Factors Leading To Early Versus Late Presentation In Patients With Neck Masses

Abstract Objective: To compare the factors that lead to early versus late presentation in patients with neck masses Study Design: Group Comparative Study. Study Setting & Duration: Department of Otorhinolaryngology and Head &Neck Surgery at Rawalpindi Teaching Hospital from 01-9-2022 to 01-03-2023. Methods: Approval of the study was obtained from the hospital's ethical committee. A total of 64 patients (32 in each group) were placed in two Groups A &  B. Group A included patients who presented early and Group B included patients who presented late. Both male and female patients were selected. In this study patients suffering from neck masses who have reported for work-up to the Department of ENT, Rawalpindi Teaching Hospital, and fulfil the complete inclusion and exclusion criteria were included. Patients were selected via consecutive nonprobability sampling. The data were analyzed for frequencies by SPSS 24. Results: A total of 64 patients were included in this study. The mean age of these patients was 48.67 ± 9.74 years, ranging from 25 to 70 years. The Frequency distribution of males at 65.63 % was found to be more than that of females at 34.36 %. In the majority of patients, the size of mass more than 1.5 cm (51.56%) revealed malignancy, while only a small percentage of patients (48.44%) had less than 1.5 cm neck mass. The majority of patients (93.75%) with addiction presented late, while just a small number (6.25%) had early presentation. The majority of patients (51.56%) with frequent visits to  Quacks /Hakeem per year were presented late. Regarding socioeconomic status, the majority of patients (28) from upper-class families presented early, compared to (11) patients from middle-class families who presented late, and all (21) patients from lower-class families who presented late. The education level reveals that the majority of patients (31), who were educated, attended a school for more than a year, but only up to ten (matriculate or similar) years, or advanced literacy: got a college- or university-level education, and they displayed early presentation. The 30 uneducated patients, who never attended an educational institution, or attended for less than one year, presented late. 31 patients had frequent visits to health care professionals and were presented early, 30 patients had fewer visits to health care professionals present late with advanced disease.  Conclusion: The majority of patients who were drug and alcohol addicts were presented late with advanced disease. Middle-class families, lower-class families, uneducated patients, and patients who did not see a healthcare provider four or more times per year, make up the majority of visits to Quacks and Hakeem each year and are presented late with advanced disease as compared to the group of patients who belong to upper class, were literate with no history of drug or alcohol addiction and have frequent visits to health care professionals. Both groups were considered to be significant (p=0.00) based on the probability ratio. This study helped to identify the role of various suspected risk factors for late presentation in head and neck cancers in an attempt to reinforce or negate their importance which will help to guide the formation of screening protocols thereby improving morbidity, and mortality and reducing financial costs.

Comparison Of Isoconazole Nitrate Versus Nystatin For The Treatment Of Otomycosis

Objective: To compare the efficacy and local adverse effects of Isoconazole Nitrate versus Nystatin for the treatment of patients having Otomycosis  Sudy Design: Group experimental study. Study Setting & Duration: Department of Otolaryngology, Head & Neck Surgery at Rawalpindi Teaching Hospital, Rawalpindi.  Duration of study was 6 months after approval by Ethical Committee from Feb 2023 to july 2023 Materials and Methods: Total of 64 patients were selected.  The study participants were individuals who, according to operational definitions had Otomycosis and who had presented for evaluation at the Department of Otolaryngology Rawalpindi teaching Hospital, Rawalpindi. They also met all inclusion and exclusion criteria requirements and these requirements were strictly adhered to in order to control confounders and bias. Isoconazole nitrate ointment was used to treat patients in Group A and Nystatin ointment was used to treat instances in Group B.  Patients were chosen by randomization using lottery method. SPSS 28 was used to determine the frequencies in the data. Results: 64 individuals (32 cases in each group) were chosen for the study by the ENT outpatient clinic. Out of which 33 (51.6%) being female and 31 (48.1) being male. The age ranged from 12 to 80 years, with a mean age of 44.29 ±19.13. After two weeks, there was a substantial improvement in 25 (39.06%) of the group A patients (p=0.08), a moderate improvement in 7 (10.9%), and a minor improvement in 5 (7.81%) patients (p=0.37) while in group B exhibited a substantial improvement in just 19 (10.9%) (p=0.08), a moderate improvement in 9 (39.0%) (p=0.38), and a small improvement in 7 (42.19%) (p=0.37). After four weeks 21 (32.81%) in Group B showed insignificant improvement, while 26 (40.63%) in Group A exhibited better improvement than Group B. The treatment for group A, which included isoconazole nitrate, was substantially more successful than the Nystatin treatment for group B. Isoconazole was found insignificantly more effective than   (p=0.08). The  majority of patients in both groups didn't notice any adverse  . Conclusion: Nystatin was shown to be significantly less efficacious than isoconazole nitrate ointment in treating otomycosis

