Neuropathy following intramuscular injections: a clinical and neurophysiological study from a tertiary care centre in Pakistan.

OBJECTIVE: To assess the clinical and neurophysiological profile of peripheral nerve injuries in patients following intramuscular injections. METHODS: The descriptive, cross-sectional study was conducted at the Department of Neurology, Mayo Hospital, Lahore, Pakistan, from July 2019 to January 2021, and comprised adult patients of either gender with isolated peripheral nerve injuries following intramuscular injections. Nerve conduction studies were performed for each patient. Data was analysed using SPSS 26. RESULTS: Of the 99 patients, 59(59.6%) were males and 40(40.4%) were females. The mean age was 26.7+/-18.1 years, 34(34.3%) patients were under weight and 78(78.8%) were either illiterate or had low literacy level. Radial nerve was involved in 56(56.6%) cases, followed by sciatic in 39(39.4%) and axillary nerve 4(4.04%). Overall, 14(14.14%) injection had been administered by doctors, while the other 85(85.85%) were given by paramadics. Marked reduction in compound muscle action potential 72(72.7%) and sensory nerve action potential 82(82.8%) was noted, while re-innervation was seen in 78(78.7%). CONCLUSIONS: Intramuscular nerve injuries can be greatly minimised by spreading awareness regarding safe injection techniques and strict implementation of standard operating procedures in hospitals and clinics.

Comparison of Endonasal and External Septoplasty for Treatment of Buckled Caudal Septal Deviation.

OBJECTIVE: To compare endonasal and external septoplasty for type 2 caudal septal deviations in terms of operative time, aesthetic and functional outcome. STUDY DESIGN: Descriptive Analysis. PLACE AND DURATION OF STUDY: ENT Department, Mayo Hospital/ K.E.M.U, Lahore, from October 2019 to October 2020. METHODOLOGY: Record of patients operated for septal deviations in 2019 were retrospectively reviewed. All patients, diagnosed with type 2 caudal septal deviations, were included; while those with marked inferior turbinate hypertrophy, deviated nasal septum after trauma, and those who could not be followed-up, were excluded. Twenty-eight patients, operated by external approach, were placed in group A; and 32 patients, who had endonasal surgery, were placed in group B. Functional outcome was assessed by nasal obstruction symptom evaluation (NOSE) scale; and cosmetic deformity was assessed by visual analog scale (VAS) pre- and postoperatively at six months. Operative time was measured for both the groups. RESULTS: Sixty patients were included. Mean preoperative NOSE scale score for group A was 67.36 ± 8.07 and postoperative was 15.82 ± 3.62 (p<0.001). Mean preoperative NOSE score for group B was 69.40 ± 5.80 and postoperative it was 18.00 ± 3.75 (p<0.001). Mean VAS score for group A preoperative and postoperative was 18.93 ± 7.86 and 76.07 ± 6.85 (p<0.001), respectively. Mean VAS score for group B preoperative and postoperative was 19.69 ± 7.82 and 71.56 ± 8.84, respectively (p<0.001). Mean operative time for group B was 52.25 ± 3.37 minutes, and for group A 115.00 ± 9.91 minutes (p<0.001). The difference in preoperative and postoperative NOSE and VAS scores compared for both groups revealed p-value of 0.952 and 0.044, respectively. CONCLUSION: Extracorporeal septoplasty resulted in better aesthetic outcome; though endonasal septoplasty had shorter operative time. Both surgical techniques resulted in good functional outcome. Key Words: Nasal septum, Nasal surgical procedures, Deviated nasal septum, Caudal deviation septum, Septoplasty,  Septorhinoplasty, Nasal obstruction symptoms evaluation (NOSE) score, Visual analogue scale (VAS).

Comparative Analysis of Nasal Smear Eosinophilia and Serum IgE Levels for the Diagnosis of Allergic Rhinitis.

