Tracheobronchial Foreign Bodies

foreign bodies, the means by which they gain accessand the measures by which accidental aspiration canbe prevented.Methods: Bronchoscopy was performed in 39 patientswho presented with a suspicion of foreign body aspirationduring a three-year period (Jan 2002 – Dec 2004) in theDepartment of ENT, Holy Family Hospital, Rawalpindi.Results: The common symptoms were sudden onset ofdyspnoea and cough. Whistle was commonest objectremoved (46.15%). Majority of patients were above tenyears of age (38.46%). Left main bronchus was thecommonest site of involvement.Conclusion: Foreign body aspiration should besuspected when there is sudden onset of respiratorysymptoms, even in the absence of a history of aspiration.Emergency bronchoscopy facility should be available inall hospitals. Mass awareness should be created throughelectronic media and family physicians, to decrease theincidence of such accidents

Eagle’s Syndrome: Presentation, Diagnosis, and Management

Objective: To study the presentation, diagnosis, and treatment options in Eagle’s Syndrome in a tertiary care hospital. Material and Methods: The study was conducted at the ENT department of District Headquarter Hospital, Rawalpindi from 1st January 2016 to 31st March 2019.  All the patients who presented in outpatient (OPD) of the ENT department with pain around the ear and throat and diagnosed as a case of Eagle’s syndrome were included in the study. All the data of gender, age, CT scan findings, pain score, and management were noted on a predesigned proforma. Percentages and frequencies were calculated for all the data by using SPSS 21 version. Results: A total of 12 patients were included in the study, with 5 (42%) females and 7 (58%) males. The patient’s age range was from 24 to 68 years. Sharp, sudden onset, nerve-like pain was the major symptom in all cases. The length of the styloid process in 6 patients was between 3-4 cm and in 6 patients between 4-5 cm on a 3-dimensional computerized tomography scan. 100% of patients were managed surgically. In Group A (50%) styloidectomy was done after tonsillectomy while in other Group B (50%) patients styloidectomy was done by tonsil sparing technique. The relief of pain was a little better in patients of Group B. Conclusion: Sudden onset, sharp, shooting pain in the jaw area, around-ear, and in the throat with no other co-morbid should be investigated for Eagle’s syndrome. 3 dimensional CT scan is the best modality to see the length of the styloid process. Styloidectomy with tonsil sparing technique is a little better than tonsillectomy and gives early and permanent relief from this painful condition

Postural Orthostatic Tachycardia Syndrome in Young Diabetics

Postural orthostatic tachycardia syndrome is a condition characterized by imbalance in autonomic reactivity leading to exaggerated heart rate and other symptoms of orthostatic intolerance. In adolescents, it is characterized either by a continuous increase in heart rate of ≥40 bpm as compared to basal heart rate or sustained basal rate of ≥130 bpm.         The objective of the research was to compare the characteristics of adolescent diabetics with postural orthostatic tachycardia syndrome with the controls.         Methods. Seventy adolescents diagnosed with type 1 diabetes mellitus who were treated at the department of Endocrinology, Government Medical College and Shri Maharaja Hari Singh hospital, Srinagar, J&K, India were selected for the study. Lying to standing test was performed. Heart rate was recorded at the 2nd, 3rd, 5th and 10th minutes. Based on the results of lying to standing test, there were selected 25 diabetic adolescents with postural orthostatic tachycardia syndrome. Their characteristics were compared with age- and sex-matched adolescents using unpaired T test. P< 0.05 was considered significant.         Results.  We observed a significantly lower body mass index (p=0.027), as well as a significantly higher fasting blood glucose level (p<0.0001) in diabetics with postural orthostatic tachycardia syndrome.         Conclusion. It may be concluded that lower body mass index and higher fasting blood glucose level may lead to the development of postural orthostatic tachycardia syndrome in adolescents.

Bone marrow involvement as a rare manifestation of relapsed choroidal melanoma

Choroidal Melanoma is the most common primary intra-ocular malignancy. Incidence of primary choroidal melanoma is about 6 cases per 1 million population. It disseminates hematogenously. The most common site of metastasis is liver. Metastatic melanoma involving the bone marrow is rare, occurring in 5% of patients with disseminated disease. However, Choroid melanoma with bone marrow involvement is very rare. Only a few case reports are published in literature.  Authors present a case of bone marrow metastasis from choroid melanoma in 55 years old female who has been treated for primary choroidal melanoma by enucleation of left eye three years back. In the evaluation of symptomatic anemia, features suggestive of bone marrow infiltration by choroidal melanoma were observed on bone marrow aspiration and biopsy. The diagnosis was confirmed by positivity of immune-histochemistry markers HMB-45 and Melana

Microstructural characterization of high-velocity oxy-fuel (HVOF) sprayed nickel coatings

