Rajindra Hospital Research Articles

Comparison between preoperative computed tomography scan of paranasal sinuses and operative findings in functional endoscopic sinus surgery (FESS) in chronic sinusitis

Background and objectives: The study was done to evaluate the role of computed tomography (CT) in clinically suspected cases of chronic sinusitis for detection, assessment of anatomical variants and pathological abnormalities of nasal cavity and paranasal sinuses. Also findings of CT were co-related with operative findings in functional endoscopic sinus surgery (FESS). The study was conducted on 60 cases attending CT section of Radiodiagnosis Department and ENT Department Rajindra Hospital, Patiala. Materials and Methods: The study was conducted on 60 cases over a period 3 years from 2010 to 2013 irrespective of gender and age group attending the ENT and radiology department. Selections of patients were based on clinical features like nasal or post nasal discharge, nasal obstruction, headache anosmia, cough and hoarseness of voice. Relevant history, clinical examination and CT examination of every patient were done. Results: In our study, the CT scan and operative findings correlated excellently in cases of paradoxical middle turbinate, bony destruction, concha bullosa, polypoidal changes in ethmoidal sinuses and osteomeatal complex normal widening. There was very good agreement between preoperative CT scan and operative findings for concha bullosa, paradoxical middle turbinate, bony destruction, osteomeatal complex normal widening, polypoidal change in sphenoid sinus. The most common pattern observed on CT scan was osteomeatal unit pattern in 35% followed by infundibular pattern (20%), sphenoethmoidal recess pattern (23.3%), unclassified pattern (15%) & sinonasal polyposis pattern (6.6%). Conclusion: CT is the imaging modality of choice to reveal mucosal changes deeper in osteomeatal complex which are not visible endoscopically and to identify extent of paranasal sinus disease. However, endoscopy has complementary role with CT in evaluation of patients of chronic sinusitis.

Age estimation from the fusion of distal end of fibula epiphysis

The range of variation in epiphyseal fusion for the distal end of fibula epiphysis in Punjab, India populations has been studied in the present study. This study evaluates epiphyseal fusion of the distal fibula in 100 young individuals, 50 males, and 50 females with age range from 16-17 years to 24-25 years. Radiographs were performed at Rajindra Hospital, Patiala, Punjab, India with 10 cases from each age group in both males and females. Both AP and lateral views of X-ray were taken. Results indicate that complete fusion in males occur at the age of 18-19 age group and in females occurs at 16- 17 year age group in the distal end of the fibula. Earliest union for males and females occur at 16 years.

Epidemiological study of road traffic accident cases admitted in government tertiary hospital: a study from Punjab, India

Background: Among all types of injuries road traffic injuries constitute a major public health problem. They lead to not only deaths but many more cases of morbidity and disability. People from all economic groups are affected but poor are affected the worst because they suffer from double brunt of injuries and also the economic loss; sometimes pushing them below the poverty line. The present study was conducted to study the epidemiological variables involved in road traffic accidents.Methods: 500 road traffic accident victims admitted in emergency department of Rajindra Hospital, a tertiary institute; attached to Government Medical College, Patiala (Punjab) were studied from July 2002 to February 2003. In this descriptive study pretested proforma was used to know the various epidemiological factors related to road traffic accident victims. The demographic variables, category of road users, details of injured pedestrians and types of vehicles involved in road traffic accidents were studied.Results: The road traffic accident victims mainly include the young males, especially 21-30 years (31.4%), married (70.6%), and men (86.8%) mainly literate (66.6%), from rural areas of Punjab. Maximum accidents occurred during night time (8pm- 4am) and major involvement was of two wheelers (63.4%). Mainly drivers were affected in the road crashes (46.6%) followed by pedestrians (21.4%).Conclusions: young male drivers are affected the most, mainly involving two wheelers. There should be regular and continuous on-going traffic safety and awareness programs covering all the media especially directed towards education of drivers, pedestrians and young population; mainly focusing on the schools and colleges youth.

Age estimation from the fusion of distal end of fibula epiphysis

The range of variation in epiphyseal fusion for the distal end of fibula epiphysis in Punjab, India populations has been studied in the present study. This study evaluates epiphyseal fusion of the distal fibula in 100 young individuals, 50 males, and 50 females with age range from 16-17 years to 24-25 years. Radiographs were performed at Rajindra Hospital, Patiala, Punjab, India with 10 cases from each age group in both males and females. Both AP and lateral views of X-ray were taken. Results indicate that complete fusion in males occur at the age of 18-19 age group and in females occurs at 16-17 year age group in the distal end of the fibula. Earliest union for males and females occur at 16 years.

