Mortality Audit in the Head and Neck Surgery Ward: A Retrospective Study in a Tertiary Care Hospital of Pakistan.

Background Mortality audit is important for healthcare workers, but this data is lacking in developing countries. It helps to provide material about the cause of death, mortality rate, age, and gender. In a surgical department, such information can help identify key public health challenges that are contributing to morbidity and mortality, and this information can help healthcare workers better tackle those pathologies and focus on their prevention and treatment. Materials and methods A retrospective study was conducted at the Department of ENT - Head and Neck Surgery, Pakistan Institute of Medical Sciences Hospital, Islamabad. Five-year data was collected from the mortality register of the ward from January 2019 to December 2023, including the age, gender, surgical diagnosis, course of hospital stay, and cause of death. The collected data was statistically analyzed and presented in the form of tables and figures. Results A total of 53 deaths in 3890 admissions were found on record, with an overall mortality rate of 1.4%. The median age of participants was 61.5 years, with a preponderance of the male gender (n=34; 64.2%). The most common cause of death was head and neck malignancy (n=39; 73.6%), followed by head and neck abscesses (n=9; 17%). The least common cause of death was diphtheria (n=2; 3.8%). Conclusion Death was more common in old-age patients, with more prevalence in the male population. The most common cause of mortality was head and neck malignancy. The total death count almost remained constant through the years.

Exploring the Significance of Vitamin D Levels as a Biomarker in Ear Diseases: A Narrative Review.

This narrative review examines the role of vitamin D as a biomarker in ear disorders, including benign paroxysmal positional vertigo (BPPV), otitis media, bell's palsy, Meniere's disease, and hearing loss. PubMed, The Cochrane Library, and Google Scholar were utilized to conduct a comprehensive literature search, and findings were combined from studies from 2014 to 2024. As highlighted in this review, there is a consistent association between vitamin D deficiency and an increased risk and recurrence of disease especially in BPPV and otitis media. Its importance as a prognostic biomarker is emphasized in Bell's palsy, where higher levels of deficiencies in vitamin D are associated with higher grades of severity on the House Brackmann grading system. Vitamin D deficiency can also lead to sensorineural hearing loss due to its receptors present in the inner ear or its effect on calcium metabolism. Serum levels of vitamin D have also been shown to influence treatment outcome of sensorineural hearing loss. The role of vitamin D in Meniere's disease is unclear as no cause has been identified for the increase in endolymphatic fluid. The findings of this review emphasize the importance of serum vitamin D as a biomarker in ear disorders and advocate for more studies to be conducted to assess the importance of optimal dosing of vitamin D for the progression and outcome of these diseases.

Comparison Between Complications of Elective and Emergency Tracheostomies.

Introduction Tracheostomy, although a common surgical procedure, is associated with potential complications. Complications can be avoided with accurate technique and proper operative and postoperative care. A surgeon should know the complications of the procedure and how to avoid them so that complications may be prevented or minimized. Objective To determine the frequency of complications in patients undergoing elective and emergency tracheostomies. Methods The cross-sectional study was conducted at the Department of Otorhinolaryngology - Head and Neck Surgery, and Intensive Care Unit (ICU) of PIMS Hospital, Islamabad, from March 1 to August 31, 2023, with a total duration of six months. A total of 110 patients admitted to the ICU and presented in an emergency falling within the inclusion criteria were counted in the study. Patients were split into two groups, i.e., elective tracheostomy (group A) and emergency tracheostomy (group B). All patients were followed for three months for adverse events related to the tracheostomy. All information was collected on Proforma and analyzed using the SPSS 23 version (IBM Corp., Armonk, NY). Results The mean age of participants was 48.47±12.68 years in group A and 49.54±10.99 years in group B (p=0.636). 40 (72.7%) and 37 (67.3%) patients were male and 15 (27.3%) and 18 (32.7%) female in groups A and B, respectively. The results of post-operative complications in both groups A and B were observed, respectively, for surgical emphysema (2 [3.6%] vs. 5 [9.1%], p=0.241), hemorrhage (2 [3.6%] vs. 4 [7.3%], p=0.401), wound infection (3 [3.6%] vs. 6 [10.9%], p=0.279), tube blockage (0 [0.0%] vs. 1 [1.8%], p=0.315), tube displacement (0 [0.0%] vs. 3 [5.5%], p=0.079), and tracheoesophageal fistula (0 [0.0%] vs. 2 [3.6%], p=0.154). The overall complications in elective tracheostomies were 7 (12.7%) and in emergency tracheostomies were 21 (38.2%). Conclusion We concluded that patients who had an emergency tracheostomy experienced more postoperative complications than those who underwent an elective tracheostomy.

Relationship of Hearing Loss and Tympanic Membrane Perforation Characteristics in Chronic Suppurative Otitis Media Patients.

Objective The objective of this study is to assess the relationship between the site of tympanic membrane (TM) perforation and the type and degree of hearing impairment. The secondary objective was to compare the duration of the disease and the degree of hearing loss. Study design This is a prospective observational study. Place and duration of the study This study was carried out in the Department of Otolaryngology/Head and Neck Surgery at the Pakistan Institute of Medical Sciences, Islamabad, from May 2021 to April 2022. Patients and methods Of all the screened patients, 77 fulfilled the inclusion criteria. Patients aged 10-40 years with inactive mucosal chronic otitis media and unilateral perforation in one quadrant were included. The site of TM rupture was observed, and audiometric analysis was performed. Results The mean age of participants was 25 ± 8.61 years, with a preponderance of the female gender (57.1%). A total of 32 (41.6%), 19 (24.7%), 19 (24.7%), and seven (9.1%) perforations involved posterosuperior, anterosuperior, anteroinferior, and posteroinferior quadrants respectively. Conductive, mixed, and sensorineural hearing loss was found in 52 (67.5%), 18 (23.4%), and seven (9.1%) cases, respectively. Of all the subjects, 13 (16.9%) had the disease for < one year, 39 (50.6%) for one to five years, 17 (22.1%) for five to 10 years, and eight (10.4%) for > 10 years. There was a statistically significant association between the degree of hearing loss and the site of perforation. No significant association was found between the site of perforation and the type of hearing loss. Duration of disease and degree of hearing loss also had no significant association. Conclusion The extent of hearing loss was found to be directly influenced by the anatomical site of perforation, with the posterosuperior quadrant perforation producing the greatest degree of impairment.

Burnout among surgeons; depression, anxiety and stress between consultant versus post-graduate trainee.

OBJECTIVE: To compare depression, anxiety and stress between consultant and post-graduate trainee (PG-trainee) surgeons and to find the difference of different factors i.e. gender, marital status, physical activity, BMI, comorbidity and Income per month between the two. METHODS: A descriptive cross-sectional study of eight months duration from March 2018 to August 2018 was conducted in Military Hospital and Combined Military Hospital, Rawalpindi, Pakistan. Convenient sampling technique was used. DASS 21 questionnaire was used for data collection. Data were entered and analysed by SPSS 22. A p-value of < 0.05 was considered statistically significant. RESULTS: The mean age of participants was 37.44±10.512 years. Out of 68 participants, 54 (79.4%) were males and 14 (20.6%) were females. There was a significant difference between the consultants and PG trainees in terms of gender, marital status and income per month (p= <0.005) PG-trainees were more depressed and anxious but not stressed as compared to consultants (p= 0.014, 0.012 and 0.280 respectively). CONCLUSIONS: There was a significant association in terms of gender, marital status and income per month between consultants and PG trainees. A statistically significant association was found between consultants and PG trainees concerning depression and anxiety showing PG trainees were more depressed and anxious.