Diagnostic accuracy of MR mammography in diagnosing malignant breast lesions taking histopathology as gold standard

Objective: To find out the diagnostic accuracy of MR Mammography in diagnosing malignant breast lesions taking histopathology as gold standard

Study Design: Cross-sectional survey

Place And Duration Of Study: Department of Radiology in collaboration with Department of Pathology, Sir Ganga Ram Hospital, Lahore, from April 2015 to April 2016

Methodology: 150 female patients with either suspicious mammographic findings or palpable lesions suspicious for malignancy referred from surgical OPD of Sir Ganga Ram Hospital were assessed. Dynamic contrast enhanced MRI was done on 1.5 Tesla MRI machine and the images were evaluated on morphological and kinetic basis. MR findings were then compared with preoperative FNAC and biopsy findings

Results: The mean age of the patients was 52.5 +/-13.4 years with maximum patients of age group 46-55 years. Out of 150, 118 [78.6%] patients were found to have malignant lesions on MRM while 116 [77%] patients were proved to have malignant lesions on histopathology. There was 93.9% sensitivity, 73.5% specificity, 89.3% diagnostic accuracy, 92.3% PPV, and 78.1% NPV of MR mammography in diagnosing malignant breast lesions taking histopathology as gold standard

Conclusion: Breast MRI has high sensitivity, specificity, and diagnostic accuracy in diagnosis of malignant breast lesions and must be used as primary imaging tool for proper characterisation of the breast lumps

Normal interpupillary, inner canthal distance and outer canthal distance in a normal population of Pakistan

Objective: This study was conducted to quantify the normal indices of anthropometric measures related to ophthalmology including Interpupillary distance [IPD], Inner canthal distance [ICD], Outer canthal distance [OCD] in a normal, healthy Pakistani population

Methods: This is a cross sectional study. Total 500 patients were chosen randomly but 499 were included in this study. Patients were selected randomly in an outpatient department of Jinnah Post Graduate Medical Centre Karachi, over the period of five months. IPD, ICD and OCD all measurements were taken with the help of plastic rule by only one researcher to minimize chances of error as much as possible. IPD was reconfirmed from auto refractometer while ICD and OCD readings were taken twice by occluding one eye of researcher to reduce error. Participants were divided into four categories on basis of: Age, Gender, ethnicity and geographical location. Patients were further categorized on basis of Ethnicity to Urdu Speaking, Sindhi, Punjabi, Pathan, and others. Moreover, four age groups were drawn ranging from 15-24 years, 25-44 years, 45-64 years and 65 years and greater

Results: Our study comprised a total of 499 patents of which 272[54.5%] were males, and 227[45.5%] were females. The mean age of the participants was 39.3 +/- 14.5 years. The mean values for the IPD, ICD and OCD in mm were 61.8 +/- 6.2, 30.9 +/- 2.9 and 85.2 +/- 6.6 respectively. A statistically significant difference was observed between IPD, ICD and OCD Indices among male and female study participants [p<0.001, p=0.043, p<0.001]. While comparing the IPD, ICD and OCD indices amongst the different ethnic groups, we found no statistically significant difference [p=0.09. p=0.28, p=0.06]. Overall, there was no correlation between the age and other variables i.e. IPD, ICD, OCD, [r = 0.07, p = 0.085], [r = 0.005, p = 0.906], [r = -0.08, p = 0.058]

Conclusion: This work has recommended normative values of IPD, ICD and OCD in Pakistani population on the basis different variables including gender, age, and ethnicity

Comparison of mean pain scores for the patients with sub hepatic drainage to those without it after elective uncomplicated laparoscopic cholecystectomy

Objective: The sub hepatic drain is often placed after laparoscopic cholecystectomy is considered to affect post operative infection, pain and sub hepatic collections. The objective of this study was to compare the degree of postoperative pain in patients with routine drainage with those without it after elective, uncomplicated laparoscopic cholecystectomy

