Home Isolated COVID-19 Patients Adhering To Recommended Guidelines: A Cross Sectional Survey In Karachi.

Objectives: To assess compliance level of coronavirus disease-2019 patients with recommended isolation guidelines. METHODS: The cross-sectional phone-based survey was conducted in Karachi, from March to October 2020 after approval from the ethics review board of Dow University of Health Sciences, Karachi, and comprised patients of either gender who had been tested positive and were advised home isolation due to mild/asymptomatic nature of their infection. Data was collected using a predesigned 42-item questionnaire in the light of the guidelines issued by the National Institutes of Health, Islamabad, Pakistan. Data was analysed using SPSS 20. RESULTS: Of the 450 patients approached, 305(68%) responded; 176(57.7%) females and 129(41.1%) males. The overall mean age was 35.16±14.15 years (range: 13-78 years). Of the total, 9(2.95%) patients did not isolate themselves at all, 51(16.7%) came into contact with other people, 75(24.6%) broke the home isolation and 69(22.6%) were sharing their rooms with other family members. Overall, 260(85.2%) participants were keeping themselves updated with the changes in the guidelines through conventional and social media. CONCLUSIONS: Coronavirus disease-2019 patients who were advised home isolation adhered to some but not all of the recommendations.

Surgical Blowhole Incision - An Unconventional Approach to Subcutaneous Emphysema Management Following Blunt Neck Trauma.

Subcutaneous emphysema is the fortuitous entry of air into subcutaneous tissue. Its occurrence in the head, neck, and mediastinum is a result of trauma or surgery. This case describes a 45-year male who presented with massive progressive subcutaneous emphysema, spreading from the peri-orbital area to the upper mediastinum, secondary to tracheal injury following blunt trauma sustained two days before presentation. We present this case to emphasize on simple management and observation of minor laryngo-tracheal trauma which can prevent further unexpected complications. In this case, we used an unconventional approach of making blowhole incision which is not in routine practice. Key Words: Subcutaneous emphysema, Blowhole, Neck trauma.

Assessment of knowledge regarding tracheostomy care and management of early complications among healthcare professionals / Avaliação do conhecimento sobre cuidados com a traqueostomia e manejo de complicações precoces entre profissionais de saúde

Abstract Introduction: Tracheostomy is commonly performed surgical procedure in ENT practice. Postoperative care is the most important aspect for achieving good patient outcomes. Unavailability of standard guidelines on tracheostomy management and inadequate training can make this basic practice complex. The nursing staff and doctors play a very important role in bedside management, both in the ward and in the intensive care unit (ICU) setup. Therefore, it is crucial that all healthcare providers directly involved in providing postoperative care to such patients can do this efficiently. Objectives: The objective of this study is to assess the knowledge regarding identification and management of tracheostomy-related emergencies and early complications among healthcare professionals so as to improve practice and further standardization. Methods: Cross-sectional observational study included two hundred and fifty-four doctors and nurses from four large tertiary care hospitals. The questions used were simple and straightforward regarding tracheostomy suctioning, cuff care, cuff management, tube blockage, and feeding management in patients with tracheostomy. Results: Based on evidence from our study, knowledge level regarding tracheostomy care ranges from 48% to 52% with knowledge scores above 50% being considered satisfactory. Significant gaps in knowledge exist in various aspects of tracheostomy care and management among healthcare professionals. Conclusion: Our findings demonstrated an adequate knowledge level among health care professionals ranging from 48% to 52% with knowledge scores above 50% being considered satisfactory and revealed that gaps in knowledge still exist in various aspects of tracheostomy care and management.

HIGHLIGHTS Healthcare workers should be well versed in identifying tracheostomy management, its complications and responding accordingly. Doctors and nurses (131 =52%) possessed good knowledge about various aspects of tracheostomy care and management. The poorest scores were regarding cuff pressure (38.9%), suction pressure (39.4%) and first response in tube blockade (31.1%). Higher scores were found in age group 26 to 30 years (54.2%) and those having 1-3 years of clinical experience (41.2%). No statistically significant assoiation of knowledge regarding tracheostomy care was apparent with age, gender or years of practice.

