Lingual tuberculosis.

Tuberculosis is a common disease in developing countries like Pakistan. Although it can involve almost any region of the body, some presentations are still very rare. This is a case report of a 36 years old male with tuberculous lesion on the tongue presenting as a lump. Patient also had disseminated disease. There are very few cases reported of this rare presentation across the globe.

Does the added benefit of ondansetron over dexamethasone, to control post-operative nausea and vomiting, justify the added cost in patients undergoing tonsillectomy and adenotonsillectomy?

OBJECTIVE: To investigate comparative effectiveness of ondansteron and dexamethasone in prophylaxis of PONV in tonsillectomy and adenotonsillectomy patients. METHODS: The study was conducted at Shifa International Hospital Islamabad from 1st January to 30th June 2009, on 60 patients undergoing tonsillectomy or adenotonsillectomy, with their consent. After consecutive alternate sampling, patients were divided into two groups containing 30 patients each. Ondansteron was given in one group, and Dexamethasone in the other group, as anti emetic, at the time of induction. Episodes of PONV were recorded at three specified intervals, i.e., immediate postoperative, 6 hours after surgery and 12 hours after surgery. Data was entered on a pre-designed performa. The data was analyzed in SPSS Version 13.0. RESULTS: Ondansteron Group had a mean age of 12.7 +/- 9.54 years (5-36 years). There were 22 (73.3%) males and 8 (26.7%) females. Dexamethasone Group had a mean age of 14.8 +/- 8.4 years (5-35 years) of whom 18 (60.0%) were males and 12 (40.0%) were females. Overall 6 patients who received ondansetron had PONV compared to 7 patients in the dexamethasone group. This difference was statistically insignificant (p > 0.05). CONCLUSION: Dexamethasone was equally effective in controlling PONV in tonsillectomy and adenotonsillectomy patients. The improved benefit of using ondansetron over dexamethasone, on a regular basis, does not justify the added cost.

Tympanic temperature comparison with oral mercury thermometer readings in an OPD setting.

OBJECTIVE: To observe and compare the Tympanic Temperature (TT) readings with the Oral Mercury Thermometer (OMT) in an OPD setting. STUDY DESIGN: Observational comparative study. PLACE AND DURATION OF STUDY: The Outpatient Department, Shifa International Hospital, Islamabad, from June to September 2008. METHODOLOGY: By consecutive sampling, 2000 OPD patients were included in the study. Both tympanic membrane and oral cavity temperatures were recorded in each patient. Patients were grouped into four age classes i.e. 5-16, 17-40, 41-60 and above 60 years. Taking the oral temperature as a standard, tympanic temperature recordings were analyzed in each age group for afebrile and febrile temperature ranges. An intra-class Pearson's correlation coefficient (r) was calculated for closeness of correlation of TT with OMT in each group. RESULTS: Mean age of the sample was 31.84+/-19.42 years. Mean temperature reading from the OMT was 36.732+/-0.66 degrees C, while the mean TT reading was 36.575+/-0.71 degrees C. Overall correlation between OMT and TT readings was 0.871 (p<0.001); higher correlation was found in children as compared to adults. In the febrile range, a strongly positive correlation of TT with OMT in the 5-16 years age group (r=0.945) was seen. A poor correlation of TT with OMT was noted for 41-60 and 60 plus groups (r=0.394 and 0.342 respectively). TT was found to have very high specificities in all age groups; highest of 100 in 17-40 years age group. The sensitivities were generally low, the lowest being 33.33 in 60 plus age group. CONCLUSION: TT measurement is a quick method for temperature recording in a busy OPD. However, it is reliable mainly for a younger population.

The predictors of difficult tracheal intubations in patients undergoing thyroid surgery for euthyroid goitre.

OBJECTIVE: To evaluate the influence of goitre on anatomic features and the correlation of these changes with difficulty in intubation. METHODS: A questionnaire was employed to assess 139 patients scheduled for elective surgery of euthyroid goitre to predict the potential of difficult intubation. These measurements were later correlated with the patients who eventually had difficult intubations. Neck circumference, mouth width, lip test, sternomental distance, thymomental distance, Mallampati score and laryngeal palpation were evaluated. RESULTS: All predictors were found to be significant as single predictors but on logistic regression analysis it was found that the circumference of the neck alone, was the independent predictor for difficult intubation. CONCLUSION: Neck thickness in patients with goitre is a significant predictor of difficult intubation and should be used in preoperative assessment to anticipate difficult intubations.

Informed consent in elective surgical procedures: "what do the patients think"?

OBJECTIVE: To analyze the patients' perspective of the process of informed consent in a tertiary care hospital setting. METHODS: A cross sectional survey was carried out at a tertiary care teaching hospital Islamabad and 200 patients were included who responded to the questionnaire. The study extended from March to May 2008. Patients were interviewed by trained personnel. Patients undergoing emergency surgery, minors and medical professionals were excluded form the study. Data was entered and frequencies and percentages were analyzed on SPSS 14. RESULTS: A total of 98% of patients admitted that informed consent was taken, however, only 81 (40.5%) patients understood the information provided. Patients reporting that their decision to proceed with surgery was actually influenced by other people including the treating doctor numbered 112 (56%). Only 58 (29%) signed their own consent form, the rest of them were signed by relatives. Only 96 (48%) patients admitted having been informed about possible complications of surgery as against 156 (78%) who were informed of sequelae of not having the surgery done. Signatures taken by the paramedics were 138 (69%). Despite a poor understanding of the process of informed consent, 187 (93.5%) still felt satisfied with the process of informed consent. CONCLUSION: There is a lack of proper understanding by the population and inadequate system of informed consent in our setting. However, majority of the people still feel satisfied with the information provided. There is a unique family system where decision-making is shared within the family.

Post tonsillectomy haemorrhage: "is day care surgery safe"?

OBJECTIVE: To compare the frequency of haemorrhage after tonsillectomy as a day care procedure versus tonsillectomy as a one day procedure. METHODS: A comparative study was conducted at the Department of ENT and Head and Neck Surgery, Shifa International Hospital, Islamabad from January 2003 to December 2007. The sample consisted of 400 patients, divided into two groups, One group was kept in the hospital for eight hours and was labeled as the daycare group while other group was kept admitted for 23 hours stay (overnight) and was labeled as the one day group. Patients with nasal pathology, bleeding diathesis and less than 4 years of age were excluded. Patients were followed up post operatively on 7th and 14th day and were inquired about any bleeding episode from the mouth during stay at home. The data was analysed at SPSS 13. RESULTS: Post tonsillectomy haemorrhage was seen in 10 patients (2.5%), 4 (2%) occurred in day care group while 6 (3%) in one day group. All were secondary haemorrhages. Chi square test showed no significant difference in haemorrhages between the two groups. CONCLUSIONS: Tonsillectomy can safely be done as a daycare procedure as there is no significant difference of post operative haemorrhage between daycare and one day admission.

Primary aspergillosis of the cheek. A diagnostic dilemma.

Primary cutaneous and subcutaneous aspergillosis is a rare entity and usually occurs secondary to systemic or disseminated aspergillosis. We describe a unique case of primary aspergillosis of the cheek in a 45-year-old male without any evidence of disseminated aspergillosis and recognizable trauma or surgical procedure in the area of cheek.