Methods: This randomized control trial [RCT] was done over six months from 9th June 2015 to 8th December 2015 at Military Hospital Rawalpindi. Sample calculated with WHO calculator and consecutive non probability random sampling used to divide 170 patients undergoing laparoscopic cholecystectomy in two groups. One group had routine sub hepatic drain and other didn't. Degree of postoperative pain was assessed according to VISUAL ANALOGUE SCALE by duty doctor at 24 hours. Data was collected and analyzed applying chi square test and p value was <0.05 considered statistically significant

Results: Our results demonstrated that intensity of post operative pain in routine drainage group is higher as compared to non drainage group after elective, uncomplicated laparoscopic cholecystectomy

Conclusion: Routine placement of sub hepatic drain in elective uncomplicated laparoscopic cholecystectomy should be avoided to reduce post-operative pain

Immature to total neutrophil ratio as an early indicator of early neonatal sepsis

Background and Objectives: Neonatal septicemia is responsible for 1.5 to 2.0 million deaths/year in the under developed countries of the world. Pakistan is number three among these countries and accounts for 7% of global neonatal deaths. The objective of the study was to determine the role of simple hematological parameter, immature to total neutrophil ratio [I/T ratio] in diagnosing early onset neonatal bacterial infection

Methods: A descriptive cross-sectional study was conducted in Neonatal Intensive Care Unit of Liaquat College of Medicine and Dentistry [LCMD] Hospital from January 2016 to January 2017. A total 85 neonates were admitted with clinical suspicion of presumed early onset sepsis or who had potential risk factors for sepsis like prematurity, prolonged rupture of membranes was carried out. After taking informed consent from parents of admitted neonates, data was collected in a structured questionnaire. Laboratory workup included White blood cell count, CRP, absolute neutrophil count, immature neutrophil count while blood C/S was kept as gold standard. Empirical antibiotics started after sample collection for workup. Manual differential count and immature neutrophil count of the peripheral blood smear was performed by a senior technician masked to clinical information. I/T ratio was calculated from WBC, neutrophils and immature neutrophil count by a simple formula

Results: Out of 85 neonates, 13 had positive blood cultures [15.29%]. The mean white blood count was 18761.18 +/- 8570.75 and mean I/T ratio was 0.1622 +/- 0.0419.About 50% of proven sepsis cases had WBC higher than 26000 as compared to 50% of cases for negative diagnoses that had WBC <15500 . The mean I/T in positive CRP 0.204 +/- 0.04 was non-significantly higher as compared to negative CRP 0.151 +/- 0.034 [p =0.084]. Point biserial correlation revealed that I/T ratio was significant strong correlation [rpb = 0.721, p < 0.001] and overall I/T ratio was a good indicator of a positive and negative blood culture result. The sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] of I/T ratio were 76.47%, 83.82%, 54.16% and 93.44% respectively. Similarly majority of neonates having high I/T ratio also depicts positive C-reactive protein [CRP] [NPV 91.23%]. Therefore, both I/T and CRP showed a high negative predictive value [I/T = 93.44% and CRP = 91.23%] in this study

Conclusion: I/T ratio is a useful tool for early onset sepsis [EOS] with reasonable specificity but cannot be relied upon as sole indicator. Combination of normal immature to total neutrophil Ratio with negative CRP values in neonates with presumed sepsis is an indicator of non-infected neonate which comprised 78.8% of our study population

One-stage Hip Reconstruction for Developmental Hip Dysplasia in Children over 8 Years of Age / 대한고관절학회지