OBJECTIVE: To compare and determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of nasal smear eosinophilia and serum IgE levels for the diagnosis of allergic rhinitis (AR). STUDY DESIGN: Analytical study. PLACE AND DURATION: ENT and Pathology Departments, KEMU/Mayo Hospital, Lahore from January 2018 to December 2019.   Methodology: Two hundred and twenty-one patients presenting with recurrent rhinitis were included in the study. They were divided into two groups: group 1 presented with history suggestive of allergy for more than four weeks and confirmed to be AR on skin prick tests; group 2 patients with negative skin prick tests taken as controls. Both groups were subjected to serum IgE levels and nasal smear for eosinophilia. Prick test was taken as gold standard, and p<0.05 was taken statistically significant. RESULTS: One hundred and twenty-one patients diagnosed as allergic rhinitis on skin prick tests in group 1 and 100 patients as controls in group 2 had negative skin prick tests. Ninety-one (75.2%) patients had AR on nasal smear eosinophilia in group 1 and 89 (73.6%) patients had AR on serum IgE levels in group 1. Sixty-eight patients (56.2%) were males and 53 (43.8%) were females in group 1. In group 2, 51 (51%) were males and 49 (49%) were females. Mean difference in nasal smear eosinophil count and serum IgE levels in AR and control group was statistically significant (p<0.001). Sensitivity, specificity, PPV and NPV of nasal smear  eosinophilia was 77.8%,71.2%, 75.2%, and 74%; and of IgE level was 82.4%, 71.7%, 73.6%, and 81%, respectively. CONCLUSION: Serum IgE and nasal smear eosinophilia levels are helpful in diagnosing allergic rhinitis; however, serum IgE level has better sensitivity and higher NPV than smear eosinophilia. Specificity of both tests is comparable. Key Words: Allergic rhinitis, Nasal smear eosinophilia, Serum IgE level.

Association of Comorbid Conditions with Six-month Survival and Disease Outcome in Patients of Necroinflammatory Otitis Externa.

OBJECTIVE: To determine association of gender, causative organisms, control of diabetes, facial paralysis, infectious agent, and hearing loss with disease outcome, in terms of six-month improvement of symptoms, static condition or expiry of patients presenting with necroinflammatory otitis externa (NOE). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: ENT Department in collaboration with Pathology Department, KEMU/Mayo Hospital, Lahore from 2016 to 2019.  Methodology: Patients with NOE were inducted. Studied variables included age at presentation, gender, diabetes, glycated hemoglobin (HbA1c) levels, comorbid conditions, facial nerve involvement, hearing loss, CT and biopsy findings, and causative organisms; and their association with outcome was observed with significance at p<0.05. RESULTS: Out of 28 patients, there were 17 males (60.7%) and 11 females (39.3%). Association between gender and survival showed that 41.2% (7) males and 27.3% (3) females survived; and 23.5% (4) males and 1 (9.1%) female expired within six months of diagnosis. Thinning of temporal bone (2/5=40%) was common among the expired patients. Twenty percent (1/5) patients diagnosed with squamous cell carcinoma and 80% (4/5)with granulation tissue (GT) expired (p=0.543) All ten patients (100%) that improved had mild to moderate hearing loss (p <0.001). Among expired group, 80% (4/5) had HBA1c of more than 7 and 20% (1/5) had good control of diabetes. Aspergillus (2/5=40%) and Pseudomonas (1/5=20%) were the commonest among expired patients; Staphylococcus (6/10=60%) and Pseudomonas (3/10=30%) infections were more frequent among the survived (p=0.005). CONCLUSION: Previously pseudomonal infection was described as the only causative agent of NOE. This study showed a rising community-acquired disease with Staphylococcus aureus 6/10 (60%) and Pseudomonas 3/10 (30%) infection. Fungal infection is associated with poor survival and death, thus requiring aggressive management. Thinning of temporal bone on CT, uncontrolled diabetes, sever hearing loss and facial paralysis score V/VI were associated with poor outcome of disease. Key Words: Necroinflammatory otitis externa, Pseudomonas aeruginosa. Diabetes, Hearing loss, Facial paralysis, Temporal bone thinning, CT scan.

