergoing underlay (95.0% vs. 57.5%) as compared to overlay myringoplasty. CONCLUSION: The underlay procedure is more effective in terms of graft uptake and lesser complications as compared to overlay myringoplasty.

Insecticide toxic effects and blood biochemical alterations in occupationally exposed individuals in Punjab, Pakistan.

Biomonitoring of people exposed to hazardous materials provides opportunities for early identification of several diseases, particularly in those individuals who are constantly exposed to pesticides, such as pesticide operators and workers in pesticide manufacturing industry. However, data on this hot topic are limited in Pakistan. In this study, insecticide toxic effects and biochemical alterations (i.e., damage in DNA and enzyme activity) were studied in blood samples of occupationally exposed individuals from Punjab, Pakistan. Eight out of twenty-seven blood samples (29.6%) of the pesticide operators were found positive in five insecticides, with the maximum concentration found for chlorpyrifos-methyl (0.039 µg/mL). Eleven out of twenty-seven blood samples (40.7%) of the pesticide industry workers were found positive in eight insecticides, with the maximum concentration found for endosulfan (0.051 µg/mL). Comet tail length was 16.88 ±â€¯4.57 µm in pesticide industry workers and 16.33 ±â€¯3.78 µm in pesticide operators, which were significantly higher (P < 0.01) than that recorded in the control group (4.84 ±â€¯2.21 µm). Values of serum cholinesterase (SChE) concentration were slightly lower (P > 0.05) in exposed individuals, whereas values of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) concentration were significantly higher (P < 0.01) in exposed individuals compared with control group. Exposure duration and total insecticide concentration in blood samples were positively associated with comet tail length, ALT activity, AST activity, and ALP activity, but negatively with SChE. DNA damage was higher in smokers vs. non-smokers. Also, a positive association was found between comet tail length and number of cigarettes per day. Overall, occupational exposure to insecticides can pose serious health risks to pesticide operators and workers in pesticide manufacturing industry, highlighting the necessity of personal protection in those groups for preventing exposure and resultant health disorders.

Determination of insecticide residues and their adverse effects on blood profile of occupationally exposed individuals.

Insecticides, essential for crop protection measures, leave behind several toxic residues that can result in a series of human health disorders. Therefore, this study was planned for the determination of residues and adverse effects of insecticides in blood samples of sprayers, pesticide-industry workers and controls by using blood parameters of these individuals as biomarkers. Optimized analytical methods using GC-MS and HPLC for the simultaneous detection of 22 currently used insecticides were adopted. Eight of twenty-seven (22.22%) sprayers' blood samples were found positive for five different insecticides. Eleven of twenty-seven (40.74%) pesticide-industry workers were found positive for eight different insecticides. The blood samples of both the exposed groups, sprayers and industry workers had significantly (P < 0.001; Mann-Whitney U-tests) low hemoglobin-Hb concentrations (12.17 ±â€¯2.13 and 12.22 ±â€¯2.37 g/dl respectively) than the average value of the control group with 14.23 ±â€¯2.37 g/dl. The erythrocyte sedimentation rates (ESRs) in sprayers and insecticide industry workers (28.78 ±â€¯20.72 and 28.17 ±â€¯25.14 mm/1st h respectively) were greater significantly (P < 0.001; Mann-Whitney U test) than the control blood samples (9.53 ±â€¯3.34 mm/1st h). These results indicate that the exposed individuals have experienced significant hemotoxic effects during insecticide exposure. The study also predicts the risk to exposed individuals in developing countries like Pakistan and demands realization of safety measures to prevent such dangerous effects of pesticide exposures.

Breast cancer risk factors: a comparison between pre-menopausal and post-menopausal women.

OBJECTIVE: To evaluate the difference between pre- and post-menopausal breast cancer regarding menstrual and reproductive risk factors METHODS: The case-control study was conducted in Mayo Hospital, Lahore, between October 2008 and April 2009. Cases were breast cancer patients admitted in the surgical and oncology floors of the hospital. Controls were hospital patients without breast cancer. The study enrolled 150 cases and 300 controls. Menstrual and reproductive history was taken from both the cases and the controls. For every risk factor age-adjusted odds ratio (OR) and 95% confidence interval (CI) was calculated by logistic regression analysis, separate for pre- and post-menopausal women. RESULTS: Among the breast cancer patients, 42.7% were pre-menopausal and 57.3% were post-menopausal. Age at menarche had no association with breast cancer for both pre- and post-menopausal women. Nulliparity was a risk factor for both pre-menopausal (OR 4.1, 95% CI 1.4-12.6) and post-menopausal breast cancer (OR 8.2, 95% CI 1.7-40.4). Among parous women only post-menopausal females having < 3 children were at increased risk for breast cancer (OR 4.5, 95% CI 1.8-11.5) compared with females having > or = 3 children. Younger age at first live birth decreased breast cancer risk in both pre- and post-menopausal women. Breastfeeding was not associated with both pre- and post-menopausal breast cancer. CONCLUSIONS: Majority of risk factors for pre-menopausal breast cancer are also associated with postmenopausal breast cancer except less parity, which increased the risk for post-menopausal breast cancer only.

Diagnostic accuracy of "pallor" for detecting mild and severe anaemia in hospitalized patients.

OBJECTIVE: To determine the accuracy of pallor of conjunctiva, nailbed, and palm in detecting mild and severe anaemia. METHODS: Three hundred and five consecutive patients admitted in the medical and surgical wards of Mayo Hospital, Lahore were enrolled in the study. Conjunctiva, nailbed, and palm of patients were assessed. Mild anaemia was defined as Hb < 11.5 g/dl for females and Hb <13 g/dl for males. Severe anaemia was defined as Hb <7 g/dl. Likelihood ratios (LR) and their 95% confidence intervals (CI) for both presence and absence of pallor at each site were calculated. To compare the accuracy of different pallor sites in diagnosing severe anaemia, their areas under receiver operating characteristics curves (AUC) were compared. RESULTS: Mild anaemia was present in 64.3% patients while severe anaemia was present in 7% patients. Presence of nailbed pallor had moderate accuracy for diagnosing mild anaemia (LR 5.6, 95% CI 4.7-6.7) while absence of pallor at nailbed, conjunctiva, and palm (LR 0.6 for all) did not rule out mild anaemia. All sites had modest accuracy for detecting severe anaemia (LR 2.5-3.0). Absence of pallor at conjunctiva (LR 0.1, 95% CI 0.03-0.5) and palm (LR 0.1, 95% CI 0.03-0.5) convincingly ruled out severe anaemia. Comparison of the AUC for different pallor sites showed that all sites were equally useful for detecting severe anaemia. CONCLUSION: Pallor is not an accurate sign for mild anaemia. Pallor of conjunctiva, palm, and nailbed has modest accuracy in detecting severe anaemia. Absence of pallor at conjunctiva and palm convincingly rules out severe anaemia.