PURPOSE: This study was performed to assess the clinical and radiological outcomes following one-stage hip reconstruction, consisting of open reduction femoral shortening and pelvic osteotomy, for neglected developmental dislocation of the hip (DDH). MATERIALS AND METHODS: This is a retrospective analysis of 77 hips in 65 patients (46 females and 19 males; 12 had bilateral dislocations), operated at a Ghurki Trust Teaching Hospital in Pakistan between 2013 and 2015. The average age at surgery was 11.02±3.43 years. According to the Tönnis classification, there were 10, 14, 22, and 31 patients in grades 1, 2, 3, and 4, respectively. The pelvic procedure utilized in this study was triple osteotomy (47 hips) followed by double and Salter osteotomy (18 and 12 hips, respectively). Postoperative evaluations were conducted using the modified MacKay's scoring system (functional outcomes) and Severin's scoring method (radiological assessment). RESULTS: Postoperatively, there were 38 (49.4%), 19 (24.7%), 14 (18.2%), and 6 (7.8%) hips in Severin grade I, II, III and IV, respectively. According to the modified McKay criteria, there were 22 hips (28.6%) in excellent condition, 44 (57.1%) in good condition, 9 (11.7%) in fair condition and 2 (2.6%) in poor condition. Both patients with poor outcomes had an unstable, painful hip with evidence of avascular necrosis of the femoral head. CONCLUSION: Based on the results presented here, we recommend the single stage procedure of open reduction, femoral shortening and pelvic osteotomy for treatment of DDH in older children with good to excellent functional and radiological outcomes.

Safety of fenbendazole in common peafowl [Pavo cristatus]

The present study was undertaken to find out the safety levels of fenbendazole in common peafowl. This bird, raised on aviaries and zoos, can be severely parasitized with Ascaridia galli [enteric worms] and Syngamus trachea [gapeworm] along with other parasitic worms. Fenbendazole is a highly effective benzimidazole-class anthelmintic in animals. The objective of this work was to provide target animal safety data in young peafowl and to demonstrate reproductive safety in adult birds. During the experimental study, diets containing fenbendazole at 0, 100, 200 and 300 ppm were fed for 21 days [three times the normal treatment duration]. Data for feed consumption, feed conversion rate, and body weights were recorded for each bird in each group. Drug concentrations in different tissues of birds were determined to correlate concentrations with clinical observations, clinical pathology, and histologic findings. There were no morbidities or mortalities after study day 21. Additionally, there were no statistically significant treatment-related differences among above mentioned parameters. Analysis of fenbendazole concentrations in kidney, liver, leg/thigh, and breast muscle and skin with associated fat revealed that, even at the highest dose level used and with no feed withdrawal, fenbendazole concentrations were relatively low in these tissues. These findings indicate that fenbendazole has a relatively wide margin of safety in young peafowl and that the proposed dose of 100 ppm in the feed for 7 consecutive days is well within the margin of safety. In the reproductive safety study, five breeder peafowl farms fed fendbendazole at 100ppm for 7 days and collected data on hatching percentage of peahen eggs before and after treatment. Reproductive performance in peahen was not adversely affected

Palladium glutathione, N-acetylcysteine, D-penicillamine conjugation chemistry

The metalloelement Palladium has a number of potential Pharmaco-clinical advantages. Palladium compounds have antiviral, antibacterial, neuroprotective and antitumor properties. However studies have also indicated some mild to serious toxic effects of Palladium metalloelements. Biothiols are important antioxidants that provide protection against metals toxicity. The interaction of metalloelements with biothiols can provide valuable information about the level of toxicity of the metalloelements and about the protective role of biothiols thereof. In this piece of work the effect of salt and complexes of Palladium on the status of different thiols [GSH, NAC, and D-Pen] in aqueous medium, were examined, The thiol quantification was carried out using Elman's method through UV-visible spectrophotometry and 1 HNMR. Results of the study performed in aqueous medium showed that level of different thiols depleted after the addition of the inorganic salts and organic complexes of Palladium. The mechanism of interaction of Palladium with thiols was examined using H-NMR. The results indicate that the depletion in the level of thiols may be due to 1:1 or 1:2 conjugation of Palladium with thiols. These conjugation reactions further suggest that the Palladium have xenobiotic nature causing oxidative stress and thiols play their role in detoxification and biotransformation of these metalloelements

Epidemic of kala pathar [paraphenylene diamine] poisoning: an emerging threat in Southern Punjab

Objective: To assess cases of the spectrum of Kala Pathar poisoning in all age groups. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital [CMH] Bahawalpur and Bahawal Victoria Hospital [BVH], Bahawalpur, from January 2016 to April 2017