Resumo Introdução: A traqueostomia é um procedimento cirúrgico comumente feito na prática otorrinolaringológica. O cuidado pós-operatório é o aspecto mais importante para alcançar bons resultados para o paciente. A indisponibilidade de diretrizes padrão para o manejo da traqueostomia e o treinamento inadequado podem tornar complexa essa prática básica. A equipe de enfermagem e os médicos desempenham um papel muito importante no manejo à beira do leito, tanto na enfermaria quanto na unidade de terapia intensiva (UTI). Portanto, é crucial que todos os profissionais de saúde diretamente envolvidos na prestação de cuidados pós-operatórios a esses pacientes possam fazer isso de forma eficiente. Objetivo: Avaliar o conhecimento sobre a identificação e manejo de emergências relacionadas à traqueostomia e complicações precoces entre os profissionais de saúde, a fim de melhorar a prática e sua padronização. Método: Estudo observacional transversal que incluiu 254 médicos e enfermeiras de quatro grandes hospitais terciários. As perguntas foram simples e diretas em relação à aspiração da traqueostomia, cuidados com o cuff, manejo do cuff, obstrução da cânula e manejo da alimentação em pacientes traqueostomizados. Resultado: Com base nas evidências de nosso estudo, o nível de conhecimento sobre os cuidados com a traqueostomia varia de 48% a 52%, com escores de conhecimento acima de 50% considerados satisfatórios. Existem lacunas significativas no conhecimento em vários aspectos dos cuidados e manejo da traqueostomia entre os profissionais de saúde. Conclusão: Nossos achados demonstraram um nível de conhecimento adequado entre os profissionais de saúde, variação de 48% a 52%, com escores de conhecimento acima de 50% considerados satisfatórios e revelaram que ainda existem lacunas no conhecimento em vários aspectos do tratamento e manejo do paciente traqueostomizado.

DESTAQUES Profissionais de saúde devem estar bem familiarizados com a identificac¸ão do manejo da traqueostomia, suas complicac¸ões e como agir de acordo com a necessidade. Médicos e enfermeiras (131 = 52%) possuíam bons conhecimentos sobre vários aspectos dos cuidados e manejo da traqueostomia. Os piores escores foram em relac¸ão à pressão adequada do cuff (38,9%), à pressão de aspirac¸ão adequada (39,4%) e primeiros socorros em caso de obstruc¸ão da cânula (31,1%). Os melhores escores foram encontrados no grupo 26 a 30 anos (54,2%) e aqueles com experiência clínica de 1-3 anos (41,2%). Não houve associac¸ão estatisticamente significante entre o conhecimento sobre os cuidados com a traqueostomia, idade e gênero e os anos de prática de médicos e enfermeiras.

The Arduous Path to Diagnosis in a Patient With a Unique Cause of Gastroesophageal Reflux Disease.

In the following report, we document a case of gastroesophageal reflux disease (GERD) emerging from a peculiar etiology. A 20-year-old male presented to the out-patient department (OPD) of ear, nose & throat (ENT) of Dow University Hospital in Karachi, Pakistan, by referral from remote hospitals with a complaint of stomach upset. Upon a detailed historical assessment of the patient, the picture of a convoluted path to diagnosis emerged. Considering the patient's short stature and a bony mass on the mandible, a full body bone scan was ordered, uncovering a brown tumor. An elevated serum parathyroid hormone (PTH) level was detected in the presence of elevated serum calcium and low vitamin D levels. Upon subsequent computed tomography (CT) and magnetic resonance imaging (MRI), a cystic tumor of the pancreas was discovered in addition to a parathyroid adenoma which was promptly operated upon through a right-sided parathyroidectomy. The procedure successfully controlled the serum calcium levels of this patient which are suspected to have produced his gastroesophageal reflux-related symptoms. This case highlights the importance of accessible medical infrastructure and one of the unique causes of GERD.

Performance Improvement of Gold Electrode towards Methanol Electrooxidation in Akaline Medium: Enhanced Current Density Achieved with Poly(aniline-co-2-hydroxyaniline) Coating at Low Overpotential.