Glucose Transporter 1 Overexpression in Oral Squamous Cell Carcinoma.

OBJECTIVE: To determine association of immunohistochemical over expression of GLUT 1 (Glucose transporter 1) in oral squamous cell carcinoma (SCC) with histopathological grade and smoking. STUDY DESIGN: Descriptive cross-sectional study. PLACE AND DURATION OF STUDY: Pathology Department, King Edward Medical University (KEMU), Lahore, from January 2018 to July 2018. METHODOLOGY: Paraffin blocks of diagnosed cases of oral SCC presenting at Pathology Department, KEMU, were selected for immunostain GLUT 1. Tumor was graded by WHO 2010 grading. Immunoreactive score (IRS) was calculated for GLUT 1, by multiplying proportion and intensity score of stain. Data was analysed by SPSS 21. Chi-square test was used to measure correlation between GLUT 1 staining, smoking and grade of tumor. P<0.005 was taken as significant. RESULTS: A total of 60 biopsies were included in the study. GLUT 1 was positive in 52 (86.6%) and negative in 8 (13.3%) biopsies. When differentiation of tumor was compared with GLUT 1 positivity with the help of Chi-square test p<0.001 and 95% CI, out of 52 positive biopsies 32 (61.5%) were well, 18 (34.6%) were moderately and 2 (3.8%) were poorly differentiated. GLUT 1 was positive in 43 (82.7%) and only 9 (17.31%) of non-smokers. GLUT 1 was negative in 7 (87.5%) smokers and positive in only 1 (12.5%) of smokers. CONCLUSION: GLUT 1 is positive diffusely in oral SCC with higher expression in lower grades of tumor. As the tumor loses squamous differentiation, it also loses GLUT 1 receptors and thus expression. Smoking has no significant relation with tumor differentiation or GLUT 1 expression.

Prognostic Value of p53 Expression Intensity in Urothelial Cancers.

OBJECTIVE: To determine association of immunohistochemical expression intensity of p53 with grade and stage of urothelial cancers. STUDY DESIGN: Descriptive cross-sectional analytical study. PLACE AND DURATION OF STUDY: Pathology Department, King Edward Medical University, Lahore, from January to December 2016. METHODOLOGY: Data of transurethral resection/radical cystesctomy urinary bladder biopsies was collected. Clinical, radiological and cystoscopic findings of patients were noted from patients' charts in the Urology Ward. Biopsies were graded histologically according to WHO 2004 grading system. TNM system was used for pathological staging. On selected slides, immunoshistochemistry for p53 was applied. Nuclear immunoreactivity was considered positive if present in >10% of tumor cells and negative if <10% of tumor cells. Intensity was considered weak (less than 15% cells) and strong (more than 15% cells). Data was analyzed by SPSS version 21. Linear-by-linear association was calculated between p53 expression and stage of urothelial tumors, Chi-Square test was used to see association between grade and intensity of p53. Qualitative variables, like grade and stage of carcinoma along with p53 expression, were calculated in terms of frequencies and percentages. P ≤ 0.05 was taken as significant. RESULTS: Out of the 70 patients, 61 (87%) were males and 9 (13%) females. Out of 25 low grade lesions, 4 (16%) cases were p53 positive; and out of 45 high grade lesions, 41 (91%) cases were p53 positive. There was 33% (2/6 cases) positivity in Tis, 55% (16/29 cases) in T1, 72% in T2 (21/29), and 100% in T3a (5/5 cases) and T3b (1/1 case). Strong intensity of p53 staining was noted to be 5.4% (n=25) of low grade and 94.6% (n=45) of high grade tumors. CONCLUSION: p53 expression was greater and more frequently strong in higher grade and stage of urothelial carcinoma. It can be used as a prognostic marker in predicting higher grade and stage of bladder cancer.