Methodology: All the cases of Kala Pathar [Paraphenylene diamine [PPD]] poisoning, admitted and treated at the study places during said period were included in the study. The assessed variable included gender, age, education status, socioeconomic status, reason of poisoning and mortality. Chi-square was applied for qualitative variables with p-value less than 0.05 was considered significant

Results: A total of 1,258 cases of PPD poisoning were included in the study; 814 [64.7%] females and 444 [35.3%] males. Their age ranged from 5 - 63 years, with median age 21 [IQR 4]. Sixty-six [5.2%] were children and the rest 1,192 [94.8%] were adults. In adults 1,125 [94.37%] cases of PPD poisoning were suicidal and 62 [5.20%] accidental cases; only 5 [0.42%] adults were intentionally poisoned. On the other hand, only one child took it with suicidal intent, 54 [81.81%] ingested it accidentally and 11 [16.66%] children were given poison deliberately with the intent to murder. The overall mortality was 24.08% - 22.81% in adults, and 46.96% in children

Conclusion: Kala Pathar [PPD] is a lethal substance when ingested. PPD poisoning is not limited to adults; many cases of pediatric poisoning are also being reported in Southern Punjab. Mortality due to Kala Pathar is high. Tracheostomy should be done immediately in all such cases; and high intensive multidisciplinary approach is required

Assessing the efficacy of aqueous garlic extract, sodium nitrite and sodium thiosulfate against prolonged oral cyanide exposure in rabbits

This study was aimed to compare the efficacy of aqueous garlic extract, sodium nitrite [SNT], sodium thiosulfate [STS] and hydroxocobalamin against oral cyanide exposure in rabbits. For this purpose, forty two adult male rabbits were divided randomly into 7 groups of 6 animals [A-G] each. Rabbits in group A were offered feed only and served as negative control, while the rabbits in group B received feed plus potassium cyanide [KCN] at 3mg/kg orally and were kept as positive control. Animals in group C received feed, KCN and intraperitoneal injection [IP] of aqueous garlic extract at 500mg/kg. Rabbits in group D were given feed, KCN and IP injection of STS at 600mg/kg. Members in group E received feed, KCN and IP injection of both aqueous garlic extract at 500mg/kg and SNT at 20mg/kg. Animals in group F were given feed, KCN and IP injection of both STS at 600mg/kg and SNT at 20mg/kg, while the rabbits in group G received feed, KCN and IP injection of hydroxocobalamin at 300mg/kg. The treatments were given to respective groups for 40 days. The efficacy of the antidotes was measured on the basis of changes in biochemical profile of rabbits in each group. In this study, hydroxocobalamin was found to be significantly more effective cyanide [CNI] antidote than garlic, STS, SNT plus garlic extract, or SNT and STS, either alone or in combination. A combination of SNT and garlic extract was the second most effective CNI antidote. The efficacy of garlic alone was significantly higher than STS alone or in combination with SNT. The efficacy of combined SNT and STS was superior to STS alone in treating rabbits with CNI toxicity. In conclusion, aqueous garlic extract alone or in combination with STS can effectively be used against cyanide toxicity

Effectiveness of training on de-escalation of violence and management of aggressive behavior faced by health care providers in a public sector hospital of Karachi

Background and Objective: Considering high burden of violence against healthcare workers in Pakistan APPNA Institute of Public Health developed a training to prevent reactive violence among healthcare providers. The purpose of this training was to equip healthcare providers with skills essential to control aggressive behaviors and prevent verbal and non-verbal violence in workplace settings. This study assesses the effectiveness of training in prevention, de-escalation and management of violence in healthcare settings

Methods: A quasi-experimental study was conducted in October, 2016 using mixed method concurrent embedded design. The study assessed effectiveness of de-escalation trainings among health care providers working in emergency and gynecology and obstetrics departments of two teaching hospitals in Karachi. Quantitative assessment was done through structured interviews and qualitative through Focus Group Discussions. Healthcare providers` confidence in coping with patient aggression was also measured using a standard validated tool"

