Factors associated with recurrent nasal polyps: a tertiary care experience

OBJECTIVE: To assess the factors associated with recurrence of nasal polyps in operated patients by endoscopic surgery. METHODS: A retrospective study was conducted on 192 patients operated for nasal polyps in a hospital set-up between 2001 and 2007. The median follow-up period was 24 months (range 12 months to 60 months). Ten variables were analyzed to study their association with polyp recurrence namely; age, gender, history of purulent nasal discharge, facial pain, anosmia, post nasal dripping (PND), headache, nasal allergy, asthma and computed tomography (C.T) staging. Analysis of recurrences was accomplished using independent sample t-test, chi-square and Fishers exact test. A probability value of p \u3c 0.05 was selected as the level of significance. RESULTS: During the study period, recurrences developed in 36 patients, with a rate of 19%. No association of recurrence with age, gender, purulent nasal discharge, facial pain, anosmia, post nasal dripping, headache, nasal allergy, and asthma were observed. The C.T staging was significantly higher among the group with recurrence as compared to the group without recurrence (p \u3c 0.001). CONCLUSION: Patients presenting with extensive disease suggested by C.T scan staging are at higher risk for the development of recurrences after endonasal surgery for nasal polyps

Surgical emphysema in the neck as a result of a dental procedure

We report the development of subcutaneous emphysema in a middle-aged woman that occurred several hours after she had undergone a dental restoration procedure. The patient presented to the emergency department, and she was admitted for observation and prophylactic antibiotic coverage. She recovered in 3 days without further intervention and was discharged

Prostate cancer metastasis to cervical node chain-an unusual clinic-pathological finding

Prostate carcinoma is one of the most common cancers in males all around the world. Head and neck squamous cell carcinoma is amongst the leading carcinoma (HNSCC) in men especially in the sub-continent. There are around 150 lymph nodes on either side in the neck and cervical lymph nodes are a common site for head and neck malignancies to metastasize however carcinoma of prostate may in rare cases metastasize to cervical chain, therefore warranting a neck dissection. In case of unknown primary of head and neck extensive work up is required to find the primary site. Our case provided a similar picture with a single enlarged node which on biopsy to our surprise revealed adenocarcinoma of prostate

Environmental sustainability through aggregate demand behavior – Does knowledge economy have global responsibility?

Purpose – This study aims to consider environmental sustainability, a global challenge under the preview of sustainable development goals, highlighting the significance of knowledge economy in attaining sustainable aggregate demand behavior globally. For this purpose, 155 countries that have data available from 1995 to 2021 were selected. The purpose of selecting these countries is to test the global responsibility of the knowledge economy to attain environmental sustainability.Design/methodology/approach – Results are estimated with the help of panel quantile regression. The empirical existence of aggregate demand-based environmental Kuznets curve (EKC) was tested using nonlinear tests. Moreover, principal component analysis has been incorporated to construct the knowledge economy index.Findings – U-shaped aggregate demand-based EKC at global level is validated. However, environmental deterioration increases with an additional escalation after US$497.945m in aggregate demand. As adeterminant, the knowledge economy is reducing CO2 emissions. The knowledge economy has played a significant role in global responsibility, shifting the EKC downward and extending the CO2 reduction phase for every selected country. Further, urbanization, energy intensity, financial development and trade openness significantly deteriorate the environmental quality.Originality/value – This study contains the empirical existence of aggregate demand-based EKC. The role of the knowledge economy is examined through an index which is calculated by using four pillars of the knowledge economy (technology, innovations, education and institutions). This study is based on a combined panel of all the countries for which the data was available

Role of knowledge economy in managing demand-based environmental Kuznets Curve

Aggregate demand or supply at equilibrium is commonly used as a representative of the macroeconomic activity of an economy whereby aggregate demand denotes the behaviour of individuals and households. However, aggregate demand can also directly affect environmental deterioration via changes in aggregate production. This study tried to explore this relationship, known as the demand-based Environmental Kuznets Curve (Demand EKC) and the role of different knowledge economy indicators. Knowledge economy indicators are proposed to influence consumption patterns, altering the demand EKC that empirical studies have understudied. For this purpose, secondary data for 147 countries were collected from 2008 to 2018, also classified as development-wise. This study found that aggregate demand significantly affects carbon emissions. The long-run results are estimated using the Fully Modified Ordinary Least Square method. Controlling factors like renewable energy consumption, population density, and financial development significantly affect carbon emissions in sample countries. This study has incorporated four pillars of a knowledge-based economy and the results showed that these indicators helped reduce consumption-related CO2 emissions

MIGRATING FOREIGN BODY IN THE THYROID GLAND, AN UNUSUAL CASE

In literature various cases have been described where foreign bodies ingested were lodged in the upper aero digestive tract, but only few of these foreign bodies perforate the oesophagus and an even fewer migrate extraluminally.1 If untreated, they may result in life threatening suppurative or vascular complications. Exploration of the neck via an external approach to remove the foreign body is the recommended treatment. The CT scan utilizing fine cuts is invaluable in localizing the foreign body for exploration. Oesophageal penetration and migration of oesophageal foreign bodies into the thyroid gland is extremely rare with only occasional case reports appearing in the medical literature over the years. We report an unusual case of an ingested foreign body that perforated the esophagus and penetrated the thyroid gland. A neck exploration was required to remove the foreign body

