Comparative role of pregabalin and carbamazepine regarding efficacy in painful diabetic neuropathy.

Neuropathic pain is the most severe and resistant type of pain which has impact on quality of life and behaviour; it most commonly occurs at night causing disturbed sleep. Diabetes mellitus is a common cause of painful neuropathy. In this study, we are comparing the effectiveness of old treatment Carbamazepine with Pregabalin in painful diabetic neuropathy. The study was an open-label trial conducted in Diabetic Clinic of Medical Unit-III, Jinnah Post-graduate Medical Center, Karachi. The duration of the study was 90 days, from December 2010 to March 2011. The study has been approved from ethical committee of JPMC, Karachi with the reference NO.F.2-81/2010-GENL/195/JPMC. 60 established patients of painful diabetic peripheral neuropathy from Diabetic Clinic of Medical Unit-III OPD were included in the 90-day study, irrespective of gender, with duration of diabetes more than 10 years. All subjects are placed into two groups. In group A, comprising of 30 patients (n=30), Pregabalin was administered and in group B, also comprising of 30 patients (n=30), Carbamazepine. The intensity of pain was compared on visual analog scale of McGill pain questionnaire. In group A (Pregabalin), the mean pain score fell from 6.17±0.14 to 3.50±0.15 from day 0 to day 90 (p-value=0.001) and the percentage of change also in visual analog scale of McGill pain questionnaire was -43.31%. In group B (Carbamazepine), the changes in pain score from initially 6.07±0.14 falling to 4.23±0.13 from day 0 to day 90 (p-value=0.001) and the percentage of change was -30.31%. Pregabalin was observed to be more potent. Both drugs were well tolerated by all participants that also completed the entire duration of the trial.

The effect of traffic noise on the hearing level of people on Karachi streets.

OBJECTIVE: To study the effects of traffic noise on hearing ability of subjects prone to traffic noise exposure. METHOD: A hospital based prospective study was performed comprising of 200 selected subjects significantly exposed to traffic noise. These included rickshaw drivers, traffic constables and shopkeepers in central business area. All subjects were questioned according to a Performa after which ENT examination was carried out followed by Pure Tone Audiometery. RESULTS: Hearing impairment showed correlation with the duration of job when analyzed by linear regression analysis with correlation coefficient r = 0.36 (p < 0.001), Hearing impairment was 33.81 + 0.42 dB according to the duration of job (in years). CONCLUSION: Subjects are perceptually exposed to potentially damaging sound pressure level in the metropolis of Karachi. It was observed that audiologically consistent noise induced hearing loss was found to be 0.42 dB per octave from 500Hz to 2000Hz per year of duration of job.

An unusual foreign body in trachea.

We report a very unusual case of foreign body (FB) in the tracheo-bronchial tract of a male child, who presented to us in the Emergency Department at our tertiary care centre with the complaint of FB in throat, cough bouts and choking sensation with pain and difficulty in breathing for whom an emergency rigid endoscopy was carried out after appropriate investigations.

Carcinoma cheek: regional pattern and management.

BACKGROUND: Oral cancer varies globally and regionally, and is closely linked with geographical, social, economical, biological, ethnic, dietary and environmental factors. In western countries it accounts for about 2-5% while in the south-east Asia for about 40% of all cancers. In Pakistan it is second commonest tumour after bronchogenic carcinoma in males and breast carcinoma in females. The objectives of this study were to find out the pattern of carcinoma cheek in our region, its etiological associations, management and prognosis. This study was conducted in the Otolaryngology and Head and Neck Surgery Department of Civil Hospital, Karachi from April 1995 to December 1998. It was prospective study. METHODS: Forty-five cases of primary carcinoma cheek were diagnosed and investigations including OPG and CT scan were carried out along with other required investigations to evaluate the extension of tumour, bony erosion and metastasis. TNM staging was done. All patients were treated surgically, sent for post-operative radiotherapy or chemoradiation and followed up for 3 years. RESULT: Among 45 cases of oral cancer, 28 were females and 17 were males. Common presenting symptom was growth or ulcer. It was more common in 41-50 years of age. Squamous cell carcinoma (SCC) was found in 95.5% of the cases. Most of the patients 31 (68%) were in T4 stage. Surgical excision was done in all cases with reconstructuion in 23 cases and neck dissection in 39 cases. In the follow up for 3 years, 30 patient remained disease free. CONCLUSION: Carcinoma cheek is a common entity in our region and now it is seen in relatively younger patients. Oral cancer is a self preventable disease. What is required is to develop awareness of oral hygiene and discourage the habit of social carcinogens use. Early diagnosis and treatment offers better chance of cure whereas advance disease has a poor prognosis.