Results: The overall self-perceived mean score of Confidence in Coping with Patient Aggression Instrument "[CCPAI]" scale was significantly higher in intervention group [Mean= 27.49, SD=3.53] as compared to control group [Mean= 23.92, SD=4.52] [p<0.001]. No statistically significant difference was observed between intervention and control groups with regard to frequency of violence faced by HCPs post training and major perpetrators of violence

Conclusion: De-escalation of violence training was effective in improving confidence of healthcare providers in coping with patient aggression

Lack of uniformity in screening, diagnosis and management of gestational diabetes mellitus among health practitioners across major cities of Pakistan

Objective: To determine knowledge, attitude and practice [KAP] regarding management of Gestational Diabetes Mellitus [GDM] among Health Care Providers in major cities of Pakistan

Methods: A knowledge, attitude and practice [KAP] questionnaire based study was conducted in major cities in Pakistan from health care providers in public and private hospitals and clinics. Questionnaires were provided to the health care providers regarding screening, diagnosis and management of patients with GDM. Data analysis was done using IBM SPSS 20

Results: A total of 210 doctors took part in the study. 55[26%] reported using fasting blood glucose as screening test for GDM whereas 129[61.4%] respondents used Oral Glucose Tolerance based WHO criteria for diagnosing GDM. Thirty six [17%] and 98[46.7%] doctors referred their patients to Gynecologists. For treating GDM, 64[30.5%] doctors prescribed insulin [NPH/Regular, 70/30 Mix]. 112[53.5] doctors used combination of capillary glucose by glucometer and plasma blood glucose tests for monitoring of glycemic control of patients with GDM

Conclusion: There is lack of agreed screening tests and criteria for diagnosis and management of GDM patients. Doctors need to be educated to follow evidence based diagnostic and management guidelines so that GDM patients can be effectively managed. Recently released South Asian Federation Societies and Pakistan Endocrine Society guidelines could be much needed consensus guidelines for doctors to apply in their daily practice to improve GDM diagnosis and treatment

Frequency of depression, anxiety and stress among the undergraduate physiotherapy students

Objectives: To assess the frequency of Depression, Anxiety and Stress [DAS] among the undergraduate physiotherapy students

Methods: A descriptive cross sectional study was conducted in various Physiotherapy Institutes in Sindh, Pakistan among undergraduate physiotherapy students. The total duration of this study was 4 months from September, 2016 to January, 2017. Data was collected from 267 students with no physical and mental illness; more than half were female students 75.3%. They were selected through Non probability purposive sampling technique. A self-administered standardized DASS [depression, anxiety and stress scale] was used to collect data and result was analyzed using its severity rating index. Data was entered and analyzed by using SPSS version 21. Descriptive statistics including the frequency of depression, anxiety, stress and demographic characteristic of the participant was collected

Results: The mean age of students was 19.3371+/-1.18839 years. The Frequency of depression, anxiety and stress found among undergraduates Physiotherapy students was 48.0%, 68.54% and 53.2%, respectively

Conclusions: It was observed that the frequency of depression, anxiety and stress among physiotherapy undergraduates students were high. It suggests the urgent need of carrying out evidence based Psychological health promotion for undergraduate Physiotherapy students to control this growing problem

Synthesis, characterization and antihypertensive activity of 2-phenyl substituted benzimidazoles