Electronically conducting poly (aniline-co-2-hydroxyaniline) (PACHA), a copolymer of aniline and 2-hydroxyaniline (2HA), was electrochemically coated on gold substrate for methanol electrooxidation in alkaline media. The electrochemical behavior of PACHA coated gold electrode towards methanol electrooxidation was investigated via cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS) for application in an alkaline fuel cell. Methanol electrooxidation was observed at two different electrode potentials depending on the concentration of the base. At the PACHA coated gold electrode, the methanol oxidation peak was observed at lower overpotential (at 0.19 V) in a solution of high base concentration (1.8 M NaOH), which was 30 mV lower than the peak for the uncoated gold electrode. In addition, the Faradic current Imax obtained on the PACHA coated electrode (20 mA) was two times higher as compared to the Faradic current Imax of the un-modified gold electrode (10 mA). In solution of lower base concentration (0.06 M NaOH), the electrooxidation of methanol became sluggish on both electrodes, as indicated by peak shifting towards positive potential and with reduced faradaic current (at 0.74 V on PACHA coated electrode; Imax 10 mA). The electrooxidation of methanol at both lower and higher electrode potentials was analyzed mechanistically and discussed in light of the literature. EIS results were interpreted using Nyquist and Bode plots. The charge transfer resistance was decreased and pseudo-capacitive behavior changed to conductive behavior when external applied potential was increased from 0.1 V to 0.4 V.

Assessment of knowledge regarding tracheostomy care and management of early complications among healthcare professionals.

INTRODUCTION: Tracheostomy is commonly performed surgical procedure in ENT practice. Postoperative care is the most important aspect for achieving good patient outcomes. Unavailability of standard guidelines on tracheostomy management and inadequate training can make this basic practice complex. The nursing staff and doctors play a very important role in bedside management, both in the ward and in the intensive care unit (ICU) setup. Therefore, it is crucial that all healthcare providers directly involved in providing postoperative care to such patients can do this efficiently. OBJECTIVES: The objective of this study is to assess the knowledge regarding identification and management of tracheostomy-related emergencies and early complications among healthcare professionals so as to improve practice and further standardization. METHODS: Cross-sectional observational study included two hundred and fifty-four doctors and nurses from four large tertiary care hospitals. The questions used were simple and straightforward regarding tracheostomy suctioning, cuff care, cuff management, tube blockage, and feeding management in patients with tracheostomy. RESULTS: Based on evidence from our study, knowledge level regarding tracheostomy care ranges from 48% to 52% with knowledge scores above 50% being considered satisfactory. Significant gaps in knowledge exist in various aspects of tracheostomy care and management among healthcare professionals. CONCLUSION: Our findings demonstrated an adequate knowledge level among health care professionals ranging from 48% to 52% with knowledge scores above 50% being considered satisfactory and revealed that gaps in knowledge still exist in various aspects of tracheostomy care and management.

Relationship of surfactant protein-D with random blood glucose and extra pulmonary infections in type-2 diabetes mellitus.

OBJECTIVES: To compare surfactant protein-D levels in type 2 diabetics and non-diabetics, and to explore its link with random blood glucose and extra-pulmonary infections. METHODS: The case-control study was conducted in 2012-13 at the Dow University of Health Sciences, Karachi, and comprised diabetic cases and non-diabetic controls. Extra pulmonary infections, body mass index and random blood glucose levels were noted and serum surfactant protein-D was analysed using enzynme-linked immunosorbent assay. Data was analysed using SPSS 20. RESULTS: Of the 120 subjects, 60(50%) each were cases and controls. Significant negative correlation was found between surfactant protein-D and infections (rs= -0.495, p=0.0001). A negative association between random blood glucose and surfactant protein-D was found, but it was not significant (p=0.15). Relative risk for extra-pulmonary infections in diabetics was 2 times higher than the controls (odds ratio: 2.10, p=0.04). CONCLUSIONS: Serum surfactant protein-D was found to have negative association with extra-pulmonary infections.

Role of Amphotericin B in Nasal Irrigation for Chronic Rhinosinusitis with Nasal Polyps.