Biomedical waste management at tertiary level hospital–Rajindra Hospital [Government Medical College], Patiala-A situational analysis

Background: Studies in India and other developing countries has shown poor practice of Biomedical waste management [BMW]. Hence this study was undertaken to situation of BMW in our hospital, to identify the gaps and to take necessary steps for rectification. Materials & Methods: This was an observational descriptive hospital based cross sectional study. All sites where biomedical waste is generated, were visited during 3 months. The collection point was visited continuously for a week after collection of data from sites. The data, thus generated, were compiled, analyzed and inferences were drawn. Results: It showed that all Indoor site [100%] had a system for segregation and appropriate display as per guidelines was present. In OPDs the buckets were kept according to the waste type being generated i.e. not all colored buckets were kept. At 10% of sites the display was not to the standards desired. Among the remaining sites, 5 sites i.e. of sites the color coding guidelines were not followed. 37 such staff members recently assigned were found untrained Conclusions: This study revealed that there is the need for the training programme and proper implementation of guidelines for BMW.

Assessing the applicability and usability of patient satisfaction levels as a tool for judging quality of service in a medical college hospital in Punjab, North India

Introduction: Healthcare industries have seen recent movements towards continuous quality improvement at the global level. Patient satisfaction is one of the established yardsticks to measure success of the services being provided in the health facilities. Aims and objectives: 1) To review satisfaction rates among patients admitted in a Medical College hospital. 2) To evaluate applicability and usability of carrying out evaluation of patient satisfaction for hospital services as an indicator of quality of services. Material and Methods: A comparative review study of patient satisfaction rates was done in two phases, first in July- August, 2013 and then in March – April, 2015 among indoor patients being discharged admitted in major wards at Rajindra hospital (GMC Patiala). Results and Discussion: Most of the patients were from underserved sections of the community. Patients show higher satisfaction levels with the services and care provide by hospital staff. Regarding basic amenities, availability of toilets/hand washing facility in the wards, cleanliness in the toilets and wards, adequacy of Fans / Lights in the wards has been stated to be much improved by the patients but 72 % respondents are claiming unavailability of drinking water. Patient satisfaction rates act as a reliable and rapid tool for assessing regular developmental activities and projecting the shortcomings to higher authorities. Conclusion & Recommendations: Assessing satisfaction of patients is simple and cost effective way for evaluation of hospital services. Regarding applicability and usability of such patient satisfaction survey, we conclude that it must be incorporated in routine hospital functions.

Assessing the applicability and usability of patient satisfaction levels as a tool for judging quality of service in a medical college hospital in Punjab, North India

Introduction: Healthcare industries have seen recent movements towards continuous quality improvement at the global level. Patient satisfaction is one of the established yardsticks to measure success of the services being provided in the health facilities. Aims and objectives: 1) To review satisfaction rates among patients admitted in a Medical College hospital. 2) To evaluate applicability and usability of carrying out evaluation of patient satisfaction for hospital services as an indicator of quality of services. Material and Methods: A comparative review study of patient satisfaction rates was done in two phases, first in July- August, 2013 and then in March – April, 2015 among indoor patients being discharged admitted in major wards at Rajindra hospital (GMC Patiala). Results and Discussion: Most of the patients were from underserved sections of the community. Patients show higher satisfaction levels with the services and care provide by hospital staff. Regarding basic amenities, availability of toilets/hand washing facility in the wards, cleanliness in the toilets and wards, adequacy of Fans / Lights in the wards has been stated to be much improved by the patients but 72 % respondents are claiming unavailability of drinking water. Patient satisfaction rates act as a reliable and rapid tool for assessing regular developmental activities and projecting the shortcomings to higher authorities. Conclusion & Recommendations: Assessing satisfaction of patients is simple and cost effective way for evaluation of hospital services. Regarding applicability and usability of such patient satisfaction survey, we conclude that it must be incorporated in routine hospital functions.

Tension Band Wiring Vs Reconstruction Plate for the Treatment of Proximal Ulna and Olecranon Fractures

Aims: To clinically compare the result of tension band wiring technique for simple transverse fracture of olecranon and proximal ulna & plate fixation for comminuted fracture of olecranon and proximal ulna and to discuss the merits and demerits of each procedure. Materials and Methods: 30 consecutive cases of the fracture of the olecranon or proximal ulna of skeletally mature patients of either sex, admitted in the Department of Orthopaedics, Rajindra Hospital and Government Medical College, Patiala were taken up for the study. Patients with Olecranon fractures were distributed alternative into two groups. Group A was managed by open reduction and internal fixation (ORIF) with tension band wiring (TBW), while group B was treated with ORIF with 3.5 mm reconstruction plate. All patients were assessed both clinically with measurement of flexion-extension and pronation- supination arcs and radiologically with elbow X-Rays. Functional outcome was estimated using the criteria laid by Weseley et al (1976), modified by Wolfgang et al (1987). Results: Thirty patients (m: 20, f: 10) with a mean age of 43.7 years were operated. They were assessed at 12 weeks. Final result was Excellent in 20 patients (66.7%)., Good in 7 patients (23.3%) and Fair in 3 patients (10%).The fracture olecranon was more common with direct blow on posterior aspect of the elbow (46.7%) . Radiological union occurred in all the 30 cases with average union time 13.06 weeks in group A and 13.6 weeks in group B. The complications occured in 11 (36.7%) cases with group A reporting higher number of complications than group B. Conclusion: Tension band wiring fixation remains the gold standard for the treatment of simple transverse fractures while reconstruction plate is more effective treatment option for improved outcome,