Hypertension is one of cardiovascular disease that is not sufficiently prevented and controlled at both hospital and community levels. Hypertension resulted in significant morbidity and mortality. The benz-imidazole ring is very important pharmacophore in modern drug discovery. The substituted benzimidazoles are the important for medicinal research. Researchers have reported that substituted Benzimidazoles are the structural isosteres of nucleotides, and easily allow them to interact with the different biopolymers, possess pharmacological activity especially antihypertensive activity. Angiotensin II Receptor Antagonists/Blockers [ARBs] compete with angiotensin II at the receptor site and block the contractile effect of angiotensin II in all vascular smooth muscles. Among all Angiotensin II Receptor Antagonists/Blockers [ARBs], Telmisartan, Milfasartan and many others have benzimidazole ring in their structure. In this study Angiotensin II Receptor Antagonists/Blockers [ARBs] have been prepared. Synthesized compounds were characterized by physical data and FTIR spectroscopic technique. Synthesized compounds studied were finally screened for their antihypertensive activity by tail cuff method of measurement of blood pressure by NIBP apparatus [None Invasive Blood Pressure] using Chart 5.0 software. The compounds synthesized were 2-[3-nitrophenyl]-1Hbenzimidazole [1a], 3-[1H benzimidazol-2-yl]aniline [1b] and 5-[1H-benzimidazol-2-yl]-2-methoxyphenol [1c]. The synthesized compounds have shown antihypertensive activity by taking Losartan as lead compound

Nasal itching and bleeding due to excessive exposure to air conditioners

Introduction: Nasal mucosa is very sensitive when it is exposed to extreme dry and cold weather conditions. Persistent or recurrent nasal itching due to such exposure is usually followed by the epistaxis. Objective of the study was to analyze effects of excessive exposure to dry and cold air of air conditioners on nose in terms of nasal itching and epistaxis

Methods: This prospective cohort study carried out on 144 healthy Pakistani individuals working in United Nations Hospital in Nyala, Sudan from February 2014 to May 2014. Individuals spending less than 8 hours daily inside air conditioners were compared to those spending more than 15 hours daily. Chi square tests were applied to compare the proportions of incidence of nasal itching and epistaxis between these two groups as well as between two age groups

Results: Mean age of all 144 subjects was 35.01 years [+/- 6.4]. Chi square test results confirmed that there was statistically significant difference of both the symptoms [nasal itching p-value 0.021 and nasal bleeding p-value 0.044] between two groups. Those spending more time in air conditioners were significantly more affected by dry and cold air. As for as the age group is concerned significantly higher number of subjects of ages more than 40 years had nasal bleeding compared to the younger age group [equal or less than 40 years]

Conclusion: Effects of exposure of dry air of air conditioners on nasal mucosa in terms of nasal itching and nasal bleeding were found to be significantly higher when subjects were exposed 15 hours or more per day. Furthermore nasal bleeding was more commonly seen in elderly subjects [more than 40 years] due to such exposure

Audit of various otorhinolaryngological diseases in Shangla valley

Objective: To assess the prevalence of various ear, nose and throat diseases in Shangla valley. Study Design: A descriptive cross-sectional study. Place and Duration of Study: Study was carried out in shangla. Duration of study was 3 months, from Jun 2014 to Aug 2014

Material and Methods: All the patients of any age group and both genders who reported with any ENT disorder and emergency were included in this study. Frequency and percentage of various ENT diseases among patients and emergency procedures performed were found

Results: A total of 2725 patients were included. The most common ENT disorder encountered was rhinosinusitis which was seen in 14.2% cases, followed by ear wax [impacted cerumen] in 13.4% and pharyngitis in 12.5% cases. Allergic rhinitis was seen in 10.4% cases, epistaxis in 7.4% and chronic suppurative otitis media in 6.4% cases. Among the emergency ENT procedures performed, anterior nasal packing was the commonest [done in 55 cases] followed by stitching of lacerations and foreign body removal from ear and nose

Conclusion: Ear, nose and throat diseases are very common in Shangla and their spectrum range from rhinosinusitis, impacted cerumen [ear wax] and pharyngitis to less common but potentially dangerous conditions like foreign body impaction in ear and nose

Comparison of chemical cautery versus topical vasoconstrictors in idiopathic pediatric anterior epistaxis

Objective: To compare efficacy of chemical cautery with silver nitrate along with fucidin ointment versus topical vasoconstrictor spray [xylometazoline 0.05%] and fucidin ointment application in idiopathic pediatric anterior epistaxis. Study Design: Randomized controlled trial. Place and Duration of Study: Study was carried out at Combined Military Hospital [CMH] Bahawalpur from Jan 2016 to Dec 2016