OBJECTIVE: To determine the effect of topical antifungal irrigation fluid containing amphotericin B on nasal polyp and their recurrence pattern, and to study the association of serum IgE in predicting the presence of fungus along with the nasal polyps. STUDY DESIGN: An interventional study. PLACE AND DURATION OF STUDY: Dow University Hospital, Dow International Medical College, DUHS, Karachi, from June 2015 to June 2017. METHODOLOGY: All adult patients having nasal polyps, who had not undergone any previous nasal surgery, were included in the study. Patients aged under 18 years, history of granulomatous diseases, immunosuppression, invasive fungal sinusitis, and pregnant ladies were excluded from the study. The ratio was kept as 1:2; one receiving irrigation with amphotericin B and the other only saline nasal irrigation without the medicine. After surgery, the patients were divided into two groups; 58 patients were in the placebo group and 29 in the amphotericin group. Serum IgE levels were documented before and one month postoperative treatment. Serum IgE level of more than 250 ng/ml was taken as a high value. All the patients were followed for six months. Recurrence was defined as the recurrence of nasal symptoms and recurrence of mucosal thickening based on repeat CT scan. Frequency tables and cross tabulations using Chi-square test were performed with p-values of 0.05 taken as significant were performed on different variables. RESULTS: A total of 87 patients were inducted. Overall 22 (25.3%) patients had recurrence of symptoms at six-month followup visit. Twelve (13.7%) of these were in the placebo group and 10 (11.5%) were in the amphotericin B nasal irrigation group. Serum IgE level preoperatively ranged between 52 - 9344 ng/dl; postoperatively it ranged from 13-1050 ng/dl. When pre and postoperative serum IgE level were compared with each other and CT scan scores, using Chi-square test, the difference was significant (p<0.001). CONCLUSION: Amphotericin B improved the CT scan score of the patients. The nasal irrigation of amphotericin B did not show significant change in the recurrence pattern of chronic sinuses with polyps. Serum IgE can be used as marker for the presence and response to treatment for non-invasive fungal sinusitis.

Efficacy of Empirical Therapy With Combined Ciprofloxacin Versus Topical Drops Alone in Patients With Tubotympanic Chronic Suppurative Otitis Media: A Randomized Double-Blind Controlled Trial.

BACKGROUND: One of the prevailing otologic infections in our country is chronic suppurative otitis media, especially the tubotympanic type for which various treatment protocols are followed. Usually, oral and topical antibiotics (mainly quinolones) are given alone or in combination. There is a lack of consensus as to whether topical drops alone are effective or a combined oral and systemic therapy should be prescribed. In our study, we have attempted to observe the efficacy of empirical therapy with combined ciprofloxacin versus topical drops only in patients with tubotympanic chronic suppurative otitis media for control of infection. METHODOLOGY: A total of 100 patients visiting the outpatient ENT department at our tertiary care hospital with clinically diagnosed chronic suppurative otitis media (tubotympanic type) were enrolled in our study. The study was reviewed and accepted by the ethical review committee. A detailed proforma was filled for all patients. All patients after aural toilet were subjected randomly to one of the 2 treatment methods, ie, topical ciprofloxacin ear drops plus an oral placebo or combined oral and topical ciprofloxacin. These patients were reviewed after 1 week of treatment. RESULTS: It was observed that 48 of 50 (96%) patients responded to treatment in the group receiving topical ciprofloxacin, whereas 49 of 50 (98%) patients responded in the group receiving combined therapy. This difference was not significant. Moreover, age, sex, and duration of discharge did not have any effect on treatment. There were minimal side effects in both groups, which were also not significant and disappeared after discontinuation of treatment. CONCLUSIONS: The results of this study show that topical ciprofloxacin drops were as effective as combined oral and topical ciprofloxacin and that the addition of oral drug did not have any beneficial effect and added only to the cost of treatment.

Career Choices of Medical doctors at Graduate level - A Multicenter Study.

OBJECTIVE: To find out the specialty choices being taken by Final year Medical students and graduate Doctors. METHOD: This is a cross sectional survey study which was conducted over two months from 1st November to 31st December 2016. Final year students and house job doctors were asked for the filling of Performa, after filling the consent form. A self-developed, anonymous questionnaire was used to conduct the study using close ended type of questions. This was a multi-center study conducted at Dow International Medical College and Jinnah Medical and Dental College. An IRB approval was taken for the study. A total of 317 individuals completed the Performa. Demaographic data included information regarding the year of passing, number of family members already in the medical profession, then specific questions were asked regarding their future career choice and the reason for choosing that particular speciality. After collection of data from both the centers a single operator entered the Data on SPSS 16 version. Frequencies and chi-square test were performed and p-valves were tabulated. RESULTS: A total of 317 individuals completed the Performa. Two hundred and nine participants (65.9%) were females and one hundred and eight (34.1%) were male participants. The age ranged from 22-29 years mean of 25.15 and SD of 1.348. One hundred and twenty one (38%) had a family member as a doctor in the family. Medicine and allied was the most sought after specialty 184(58%), followed by surgery and allied in 108(34%). Non-Clinical Specialty such as radiology, basic sciences was taken up by 27(7.9%). CONCLUSION: The working hours followed by passion for the chosen field were the important reasons for selecting any specialty. The next most important reason was higher income and other family responsibilities of an individual. The ladies are opting more for fields with a controllable life style.

