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

Digital public sphere and Palestine-Israel conflict: A conceptual analysis of news coverage

The news coverage of conflicts has transformed with the introduction of digital media and social media platforms. The available literature on media coverage of Palestine-Israel conflict is mainly focused on traditional news coverage or social media dimension of the conflict information. There exists a literature gap on social media coverage of Palestine-Israel conflict by the traditional news organizations. This study explores the changing pattern of traditional media’s coverage of the longstanding conflict in the wake of new communication technologies through appraisal of the existing literature. The analysis revealed that the traditional news organizations have adopted social networking platforms as a business model to cover the Palestine-Israel conflict. It was found that the traditional news outlets use the new media because it is cost-effective and have instantaneous outreach to maximum number of netizens. The new tools of communication offer multimedia platforms where conflict-related text, videos and images can be posted simultaneously. The study proposes to conduct future research on media-conflict relationship by focusing the use of new communication tools by the traditional medi

Vitamin D deficiency prevalence and predictors in early pregnancy among Arab women

Data regarding the prevalence and predictors of vitamin D deficiency during early pregnancy are limited. This study aims to fill this gap. A total of 578 Saudi women in their 1st trimester of pregnancy were recruited between January 2014 and December 2015 from three tertiary care antenatal clinics in Riyadh, Saudi Arabia. Information collected includes socio-economic, anthropometric, and biochemical data, including serum vitamin D (25(OH)D) levels, intake of calcium and vitamin D, physical activity, and sun exposure indices. Pregnant women with 25(OH)D levels 3.5), low HDL-cholesterol, and living in West Riyadh were significant independent predictors for vitamin D deficiency, with odds ratios (ORs) (95% confidence interval) of 25.4 (5.5–117.3), 17.8 (2.3–138.5), 4.0 (1.7–9.5), 3.3 (1.4–7.9), 2.8 (1.2–6.4), and 2.0 (1.1–3.5), respectively. Factors like increased physical activity, sun exposure at noon, sunrise or sunset, high educational status, and residence in North Riyadh were protective against vitamin D deficiency with ORs 0.2 (0.1–0.5); 0.2 (0.1–0.6); 0.3 (0.1–0.9); and 0.4 (0.2–0.8), respectively. All ORs were adjusted for age, BMI, sun exposure, parity, summer season, vitamin D intake, multivitamin intake, physical activity, education, employment, living in the north, and coverage with clothing. In conclusion, the prevalence of vitamin D deficiency among Saudi women during early pregnancy was high (81%). Timely detection and appropriate supplementation with adequate amounts of vitamin D should reduce the risks of vitamin D deficiency and its complications during pregnancy

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.

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

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

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

Tea and coffee consumption in relation to vitamin D and calcium levels in Saudi adolescents

Background Coffee and tea consumption was hypothesized to interact with variants of vitamin D-receptor polymorphisms, but limited evidence exists. Here we determine for the first time whether increased coffee and tea consumption affects circulating levels of 25-hydroxyvitamin D in a cohort of Saudi adolescents. Methods A total of 330 randomly selected Saudi adolescents were included. Anthropometrics were recorded and fasting blood samples were analyzed for routine analysis of fasting glucose, lipid levels, calcium, albumin and phosphorous. Frequency of coffee and tea intake was noted. 25-hydroxyvitamin D levels were measured using enzyme-linked immunosorbent assays. Results Improved lipid profiles were observed in both boys and girls, as demonstrated by increased levels of HDL-cholesterol, even after controlling for age and BMI, among those consuming 9–12 cups of coffee/week. Vitamin D levels were significantly highest among those consuming 9–12 cups of tea/week in all subjects (p-value 0.009) independent of age, gender, BMI, physical activity and sun exposure. Conclusion This study suggests a link between tea consumption and vitamin D levels in a cohort of Saudi adolescents, independent of age, BMI, gender, physical activity and sun exposure. These findings should be confirmed prospectively