Material and Methods: Total 112 patients fulfilling the inclusion criteria were selected from Ear Nose Throat [ENT] outpatient department at CMH Bahawalpur. They were randomly divided into two groups of 56 cases in each group. Group A individuals were treated by cauterization with 75% silver nitrate followed by fucidic acid ointment. Group-B individuals were treated with topical vasoconstrictor spray [xylometazoline 0.05% twice a day for one week] along with fucidic acid ointment. Efficacy was determined in terms of control of epistaxis, whether the procedure was effective in controlling epistaxis or otherwise i.e. patient again developed bleeding from same side of nose and needed further treatment to control epistaxis. All the cases were followed up for two months after procedure to check their efficacy

Results: There were total 61 [54.46%] males and 51 [45.54%] females among the cases. Mean age of patients was 8.27 [+/- 2.34] years. Both the groups were comparable as regards the gender [p=0.817] and age [p=0.749]. Group-A were treated with silver nitrate cauterization followed by fucidic acid ointmnet application and group-B were treated by vasoconstrictor nasal spray along with fucidic acid ointment. In group A [silver nitrate cautery], 87.5% cases had no rebleed during two months follow up and in group-B, 67.8% children had no rebleed during two months follow up period [p=0.022]

Conclusion: Chemical cauterization with silver nitrate along with fucidic acid ointment application was found to be more effective as compared to xylometazoline nasal spray and fucidic Acid ointment application in treating idiopathic pediatric epistaxis

Diagnostic accuracy of ultrasonography in diagnosing maxillary sinusitis

Objective: To determine the diagnostic accuracy of ultrasonography in diagnosing maxillary sinusitis while keeping magnetic resonance imaging as gold standard. Study Design: Cross sectional, validation study. Place and Duration of Study: Radiology Department Combined Military Hospital Rawalpindi, from Mar 2014 to Sep 2014

Material and Methods: Consenting three hundred and ninety-one patients diagnosed clinically as a case of maxillary sinusitis at Combined Military Hospital Rawalpindi during the study period fitting the inclusion criteria were selected. Ultrasonography of maxillary sinuses focusing on mucosal thickening, fluid level and cystr polyp was done for all patients. After ultrasonography all patients underwent MRI at our department to look for mucosal thickening, fluid levels and total opacity appearing hyperintense on T2 weighted sequence. Diagnostic accuracy of ultrasonography was evaluated in the diagnosis of maxillary sinusitis

Results: The sensitivity of Ultrasonography in diagnosis of maxillary sinusitis keeping MRI as Gold Standard was quite low at 40.15%. The ability [specificity] of Ultrasonography in diagnosis of maxillary sinusitis taking MRI as Gold Standard was good i.e. 84.67%. The diagnostic accuracy was encouraging at 55.75%

Conclusion: Ultrasonography had low sensitivity but high specificity in diagnosis of maxillary sinusitis

Efficacy of intravenous lignocain versus sevoflurane in prevention of coughing and desaturation at extubation in children

Objective: To compare the efficacy of intravenous lignocain versus sevoflurane in prevention of coughing and desaturation at extubation in children less than 6 years of age. Study Design: Randomized controlled trial. Place and Duration of Study: This study was carried out at Combined Military Hospital Nowshera, from May 2013 to May 2016

Material and Methods: This randomized controlled trial study was conducted at Combined Military Hospital Nowshera from May 2013 to May 2014 after obtaining approval from the hospital ethics committee [IREC-0003/5/13/Aneas]. Sample size [n=710 patients] was calculated by using WHO Sample Size calculator with confidence level of 95%, level of significance 5%. Children aged three months to six years undergoing surgical procedures requiring the placement of definitive airway were randomly assigned into two groups. Patients were anaesthetized by standardized balanced anaesthesia technique. In group-A [n=355], three minutes prior to extubation lignocain 2% was used intravenously. In group-B [n=355], isoflurane was switched off, breathing circuit changed and sevoflurane started at minimum alveolar concentration [MAC 3-4%] for 3 minutes prior to extubation. Assessment for extubation was clinical. Oxygen saturation and severity of coughing were noted for 5 consecutive minutes, after extubation. Data were analysed by using statistical package for social sciences [SPSS] version 20. A p-value