Frequency of different blood groups and its association with BMI and blood pressure among the female medical students of Faisalabad.

OBJECTIVE: To determine the frequency of different blood groups among female medical students and to find the association of blood groups and body mass index with blood pressure. METHODS: This cross-sectional study was performed at the University Medical and Dental College, Faisalabad, Pakistan, from March to April 2016, and comprised female medical students. Participants were divided into groups on the basis of their ABO blood groups and on body mass index criteria. Blood groups were determined by simple conventional slide method. Blood pressure was estimated by manual auscultatory technique with a mercury sphygmomanometer. Data was analysed usingSPSS20. RESULTS: There were 145 students with an overall mean age of18.4±0.75 years (range: 17-23 years). Blood group B was the predominant group 65(44.8%). Besides, 130(89.6%) subjects were rhesus positive and 23(53%) subjects of blood group O were pre-hypertensive. Multiple regression analysis indicated significant positive association of blood group O with both systolic and diastolic blood pressure (p=0.002, 0.001). However, subsequent logistic regression showed significant association only with diastolic blood pressure (p=0.001). Relative risk of pre-hypertension for obese (p=0.001) was greater than non-obese subjects. Body mass index was significantly associated with both systolic and diastolic blood pressure (p=0.004, 0.042). CONCLUSIONS: Blood group B was the most common blood group. Blood group O was associated with diastolic pre-hypertension, while body mass index was associated with both systolic and diastolic pre-hypertension.

Relationship of Oral Tumor Thickness with the rate of lymph node metastasis in Neck based on CT Scan.

OBJECTIVE: To determine the relationship of tumor thickness of oral lesions with metastasis in neck based on CT scan. METHODS: A total of 58 oral squamous cell carcinoma patients having the median age of 46 (39-55) years. with either gender presented with malignant tumor of buccal mucosa and tongue were prospectively enrolled. A CT Scan with contrast was performed on all patients. Correlation of tumor thickness level with metastasis in neck was calculated using spearman's rank correlation coefficient test. RESULTS: Median age of the patients was 46 (39-55) years with preponderance of male gender, i.e. 48 (82.8%). Strong positive significant correlation was observed in between transverse dimension (TS) tumor size and stages of tumor (rho 0.673, p-value <0.001), Anterioposterior (AP) tumor size and stages of tumor (rho 0.675, p-value <0.001), and Craniocaudal (CC) tumor size and stages of tumor (rho 0.771, p-value <0.001). CONCLUSION: CT scan of neck with contrast can be used for predicting the positive presence of lymph node in neck with primary tumors having a size of more than 4 mm.

Endoscopic repair of cerebrospinal fluid rhinorrhoea in a developing country.

The objectives of the study was to determine the causes and outcome of endoscopic repair of cerebrospinal fluid (CSF) leak in a developing country. A total of five patients were recruited in the study. The age of patients ranged from 8 to 65 years. Four patients were male and one was female. In two cases of iatrogenic injury, the first was in the sphenoid sinus. The second was following functional endoscopic sinus surgery (FESS). Fascia lata was used to repair all cases. Beriplast was used as sealing agent in four cases and clotted blood was used in remaining case. Despite the small number, CSF rhinor rhoea was resolved in all cases. The patients were followed up for 2.5 to 6.5 years. Endoscopic repair is a viable option even in developing countries. It is cost effective and has a very low morbidity rate with no mortality at all.

Role of irrigation with hypertonic saline for a recurrent skull base hydatid cyst: case report and review of the literature.

