Objective: To determine the hemostatic and hemodynamic effects of two different doses of epinephrine during endoscopic sinus surgery. Study Design: Randomized Control Trial. Setting: Department of Otolaryngology, Teaching Hospital, D. G. Khan Medical College, Dera Ghazi Khan. Period: 1st January, 2020 to 31st December, 2020. Material & Methods: A randomized control trail was done at ENT Department, Teaching Hospital Dera Ghazi Khan. 96 subjects were included and divided into two groups. Group-A patients received lidocaine hydrochloride, 2%, with 1:100,000 epinephrine while group-B patients received lidocaine, 2%, with 1:200,000 epinephrine. Data were collected through a structured proforma and analyzed using SPSS version 22.0. Numerical variables presented as mean and standard deviation and qualitative variables as frequency and percentages were calculated. Independent sample t test was used to compare the quantitative variables between both groups. Chi-square test was used to estimate the association between qualitative variables. P-value <0.05 was considered significant. Results: Among 30 patients of Group-A, 60.4% were males, mean age was 39.73+10.736 years and the mean blood loss was 202.58+12.218 ml. In Group-B, 64.6% were males, mean age was 39.35+11.421 years and the mean blood loss was 176.90+5.846 ml. In Group-A, mean heart rate at 0 minute, and 5 minutes was 76.54+1.786, and 76.65+1.296 while in Group-B was 75.50+2.568, and 73.88+1.886, respectively. In Group-A, mean SBP at 0, and 5 minutes was 108.17+3.191, and 107.17+2.234 while in Group-B was 106.25+3.795, and 103.56+1.821, respectively. Conclusion: Lidocaine hydrochloride 2% with epinephrine dose of 1:200,000 is more effective during endoscopic sinus surgery than epinephrine dose of 1:100,000 with Lidocaine hydrochloride 2%.
High-grade glioma is also called a malignant glioma because it is fast-growing and spread rapidly through brain tissue. Due to the rarity of high-grade glioma, its diagnosis and management are multi-faceted. We present a case of a 10-year-old girl presented with headache, seizure, and right-sided weakness of upper and lower limbs. Neurological exam revealed reduced power in both upper and lower right limbs with reduced sensation and reflexes. Magnetic resonance imaging revealed an ill-defined altered signal intensity mass involving the left temporal lobe with parenchymal involvement and surrounding perilesional vasogenic edema. Biopsy of the lesion confirmed high-grade glioma. The patient underwent external beam radiation therapy with concomitant daily temozolomide treatment, followed by adjuvant standard temozolomide. However, progressive neurological worsening and an increased lesion size led to partial tumor resection through a craniotomy to remove intracranial hypertension, which was unsuccessful, and the patient could not survive after the procedure.
Objective: To find out frequency of post-thyroidectomy hypocalcaemia among patients undergoing total thyroidectomy. Study Design: A prospective cohort study. Place and Duration: The Department of ENT, Shahida Islam Teaching Hosptial, Lodhran from January 2021 to December 2021. Methodology: A total of 181 patients of both genders aged 12-65 years with multinodular goiter, carcinoma thyroid or recurrent goiter and who were indicated total thyroidectomy were included. At the time of enrollment, demographic characteristics like gender, age and residential status were noted. Pre-surgery thyroid profile and serum calcium were measure from institutional laboratory. Standard procedure protocols were followed for total thyroidectomy. Post-surgery, measurement of serum calcium level was done after 24-hours and serum calcium level<8.0 mg/dL was labeled as hypocalcaemia. Results: In a total of 181 patients as per inclusion/exclusion criteria who underwent total thyroidectomy, 137 (75.7%) were female. Mean age was 43.6+8.2 years while 113 (62.4%) patients were aged between 40-60 years. Residential status of 98 (54.1%) patients was rural. Pre-surgery diagnosis was malignant in 41 (22.7%) patients while it was benign in 140 (77.3%) patients. Post-thyroidectomy hypocalcaemia was noted in 59 (32.6%) patients. Female gender (p=0.0251) and baseline hypertension (p=0.0287) were found to have significant association with post-thyroidectomy hypocalcaemia. Clinical Implications: Following patients of hypocalcaemia would certainly give us information about the proportion of transient hypocalcaemia and permanent hypocalcaemia. Conclusion: Frequency of post-thyroidectomy hypocalcaemia was found to be high (32.6%). Female gender and baseline hypertension were found to have significant association with post-thyroidectomy hypocalcaemia. Keywords: Calcium, carcinoma thyroid, hypertension, hypocalcaemia, multinodular goiter, thyroidectomy.
Objective: To determine the frequency of etiological factors involved in patient of epistaxis presenting at D.G Khan Hospital, D.G Khan. Study design: Cross sectional study Place and duration: Department of ENT, D.G Khan Hospital, D.G Khan from January 2022 to September 2022. Methodology: Total 167 patients with acute episode of nasal bleeding, either male or female, age between 10-60 years were recruited and etiological factors of episode were evaluated. Results: Total 167 patients with Epistaxis were selected. Mean age was 39.03 ± 14.97 years. Age range was 10-60 years, Males were 103 (62%) while females were 64 (38%). The commonest cause of epistaxis was idiopathic 86 (51.5%) cases, followed by nasal trauma 39 (23.4%), Nasopharyngeal carcinoma 11 (6.6%), sinusitis 9 (5.4%), tumors 5 (3%) bleeding disorder 8 (4.8%) and hypertension in 9 (5.4%) patients. Practical implication: Understanding the frequency of etiological factors involved in patients with epistaxis is a critical objective. The practical implications of this research could have significant benefits for the community: 1. Improved Clinical Practice: By determining the common causes of epistaxis, healthcare professionals can improve their diagnostic approach, providing more accurate and timely treatment, ultimately leading to better patient outcomes. 2. Early Intervention and Prevention: Understanding the etiological factors may enable the development of preventative strategies or early intervention approaches, potentially reducing the overall incidence of epistaxis. 3. Education and Awareness: This study could lead to increased public awareness about the common causes of epistaxis, encouraging individuals to take necessary precautions and seek early medical attention when needed. 4. Resource Allocation: Health resources could be better distributed based on the findings of this study, ensuring that facilities and personnel are adequately equipped to handle the most common causes of epistaxis. Overall, this study could substantially contribute to the community's overall health by enhancing the management and understanding of epistaxis. Conclusion: Results was present study showed that most common etiological factor of epistaxis was Idiopathic and nasal trauma was second in number. In most of cases, right nasal cavity was involved. Male were more victim of epistaxis as compared to females and epistaxis was commonly seen in 4th and 5th decade of life. Keywords: Epistaxis, Nosebleed, Idiopathic, etiology, nasal tumor, hypertension, nosebleed
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