Diagnostic Accuracy Of Barium Swallow For Dysphagia, Keeping Rigid Esophagoscopy As The Gold Standard

Objective: To determine the diagnostic accuracy of Barium Swallow in detection of patients presenting with dysphagia. Study Design: Cross-sectional validation study. Study Setting & Duration: Department of Otorhinolaryngology, Head & Neck Surgery, District Headquarter Hospital Rawalpindi from 01-09- 2022 to 01-03-2023. Materials and Methods: Approval of the study was obtained from the Hospital Ethical Committee. A total of 111 patients both male and female patients were selected. The patients suffering from dysphagia as per operational definitions and who have reported for work-up to the Department of ENT, District Headquarters Hospital, Rawalpindi, and fulfill the complete inclusion and exclusion criteria, were selected. Informed consent was obtained from all the patients. Patients were selected by consecutive non-probability sampling technique. The data was analyzed using SPSS 24. Results: A total of 111 patients were included in this study. The mean age of these patients was 50.79 ± 13.01 years, ranging from 28 to 70 years. The frequency distribution of females 70.27 % was found to be more than that of males 29.73 %. Majority of patients' barium swallow (74.77%) revealed pathologies, while only a small percentage of patients (25.23%) had normal barium swallow. Most of patients (87.39%) had pathologies found during rigid esophagoscopy, while just a small number (12.61%) had normal rigid esophagoscopy. Comparing both investigating tools, esophagoscopy discovered 87.39% of pathologies while Barium swallow detected 74.77%, indicating that esophagoscopy was a more accurate procedure. Patients had esophageal web 55 (25.2%) on barium swallow and 69 (62.2%) on the Rigid esophagoscopy. Barium Swallow had esophageal stricture 28 (52.2) and no Pathology was detected in 28 (25.2 %) patients. As well as Rigid esophagoscopy had esophageal growth13 (11.7), esophageal stricture 15 (13.5), and no Pathology was detected in 14 (12.6 %). Rigid esophagoscopy is more efficient in detecting esophageal pathology than Barium Swallow. In Barium swallows most patients had esophageal web 55 (25.2%) than the esophageal stricture 28 (52.2) and no pathology was detected 28 (25.2). In rigid esophagoscopy most patients had esophageal web 69 (62.2%) than the esophageal growth13 (11.7), esophageal stricture 15 (13.5) and no pathology detected 14 (12.6). Conclusion: A range of diseases are associated with dysphagia can be found in patients. Two often used diagnostic methods are barium swallow and rigid esophagoscopy. Both Barium swallow and Rigid esophagoscopy are successful in the diagnosis of esophageal cancer. The use of a Rigid esophagoscopy is still a gold standard diagnostic and therapeutic tool for upper aerodigestive tract pathologies

Fear of Covid-19 and Depression: Mediating Role of Anxiety and Stress Among University Students

