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Background: Chest radiography is not routinely recommended before certain elective surgeries, considering it as unnecessary investigation. The objective of this study was to evaluate chest radiography as a pre-operative screening test for elective ENT surgeries and to highlight importance of its utility in routine. Materials & Methods: This cross-sectional study was carried out in the Departments of Radiology and ENT Head and Neck Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan from September 2021 to March 2023. 2826 patients, undergoing elective non-cancerous ENT surgery, and their CXR were evaluated preoperatively. Patients with ASA 1 and 2 and aged between 10-60 years were included. CXR were evaluated by radiologist and findings were divided into normal and abnormal with abnormalities further classified into significant and non-significant with respect to organ system. Results: The mean age of participants was 28±9.61 years, with a preponderance of the male gender (60.5%). Of total, 2697 (95.7%), CXRs had no abnormality, while 122 (4.3%) CXRs had abnormalities. Out of 122 total abnormalities, only 25 (20.5%) were significant, while rest 97 (79.5%) were non-significant. Conclusion: Chest x-rays are not regularly required in pre-operative assessment of clinically well patients. Almost all of the patients in our study had no abnormality and those few who had abnormality was incidental and mostly non-significant. [ABSTRACT FROM AUTHOR]

Scleredema Diabeticorum (SD) is a rare condition characterized by diffuse, symmetrical induration along with non-pitted swelling mostly on the upper back as a result of mucin being deposited in the dermis. It can also involve posterior neck, shoulders, and scalp. We report a case of 48 years old female patient from Pakistan, with uncontrolled diabetes mellites type 2 for the last 15 years, presenting with thickened skin at the back of the neck resulting in difficulty in neck and shoulder movements. This led to decreased functional class from I to II causing her to develop insomnia and depression. Scleredema diabeticorum is a difficult disease to manage as it runs a long and debilitating course with little propensity of remission with available treatments. [ABSTRACT FROM AUTHOR]

Crimean Congo Hemorrhagic Fever (CCHF) one of the fatal viral infections has been described in around 30 countries around the world and is endemic in some parts of Pakistan. The fever is transmitted to humans by the bite of an infected tick either by direct contact with the blood or tissue via infected humans and livestock. We present here case of a 34-year-old Pak defense services officer who reported with nonspecific symptoms of high grade fever, myalgias and vomiting but rapidly deteriorated and developed bleeding diathesis. He was diagnosed to have CCHF and managed with Ribavirin, repeated transfusions and IV fluids with strict nursing barrier and use of Personal Protective Equipment (PPE). The patient recovered well. [ABSTRACT FROM AUTHOR]

Adie's pupil, an efferent pupillary defect is caused by injury to parasympathetic pupillomotor nerve supply to Iris sphincter muscle. More commonly seen in young adult females with up to 80% cases having unilateral involvement. According to literature, Adie's Pupil may occur alone or as a part of a systemic condition or may be associated with a syndromic presentation. Bilateral Adie's pupil in a female at initial presentation with mild visual symptoms and no syndromic association is sparsely reported in literature. [ABSTRACT FROM AUTHOR]

Thyroid storm is caused by the excess of thyroid hormone; it is a rare as well as fatal condition. The most effective way to decrease the mortality and morbidity caused by this disease is to diagnose it as soon as possible. The presenting features comprise a multitude of non-specific symptoms such as high fever, tachycardia, heart failure, gastrointestinal upsets, delirium, and coma. We presented a unique incident of thyroid storm in a middle aged woman who was admitted for high fever, confusion and atrial fibrillation. Clinical diagnosis of thyroid storm was augmented by laboratory findings of hyperthyroidism. The patient was managed accordingly and she eventually recovered. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of chewing in addition to pharmacological management of post-tonsillectomy pain and return to the normal diet. Methodology: To determine the impact of chewing gum on post-operative pain, a 12-month comparative cross-sectional study was carried out on 87 post-tonsillectomy patients at the Pakistan Institute of Medical Sciences (PIMS) Islamabad. Two groups of patients having elective tonsillectomy were created: Group A (chewing gum) and Group B. (routine care). Following surgery, patients were monitored to assess postoperative pain using a Visual Analogue Scale (VAS) from day 1 to day 7 and resume their regular diet. Results: Out of 87 patients, 49 (56.3%) belonged to group A, and 38 (43.7%) belonged to group B. Mean age of the participants was 23.8±5.2 years. The total number of male and female participants was 56 (64.4%) and 31 (35.6%) respectively. There was significantly lesser pain experienced by patients in group A as compared to group B from day 2 through day 5 (p<0.001), whereas there were no statistically significant differences observed between the two groups on the 1st,6th and 7th post-operative days in terms of post-op pain (p=0.589, 0.516, 0.376). In terms of resuming a normal diet, there was no statistically significant difference between the two groups. (p= 0.456). Conclusion: Postoperative use of chewing exercises significantly decreases pain in the immediate post-tonsillectomy period and is recommended for use as a non-pharmacological adjunct for post-tonsillectomy pain management. [ABSTRACT FROM AUTHOR]