Connecting higher education and renewable energy to attain sustainability for BRICS countries: A climate Kuznets curve perspective

Purpose – Increased trapped heat in the atmosphere leads to global warming and economic activity is the primary culprit. This study proposes the nonlinear impact of economic activity on cooling degree days to develop a climate Kuznets curve (CKC). Further, this study explores the moderating role of higher education and renewable energy in diminishing the climate-altering effects of economic activity.Design/methodology/approach – All the selected BRICS economies range from 1992 to 2020. The CKC analysis uses a distribution and outlier robust panel quantile autoregressive distributed lagged model.Findings – Results confirmed a U-shaped CKC, controlling for population density, renewable energy, tertiary education enrollment and innovation. The moderating role of renewable energy and education can be exploited to tackle the progressively expanding climate challenges. Hence, education and renewable energy intervention can help in reducing CKC-based global warming.Research limitations/implications – This study highlighted the incorporation of climate change mitigating curriculum in education, so that the upcoming economic agents are well equipped to reduce global warming which must be addressed globally.Originality/value – This study is instrumental in developing the climate change-based economic activity Kuznets curve and assessing the potential of higher education and renewable energy policy intervention

Harmonic scalpel versus electrocautery tonsillectomy: a comparative study in adult patients

OBJECTIVE: To compare harmonic scalpel (HS) tonsillectomy with electrocautery (EC) tonsillectomy in terms of operating time, intra-operative blood loss, post-operative pain and secondary haemorrhage.METHODS: Sixty adult patients subjected to tonsillectomy only, were evaluated in this prospective study. The patients were stratified into 2 groups (30 each) based on the dissecting instrument used (HS vs. EC) at Aga Khan University Hospital Karachi Pakistan from June, 2006 to August, 2008.RESULTS: The mean operative time was less in electrocautery group (EC 3.57 +/- 0.85 minutes Vs HS 4.20 +/- 1.37 minutes;

Management of allergic fungal sinusitis with postoperative oral and nasal steroids: a controlled study.

In Patients with allergic fungal sinusitis, the mainstay of treatment remains surgical removal of allergic mucin and fungal debris. But as a single modality, surgery is associated with high rates of recurrence, so a number of adjunctive medical modalities have been tried, including postoperative corticosteroid therapy. We conducted a study of 63 Patients with allergic fungal sinusitis who underwent endoscopic sinus surgery with or without postoperative steroid therapy. A group of 30 Patients who had been treated prior to January 2000 had undergone surgery only, their cases were reviewed retrospectively, and they served as historical controls. Another 33 Patients who were treated after June 2000 underwent surgery plus oral and nasal steroid therapy. All Patients were followed for a minimum of 2 years. Recurrences were seen in 50.0% (15/30) of the no-steroid group and 15.2% (5/33) of the steroid group-a statistically significant difference (p = 0.008). The results of our study strongly support the use of steroids to control allergic fungal sinusitis and prevent its recurrence, and we recommend further study to identify the optimal dosage and duration of therapy

Rhinocerebral zygomycosis in Pakistan: clinical spectrum, management, and outcome

OBJECTIVE: To study the disease spectrum and salient management features of 36 patients with histopathologically-confirmed rhinocerebral zygomycosis seen at our academic center over a 16-year period. METHODS: Retrospective review of patients admitted to the Aga Khan University Hospital in Karachi, Pakistan from January 1991 to December 2006 with histopathologically-confirmed zygomycosis of the head and neck. RESULTS: Mean patient age was 40 +/- 5.0 years (range, 34-63 years), and 23 (64%) patients were male. Thirty-two (89%) patients were referred from clinical services other than otolaryngology. Underlying predisposing conditions included diabetes mellitus (21 patients), haematologic diseases (9), and renal failure (6). Twenty (55%) patients had limited sinonasal disease, ten (28%) had orbital involvement, and six (17%) had intracranial extension. All patients underwent rigid nasal endoscopy and biopsy, and black necrotic tissue was seen in 22 (61%) instances warranting endoscopic or open surgical debridement. Four of 6 patients undergoing open surgery required orbital exenteration. Overall patient survival was 56% (20/36 patients). Diabetic patients had improved survival (17/21, or 81%) compared to patients with haematologic disorders (3/9, or 33%) (p = 0.001). All six patients with intracerebral disease died. Eighteen of the 22 (82%) patients treated with surgery plus amphotericin B survived vs. two of 14 (14%) receiving amphotericin B alone (p \u3c 0.001). CONCLUSIONS: In rhinocerebral zygomycosis, an aggressive, multidisciplinary, diagnostic and therapeutic approach that utilizes CT or MRI staging, and combines endoscopic or open surgical debridement with amphotericin B-based antifungal therapy offers the best chance of recovery