Fear of CIVID-19 and psychological health issues are most common in general population, health professionals and students after emerging the COVID-19 infection. The literature review elaborated the correlation among fear of COVID-19, stress, depression and anxiety among students at different levels.The current study was conducted with two objectives. First aim was to assess the relationships among fear of COVID-19, stress, anxiety and depression among university students. The second objective was to measure the mediating role of anxiety and stress between the relationship of fear of COVID-19 and depression.Total 500 Government and private university students were selected through convenient sampling technique to obtain the online data. Fear of COVID-19 Scale and Depression, Anxiety & Stress Scale were used as measuring tool to collect data. The results depicted that fear of COVID-19, stress, depression and anxiety had statistically significant positive relationships with each other. Mediation analysis also indicated the anxiety and stress as mediators with significant value (FCV with depression= p≥.05) and direct effect (-, +) in the presence of the mediators (anxiety and stress).The current study indicated the dire need of counseling services for students in order to reduce the fear of COVID-19 and symptoms of psychological disturbance

Pregnancy and neonatal outcomes of COVID-19: The PAN-COVID study

Objective To assess perinatal outcomes for pregnancies affected by suspected or confirmed SARS-CoV-2 infection. Methods Prospective, web-based registry. Pregnant women were invited to participate if they had suspected or confirmed SARS-CoV-2 infection between 1st January 2020 and 31st March 2021 to assess the impact of infection on maternal and perinatal outcomes including miscarriage, stillbirth, fetal growth restriction, pre-term birth and transmission to the infant. Results Between April 2020 and March 2021, the study recruited 8239 participants who had suspected or confirmed SARs-CoV-2 infection episodes in pregnancy between January 2020 and March 2021. Maternal death affected 14/8197 (0.2%) participants, 176/8187 (2.2%) of participants required ventilatory support. Pre-eclampsia affected 389/8189 (4.8%) participants, eclampsia was reported in 40/ 8024 (0.5%) of all participants. Stillbirth affected 35/8187 (0.4 %) participants. In participants delivering within 2 weeks of delivery 21/2686 (0.8 %) were affected by stillbirth compared with 8/4596 (0.2 %) delivering ≥ 2 weeks after infection (95 % CI 0.3–1.0). SGA affected 744/7696 (9.3 %) of livebirths, FGR affected 360/8175 (4.4 %) of all pregnancies. Pre-term birth occurred in 922/8066 (11.5%), the majority of these were indicated pre-term births, 220/7987 (2.8%) participants experienced spontaneous pre-term births. Early neonatal deaths affected 11/8050 livebirths. Of all neonates, 80/7993 (1.0%) tested positive for SARS-CoV-2. Conclusions Infection was associated with indicated pre-term birth, most commonly for fetal compromise. The overall proportions of women affected by SGA and FGR were not higher than expected, however there was the proportion affected by stillbirth in participants delivering within 2 weeks of infection was significantly higher than those delivering ≥ 2 weeks after infection. We suggest that clinicians’ threshold for delivery should be low if there are concerns with fetal movements or fetal heart rate monitoring in the time around infection

Fear of Covid-19 and Depression: Mediating Role of Anxiety and Stress Among University Students

Fear of CIVID-19 and psychological health issues are most common in general population, health professionals and students after emerging the COVID-19 infection. The literature review elaborated the correlation among fear of COVID-19, stress, depression and anxiety among students at different levels.The current study was conducted with two objectives. First aim was to assess the relationships among fear of COVID-19, stress, anxiety and depression among university students. The second objective was to measure the mediating role of anxiety and stress between the relationship of fear of COVID-19 and depression.Total 500 Government and private university students were selected through convenient sampling technique to obtain the online data. Fear of COVID-19 Scale and Depression, Anxiety & Stress Scale were used as measuring tool to collect data. The results depicted that fear of COVID-19, stress, depression and anxiety had statistically significant positive relationships with each other. Mediation analysis also indicated the anxiety and stress as mediators with significant value (FCV with depression= p≥.05) and direct effect (-, +) in the presence of the mediators (anxiety and stress).The current study indicated the dire need of counseling services for students in order to reduce the fear of COVID-19 and symptoms of psychological disturbance

Bruk av kvetiapin mot insomni i primærhelsetjenesten. Kvalitetsforbedringsprosjekt