The high-velocity oxy-fuel (HVOF) thermal spray process is a form of surface engineering technology in which high kinetic energies are used at relatively low temperatures to deposit high quality coatings. In this thesis, a detailed microstructural analysis was carried out to investigate the effect of substrate material properties and surface conditions, including surface chemistry and roughness, on splat formation behaviour. Nickel powder was sprayed onto five different substrates using the HVOF process. A range of characterisation techniques, including scanning electron microscopy, focused ion beam microscopy, transmission electron microscopy, together with scanning transmission electron microscopy and energy-dispersive X-ray spectroscopy were employed to analyse the samples. The particle solidification behaviour and mechanisms of splat formation were analysed, with particular attention to the changes occurring at the splat-substrate interface, the subsequent bonding behaviour due to the impact of high thermal and kinetic energy particles on the substrates of different compositions and with variable surface conditions. It was shown that most particles reached the substrate surface in a partially melted form owing to the high velocity and low temperature typical in the HVOF process. It was observed that splat morphologies, their frequency of occurrence and splat-substrate bond quality are all greatly affected by the surface condition and thermo-physical properties of the substrate. Relatively higher surface roughness led to a reduction in the flattening velocity and the splashing of the splats. The presence of adsorbates, revealed through X-ray photoemission spectroscopy (XPS), promoted the formation of doughnut-shaped splats. It was observed that the interface temperature and the thermophysical properties of the substrate contributed significantly toward splat-substrate elemental interdiffusion at the interface. Both particle size and the location of impact on a grit-blasted rough surface played important roles in defining the melting state, flattening degree and, ultimately, adhesion of the particles with this substrate. It was shown that the degree of substrate melting and the associated time for re-solidification are critical for particle bonding on a softer, low melting point substrate. The microstructural findings, aided by theoretical models, revealed that a mixture of mechanical and metallurgical bonds can exist between the splats and substrates

Opt-Out Forced Choice Effect in Combined Revealed and Stated Preference Discrete Choice Models: A Gender Perspective

In this study, we assess the convergent validity of preferences and willingness-to-pay (WTP) values for beach quality improvements from a gender perspective by isolating opt-out forced-choice effect from the SP1 DCE data (that is a forced-choice situation when a respondent was asked to select among the competing labelled alternatives if they chose an opt-out). Following this approach, we combine the RP discrete choice model and SP1 DCE datasets by splitting them into female and male sub-samples and then investigate whether estimated preferences and WTP values are susceptible to this effect from a gender perspective. Using the multinomial logit (MNL) models, we find that female visitors’ preferences are compatible across RP and SP1 data if the forced-choice effect is isolated from SP1 data, whereas this is not true for the male visitors. However, WTP values appear similar for both the female and male RP and SP1 sub-samples. Also, the sources of opt-out forced choices appear more promising for females than those of male counterparts in the estimated binary logit models. Our results, therefore, suggest that preferences’ similarity is a gender-specific if the opt-out forced-choice effect is isolated, but WTP similarity is not

Efficacy and safety of ormeloxifene in the management of dysfunctional uterine bleeding

Background: The term dysfunctional uterine bleeding (DUB) is used for abnormal uterine bleeding occurring in the absence of identifiable pathology. A number of drugs are available for management of DUB- nonsteroidal anti-inflammatory drugs, tranexamic acid, ethamsylate, hormones like Oral contraceptives progestins etc. The present study was done to determine the efficacy and safety of ormeloxifene in the management of DUB.Methods: This prospective clinical study involved 50 cases with DUB who were treated with ormeloxifene 60 mg tablet twice a week for first 12 weeks and the once a week for next 12 weeks. They were followed after 6 months of therapy. The outcome was studied by assessment of menstrual blood loss by PBAC score, Hb level in g/dl, endometrial thickness in mm, relief of dysmenorrheal and any side effects of drugs.Results: The median PBAC score was significantly reduced from 316 to 52 after 6 months of therapy. The mean Hb concentration was significantly increased from 7.8 g/dl to 9.1 g/dl at 6 months of therapy. The mean endometrial thickness was reduced from 10 mm to 7.9 mm after 6 months of therapy. 66% of women showed marked subjective improvement in symptoms. Amenorrhea was the main side effect (12%).Conclusions: Ormeloxifene has significant effect in reducing endometrial thickness, decreasing the amount of menstrual blood loss, reducing dysmenorrhea and thereby improving the general condition of the patient. It is definitely a better alternative to hysterectomy in women who wish to avoid surgeries and maintain their reproductive functions

CEREBRAL VASOMOTOR REACTIVITY TO ASSESS BRAIN DYSREGULATION IN POST COVID NEUROLOGICAL SYNDROME

Background: COVID-19 has wide-ranging physiological effects, with many patients complaining of persistent asthenia following recovery from the acute phase of the infection. The frequent term for this is Long Haul COVID (LHC). While we have tools to measure effects on general physiology in human subjects, a metric for cerebral dysregulation is lacking. Cerebral blood flow (CBF) is closely regulated in the healthy young person. Dysregulation has been well described in many conditions, including Posterior Reversible Encephalopathy Syndrome (PRES), and is associated with neurological deficits. Cerebral Vasomotor Reactivity was used as a tool to assess this dysregulation. Methods: Transcranial Doppler (TCD) study for CVR was performed under the influence of Carbogen gas. A questionnaire collected prior to the procedure provided additional details on subjects demographics and COVID history. Cases and controls were recruited using self-reported questionnaire. Statistics involved assessing the reproducibility of the test as well as discovering differences between cases and control groups. Results: CVR was assessed for 26 subjects. CBF velocity in the left MCA was analyzed at baseline, at peak Carbogen exposure, and in hypercapnic phase. The reproducibility of the test was established within the longitudinal repeated measures data. The cases and control groups were insignificant in difference at base level but significant when controlled for confounders. CVR was found to increase by 3.76 units in cases compared to controls. Confounders like BMI, gender and age was found significantly different between cases and controls. Number of COVID episodes and symptom severity was significant for CVR. Conclusion: This simple bedside test was found to be to be effective in producing a reactivity among all the subjects and was homogenous in its effect irrespective of baseline subject differences. As a preliminary test, the test showed differences among cases and control groups. The sample for the test lacked sufficient power and observations. A bigger sample size and a subsequent longitudinal follow up may help better understand the use of CVR to screen high-risk population for cerebrovascular anomalies