Hydatid cyst is a parasitic disease caused by the tapeworm Echinococcus granulosus. This disease is a rare finding in the head and neck region, and its presentation varies according to the area involved. We report the case of a 25-year-old woman who presented with bilateral neck swelling, which was found on histopathologic examination to be caused by a hydatid cyst. The patient underwent surgical drainage of the cyst and a modified radical mastoidectomy, followed by a 3-month course of treatment with albendazole. However, she experienced a recurrence in the left neck region 1 year later. At that time, reexploration of the left mastoid cavity was performed, with debridement of diseased occipital bone and foramen magnum. Intraoperatively, we used a novel method of saline irrigation with 3% hypertonic saline, previously not tested on exposed nerves, in an attempt to prevent further recurrence. Four years after the second surgery, no disease recurrence was found, and no neurologic sequelae were noted. We conclude that hypertonic saline irrigation can be considered as an option for preventing recurrence in cases that are difficult to clear surgically, especially around cranial nerves, although more studies are needed to document the safety of this approach.

Pediatric tracheostomy: complications and role of home care in a developing country.

INTRODUCTION: Tracheotomy in its earlier days was most commonly performed for acute airway infection in children. Its indications are now changing; it is now most commonly performed for congenital malformations (McMurray and Prescott in Practical pediatric otolaryngology. W.B. Saunders Company, Philadelphia, pp 575-592, 1996). This shift in indication has increased the rate of survival of such patients, and therefore the number of children going home after tracheostomy has also increased. OBJECTIVE: This study was conducted (1) to observe the pattern of indication and complications for tracheostomy, in our part of the world, (2) the rate at which tracheostomy can help wean patients off the ventilator, and (3) the feasibility of sending these children home with tracheostomy. MATERIALS AND METHODS: A retrospective study was done on 127 patients. The indications, final outcome and the complications encountered in and outside the hospital were studied through review of charts. RESULTS: Based on the main indications, patients were grouped into: prolonged ventilation group (PV) 61%, followed by mechanical obstruction group (MO) 22%, and the last being adjunct to surgery group (AS) 17%. The in-hospital complication rate was 30% and that at home was 18.11%. The most common complications included upper respiratory tract infections, and blockage or displacement of tubes. The late complication rate was 4%. Hundred (78.8%) patients on the ventilator could be successfully weaned off, with a p value of 0.001; 81 were sent home with the tracheostomy tube (TT). Forty of these were successfully decannulated and the overall decannulation rate was 48.8%. CONCLUSION: A large number of tracheostomies have been performed in the PV group to reduce the intensive care unit (ICU) stay and to prevent nosocomial infections. The need arises from the high cost of prolonged stay in an ICU setup, which is a cause of major economic burden, and lack of financial assistance for these patients worsens the scenario. Home care of the tracheostomy tubes remains a good option for patients requiring long periods of time to overcome their primary pathology.

Incorporating the endoscope into middle ear surgery.

We conducted a study to evaluate the use of a pediatric rigid otoendoscope for determining the extent of middle ear disease and for assessing ossicular integrity and mobility during tympanoplasty. Our study population was made up of 132 patients who were undergoing surgery for the treatment of chronic suppurative otitis media; of this group, 41 patients underwent otoendoscopy and 91 underwent scutum lowering for purposes of visualization. In the otoendoscopy group, the ossicles were successfully visualized and their mobility assessed in 34 patients; the remaining 7 patients subsequently underwent scutum lowering. A 30 degrees endoscope allowed for complete visualization of the middle ear in almost all of the 34 cases. The mean duration of surgery for the 34 patients in the otoendoscopy group was 62.85 minutes (+/- 15.57), which was significantly shorter than the duration of surgery (71.23 +/- 15.65 min) for the 98 patients who underwent scutum lowering (p < 0.005). A total of 50 patients required less than 60 minutes of surgical time--26 of 34 (76.5%) in the endoscopy group and 24 of 98 (24.5%) in the scutum-lowering group. Statistical analysis revealed that the possibility of completing a procedure in less than 60 minutes was 73.65% (+/- 12.56%) when endoscopy was used and 58.62% (+/- 12.60%) when scutum lowering was used--again, a statistically significant difference (p < 0.005). We conclude that incorporation of an angled otoendoscope into middle ear surgery is a worthwhile alternative to scutum lowering.