Denne oppgaven er et forslag til et kvalitetsforbedringsprosjekt hvor målet er redusert forskrivning av kvetiapin, utenfor indikasjon, mot insomni i primærhelsetjenesten. Årsaken til at allmennlegetjenesten er valgt som det primære målet for dette kvalitetsforbedringsprosjektet, er fordi pasienter med insomni henvender seg først og fremst til allmennleger. For allmennleger kan i de fleste tilfeller selv starte opp en behandling i henhold til godkjente og anbefalte indikasjoner og retningslinjer. Undersøkelse av dagens praksis viser at det er nettopp i dette leddet at behandlingen av insomni svikter med tanke på forskrivning av kvetiapin mot insomni. Dette samsvarer med gruppedeltakernes erfaringer fra praksistiden og jobb. Derfor vil det i denne oppgaven redegjøres for hvilke tiltak som kan settes i verk i primærhelsetjenesten for å redusere forskrivningen av kvetiapin mot insomni, og dermed bedre kvaliteten av tilbudet for insomni med størst mulig gevinst for pasientene som insentiv

An Insight into the Algal Evolution and Genomics

With the increase in biotechnological, environmental, and nutraceutical importance of algae, about 100 whole genomic sequences of algae have been published, and this figure is expected to double in the coming years. The phenotypic and ecological diversity among algae hints at the range of functional capabilities encoded by algal genomes. In order to explore the biodiversity of algae and fully exploit their commercial potential, understanding their evolutionary, structural, functional, and developmental aspects at genomic level is a pre-requisite. So forth, the algal genomic analysis revealed us that algae evolved through endosymbiotic gene transfer, giving rise to around eight phyla. Amongst the diverse algal species, the unicellular green algae Chlamydomonas reinhardtii has attained the status of model organism as it is an ideal organism to elucidate the biological processes critical to plants and animals, as well as commercialized to produce range of bio-products. For this review, an overview of evolutionary process of algae through endosymbiosis in the light of genomics, as well as the phylogenomic, studies supporting the evolutionary process of algae was reviewed. Algal genomics not only helped us to understand the evolutionary history of algae but also may have an impact on our future by helping to create algae-based products and future biotechnological approaches

Zinc oxide loaded chitosan-elastin-sodium alginate nanocomposite gel using freeze gelation for enhanced adipose stem cell proliferation and antibacterial properties

Hydrogels have been the material of choice for regenerative medicine applications due to their biocompatibility that can facilitate cellular attachment and proliferation. The present study aimed at constructing a porous hydrogel composite scaffold (chitosan, sodium alginate and elastin) for the repair of chronic skin wounds. Chitosan-based hydrogel incorporating varying concentrations of zinc oxide nanoparticles i.e. ZnO-NPs (0, 0.001, 0.01, 0.1 and 1 % w/w) as the antimicrobial agent tested against Escherichia coli (E.coli) and Staphylococcus aureus (S. aureus) exhibited good antibacterial activities. ZnO-NPs were characterized by UV visible spectroscopy, Scanning electron microscopy (SEM) analysis, Fourier transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD) analysis. Fabricated gels were characterized by SEM analysis, FTIR, XRD, swelling ratio, degradation behavior and controlled release kinetics of ZnO-NPs. In vitro cytocompatibility of the composite was investigated using human adipose stem cells (ADSCs) by MTT and lactate dehydrogenase (LDH) assay, further assessed by SEM analysis and PKH26 staining. The SEM and XRD analysis confirmed the successful loading of ZnO-NPs into these scaffolds. Fluorescence PKH26 stained images and SEM analysis of ADSCs seeded scaffolds revealed biocompatible nature. The findings suggested that the developed composite gels have potential clinically for tissue engineering and chronic wound treatment.The authors acknowledge Dr. Muhammad Ali, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA, for checking the manuscript for English language, grammar, style and syntax. The authors acknowledge Higher Education Commission Pakistan for providing funding for conduct of this work from TDF 02-163 (Dr. Azra Mehmood) and HEC NRPU Project number 8762 (Dr. Muhammad Yar).Scopu