Results: In group-A, 156 patients were less than 2 years of age while in group-B, 135 patients were less than 2 years old. In group-A, 199 and in group-B, 220 children were 2-6 years of age respectively. Post stratification the p-value for weight was 0.17 [p-value>0.05] and t-statistic was 1.36. Post stratification p-value for gender was 0.12 [p-value>0.05] and chi square statistic was 2.49. Demographic comparison described in table-I. Group A had more eventful extubation with 270 cases of cough [76%] as compared to group-B where it were noted in 199 cases [56%]. Similarly desaturation was observed in 85 cases in group-A [24%] as compared to 28 cases [8%] in group-B. The difference between the groups was satistically significant as shown in table-II and III

Conclusion: Sevoflurane based anaesthetic vapor mixture results in statistically significant prevention from events like coughing episodes and desaturation in post-extubation in children less than six years of age undergoing elective surgery

Correlation of anterior chamber depth with peripapillary nerve fiber layer thickness

Objective: To determine correlation of anterior chamber depth with peripapillary nerve fiber layer thickness. Study Design: Descriptive cross sectional study. Place and Duration of study: Armed Forces Institute of Ophthalmology Rawalpindi, from Apr 2016 to Oct 2016

Patients and Methods: Anterior chamber depth and peripapillary nerve fiber layer thickness was measured in 200 eyes of 110 patients, between 10-40 years of age. Anterior chamber depth was measured in mm, by taking average of 3 readings, measured by optical biometry [IOL Master, Carl Zeiss Meditec, Dublin whereas average peripapillary retinal nerve fibre layer pRNFL thickness was obtained by taking average of 12 segments RNFL thickness measurement, calculated by Spectral domain optical coherence tomography [SD OCT] [3D OCT-1000 Markll, Topcon Co, Tokyo, Japan] after dilating pupils with one drop of 1% Tropicamide, instilled three times, 10 minutes apart. Three readings were taken for each eye. The mean of the three readings was used for the analysis. Pearson correlation [+1/-1] was calculated between anterior chamber depth, peripapillary nerve fiber layer thickness and age

Results: Two hundred eyes of 110 patients were included in the study. Both eyes were considered in 90% of the patient, however only Right eye was considered in 6.3% of the patients while left eye in 3.7% of the patients. Mean age of the patients was 26.58 +/- 8.88 years. Mean visual acuity of patients measured by log MAR was 0.52 +/- 0.12. Mean Anterior chamber depth [ACD] of patients was 3.41 +/- 0.35 while mean RNFL appeared to be 103.26 +/- 8.89 um

Conclusion: It was concluded that anterior chamber depth was neither related significantly with peripapillary nerve fiber layer nor with age

Correlation of curve of spee with maxillo-mandibular discrepancy among different malocclusion groups

Objective: To assess the depth of curve of Spee [COS] in different malocclusion groups, to relate this to the maxillo-mandibular discrepancy using ANB, and to determine whether the depth of curve of Spee is affected by maxillo-mandibular discrepancy. Study Design: Descriptive cross sectional study. Place and Duration of Study: The study was conducted at KRL General Hospital Orthodontic Department, from Aug 2017 to Jan 2018

Material and Methods: One hundred and fifty patients between 18-40 years of age were recruited after filling data collection pro forma from their initial lateral cephalometric radiographs and initial study models. Data was recorded in specially made pro forma and analyzed using SPSS 20.0. Analysis included frequencies, mean +/- standard deviation [SD] and Pearson correlation. A p-value <0.001 was considered significant

Results: Results have established a positive correlation between curve of Spee and ANB values with a highly significant p-value of <0.001. As the value of ANB increases so does the depth of curve of Spee and vice versa

Conclusion: There is a significant difference amongst curve of Spee values of class 1, class II and class III malocclusions which is linearly coherent with ANB values