Background In our setup, head and neck cancer (HNC) is the most common, and patients frequently present at an advanced stage, which results in dismal outcomes. Delays on the part of the patient (such as resistance to seeking treatment) or the provider (such as misdiagnosis or an extended wait period for consultation) may be the cause of a late presentation. The presentation stage may vary depending on several factors, including age, gender, smoking status, job status, and education. Objectives The study aims to identify factors that lead to advanced-stage presentations of HNCs and to determine the delays brought on by patient- or healthcare provider-related factors and how these factors affect HNC disease staging among biopsy-proven HNC patients. Materials and methods Participants in the study were those who initially presented with a biopsy-verified HNC at the cancer clinic of the department of otolaryngology-head and neck surgery at Pakistan Institute of Medical Sciences (PIMS), Islamabad. Patients answered questions on their first symptom presentation, past healthcare professional visits, and intervals between visits on a Cancer Symptom Interval Measure (C-SIM) questionnaire. For every patient, clinical and demographic information was gathered. TNM staging was completed. The test of significance was applied where applicable. Results Age, gender, education level, and smoking status had no bearing on the presentation stage. Patients without jobs present at a statistically significant higher stage (p = 0.038). The most prevalent histological form of HNC was squamous cell carcinoma 79 (82.29%), with the oral cavity and larynx being the most common sites of the disease 30 (31.25%) and 29 (30.21%) respectively. Patients took an average of 5.28 ± 9.12 months from the onset of symptoms to their first appointment with a healthcare provider. Prior to diagnosis, the majority of patients saw three or more healthcare providers (range: 1-8). The duration from the initial visit to a healthcare provider to the initiation of treatment was 3.06 ± 5.88 months. Based on the stage at presentation, there were no discernible variations in the times to presentation (p>0.05). Conclusion Significant delays and high stage of presentation are caused by unemployment. The majority of the delay was caused by the patient's tardiness in seeing a medical practitioner, yet the presentation stage was not greatly impacted by this delay., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Research Review Board, Pakistan Institute of Medical Sciences, Islamabad issued approval F.3-1/2023(ERRB)/Chairman. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Khurshied et al.)

Background Since bilateral nasal packing entails nasal and airway obstruction, this practice consequently leads to oral breathing. The resulting hypoxemia may then negatively impact vital signs, including blood pressure (BP), blood oxygen saturation (SpO2), and heart rate (HR). These systemic effects have a detrimental effect on patients. Objective The objective of this study is to observe the effects of bilateral nasal packing on patients' post-operative vital signs. Materials and methods This prospective study was conducted in the department of otolaryngology - head and neck surgery over a six-month period. The study included 83 post-operative patients with nasal surgery, in which bilateral merocele nasal packing was performed. The patients' pulse oximetry, systolic and diastolic BP, and HR were recorded four times the night before and after surgery. A statistical analysis was performed, and the mean values, standard deviation, and range were calculated. A paired sample t-test was also applied. The results are presented in figures and tables. Results The mean age of the participants was 27.65 ± 10.72 years, and 56 (67.5%) were male. Septoplasty was the most common surgery performed, with 63 participants having undergone this procedure (75.9%). When the pre-operative mean values of systolic and diastolic BP, SpO2, and HR were compared with the post-operative mean values, when a bilateral nasal pack was in place, a significant increase was found in all, with a p-value of <0.001 in each. Conclusion Bilateral nasal packing affects patients' vital signs by significantly increasing diastolic and systolic BP and decreasing SpO2. The HR is also significantly increased when packing is in place., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethical Research Review Board of Pakistan Institute of Medical Sciences issued approval F.3-1/2023(ERRB)/Chairman. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Khurshied et al.)

Background Mortality audit is important for healthcare workers, but this data is lacking in developing countries. It helps to provide material about the cause of death, mortality rate, age, and gender. In a surgical department, such information can help identify key public health challenges that are contributing to morbidity and mortality, and this information can help healthcare workers better tackle those pathologies and focus on their prevention and treatment. Materials and methods A retrospective study was conducted at the Department of ENT - Head and Neck Surgery, Pakistan Institute of Medical Sciences Hospital, Islamabad. Five-year data was collected from the mortality register of the ward from January 2019 to December 2023, including the age, gender, surgical diagnosis, course of hospital stay, and cause of death. The collected data was statistically analyzed and presented in the form of tables and figures. Results A total of 53 deaths in 3890 admissions were found on record, with an overall mortality rate of 1.4%. The median age of participants was 61.5 years, with a preponderance of the male gender (n=34; 64.2%). The most common cause of death was head and neck malignancy (n=39; 73.6%), followed by head and neck abscesses (n=9; 17%). The least common cause of death was diphtheria (n=2; 3.8%). Conclusion Death was more common in old-age patients, with more prevalence in the male population. The most common cause of mortality was head and neck malignancy. The total death count almost remained constant through the years., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Khurshied et al.)