May 1992, Volume 42, Issue 5

Case Reports


Fatema Jawad  ( 7/6, Rimpa Plaza, MA. Jinnah Road, Karachi-74400. )

RHINOSCLEROMA Hyder, M.J. Pak.J. Otolaryngol., 1991; 7:173-174.
The case of a 38 year old woman diagnosed as rhinoscleroma is presented. She first came with right sided epistaxis which was controlled by nasal packing. 15 months later she presented with bilateral nasal obstruc­tion. Examination revealed a large fleshy polypoidan mass in the right nasal fossa and a few small polypi in the left nasal fossa. A small left sub-mandibular gland was enlarged. The nasal polypi were removed elsewhere and diagnosed as chronic inflammatory tissue. Ayear later the polypi recurred. A CT scan showed opaque maxillary antra too. Bilateral caldwell luc procedure with excision of nasal masses were performed. Soft fleshy masses were removed from the maxillary antra also. The excised tissue was stained and cultured giving a diagnosis of rhinoscleroma. No organism were found on culture. Trimethoprim- sulphamethoxazole were given for 6 months which gave good results and no recurrence was noted. Rhinoscleroma is endemic in central America, south Asia, Africa and Middle East. Diagnosis is con firmed by either culture, biopsy, serology or im­munochemistry. K. rhinoscleromatis is resistant to penicillin and erythromycin. It is sensitive to antibiotics with gram negative coverage and has found to be successfully treated with oxytetracycline.
OTOMYCOSIS IN ANKARA. Akiner, M.N., Anadolu, Y., Anadolu, R. and Peksari, Y. Pak. J. Otolaryngol., 1991; 7:161-163.
A study was conducted at the outpatients depart­ment of Ankara University Medical School, ear, nose and throat department, to evaluate and compare the clinical diagnosis of otomycosis with the results of light micros­copy and fungal cultures. One hundred and thirty two patients were ex­amined. There were 70 males and 62 females with the average age being 38 years. They presented with com­plaints of itching in the ear, discharge pain and impaired hearing. The desquamated material from the external auditory canal was examined directly under the light microscope by first being placed in 20% potassium hydroxide on a slide which was then placed in a damp media for 20 minutes. Fungal hyphae and spores were searched. Culture was done on Sabourad’s baning agar gel kept at room temperature for 7 days. The growth was then painted with lactophenol cotton blue and observed under the microscope to differentiate the type of fungus. By direct microscopy 35 cases could be diagnosed as otomycosis. In cultures, 56 cases were positive of which 42 were aspergillus niger and 14 were candida albicans. The external auditory canal has a suitable environ­ment for mycotic growth. Moisture is a precipitating factor and excessive persiration or water left in after swimming or bathing accelerates fungal growth. Cerumen inhibits niycotic growth. If it is decreased then the environment becomes suitable for otomycosis. The inner ear can get involved especially in immunosup­pressed or malnourished individuals. Fungal cultures provide an accurate diagnosis of otomycosis.
ABUSE OF DRUGS BY THE MEDICAL STUDENTS. Chaudhry, MS. Pak.J. Clin. Psychiat., 1991; 1:75-79.
A survey was carried out in the Quaid-e-Azam Medical College Bahawalpur to assess the extent of drug abuse in the students community in 1983. A question­naire proforma without any identification mark was filled in by every student independently and confidentially. $ Only those students who were using drugs for more than 3 months were included in the study. Age, sex, substance, duration and reason for starting the drug, source of procurement, achievement of desired effects, previous attempts at withdrawal and the symptoms experienced were all noted. A specific question was asked at the end about prohibition of sale of psychotropic drugs without a doctor’s prescription. The students participating in the study numbered 855 of which 769 were males and 86 females. 65 students were identified as drug abusers. These were 60 males and 5 females. The ages ranged between 20 and 26 years. Benzodiazepines were used by 26 students. Stimulants as ritalin was taken by 14. Opium and its derivatives were utilised by 12 students whereas 8 had charas, 3 hypnotics and 2 were taking alcohol. There was no case of heroin abuse. Eleven individuals were using drugs for less than a year, 46 for 1 to 3 years and 8 for more than 3 years. 23 students took the drug to relieve tension and worries, 17 to increase concentration, 10 for pains and aches, 6 for company and enjoyment, 4 for curiosity’s sake and 5 for fatigue and insomnia. The source of procurement of the drugs were from chemists and illegal sellers and the route of administra­tion was oral or smoking. None reported withdrawal symptoms because no attempt to stop its use was made, All the students answered the last question regarding restrictions of sales in "yes" Drug abuse should be considered as a hazard and stringent steps taken to curb it.
A double blind study was conducted to compare the effect of two depot neurolcptics, flupenthixol decanoate and fluphenazine decanoate in patients diag­nosed as chronic schizophrenia. 45 well stabilized cases were selected and the first 8 weeks were an open study with 40 mgflupenthixol decanoate or 25mg fluphenazine decanoate fortnightly. During the second half of the trial patients received either of the drug every two weeks randomly. Four weekly clinical assessments were made on every case. The clinical Global Impression Scale and Brief Psychiatric Rating Scale showed clinical improve­ment in both the groups. The Depression Hamilton Scale also indicated an overall mood improvement in all the patients. Side effects were found to be less in the flupenthixol treated group. The study thus concluded that long acting neuroleptics are as effective as oral drugs in the main­tenance treatment of chronic schizophrenia. Flupen­thixol decanoate was found to be better tolerated than fluphenazine decanoate due to lesser side effects.

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