To study the relation of anthropometric factors with total and differential leucocyte count in healthy newborns

Introduction: The normal blood picture in newborn infant has been the subject of several studies since the beginning of this century. Several studies were conducted to evaluate relation of hematological parameters of neonate with a perinatal events, maternal and neonatal factors.  But only few studies were conducted to compare hematological values of neonate with anthropometric parameters. Objective of this study is to evaluate the effect of neonatal anthropometric factors i.e. weight, including head circumference and length on total and differential leucocyte count in cord blood of healthy newborns. Material & Methods: The study was conducted on 200 healthy newborns admitted in neonatology section of Department of Paediatrics, Govt. Medical College/ Rajindra Hospital, Patiala. Cord blood sample (2ml) was taken at birth by milking the cord  into an EDTA containing vial then  used for calculating total leucocyte count and differential leucocyte count. TLC was done by manual method (haemocytometer method) using improved Neubauer Chamber. Results & conclusion:  it can be inferred that Total leucocyte count increases with increasing weight and length of the newborn. Similarly, neutrophils and lymphocytes increases with increasing weight whereas only lymphocytes increases with increasing length of the newborn. However, head circumference has no effect on Total and differential leucocyte count in healthy newborns.

Impact of Socio-Economic Status, Rural Background and Gender on the Prevalence of Chronic Obstructive Pulmonary Disease

Background : Prevalence of COPD and resistance towards drugs available for its treatment are increasing day by day. Objectives : To assess the impact of socio-economic status, rural background and gender on the prevalence of Chronic Obstructive Pulmonary Disease. Methods : This observational, prospective, open study was conducted in the Department of Chest&TB Rajindra Hospital, Patiala. A total of 250 patients were included in the study over a period of 1 year of mild to very severe stage of COPD according to GOLD guidelines for COPD 2011. Impact of rural background, household medium of cooking food, male: female ratio of disease occurrence, and patient's socio-economic status were evaluated using modified kuppuswami grading. Results : In the rural population 100 patients out of 215 patients were males and 115 patients were females showing the rising trend of COPD in females of rural background and using biomass combustion and kerosene stove as the medium for cooking food, moreover most of the patients were living in the overcrowding. According to modified kuppuswami classification of socio-economic status, 170 patients were in the lower lower class, and 45 patients were in lower middle class socio-economic status in the rural background. Conclusion : Highest prevalence of COPD was seen in 51-60 years age group and among the patients of rural background with 215 patients (86%) affected with COPD out of 250 patients. With modified kuppuswami grading of Socio-economic status (SES), we found out that maximum patients in the rural background were from lower lower class SES thus signifying that poor socio-economic status can be a link to COPD.

Aerial pollen diversity in Punjab and their clinical significance in allergic diseases

The present study has been carried out to assess the allergenicity of dominant pollen types from the atmosphere of nine districts of the state of Punjab, India. During the study period (2012–2014), 30 different kinds of pollens belonging to 17 families were recorded. Antigenic extract of thirteen pollen types were selected for skin prick tests (SPT). The allergenic pollens selected for the present study belong to families: Asteraceae, Amaranthaceae, Brassicaceae, Cannabaceae, Chenopodiaceae, Meliaceae, Moraceae, Myrtaceae and Xanthorrhoeaceae. Total 165 sensitized patients having diagnosed with bronchoprovocation test were selected for SPT. Diagnostic tests were performed in ENT department, Rajindra hospital Patiala, and SPT were done in the clinic of Dr. H.S. Bedi at Patiala. Antigenic reactivity (3+ to above) to various allergens varied from 2.4 to 9.09 %. Patients showed maximum allergenic sensitivity to Parthenium hystrophorus (9.09 %) followed by Morus alba (8.48 %), Amaranthus spinosus (7.87 %) and Ageratum sp. (6.06 %). Least reactivity was shown by Brassica compestris and Eucalyptus sp. (2.4 %).

Comparative study between Dynamic Condylar Screw and Locking Plate Fixation in fractures of distal femur in adults-A study of 30 cases

Background: The aim of treatment of the distal femoral fractures has been a balance between the goal of anatomical alignment and need for early function of limb. Objective: 1. To compare the rigidity of fixation achieved. 2. To compare the restoration of anatomical joint surface. Methodology: 30 patients of distal femoral fractures admitted to Department of Orthopaedics, at Government Medical College, Rajindra Hospital, Patiala. Only those cases were selected where ORIF is indicated like in patients with displaced intra-articular fractures, multiple injuries, severe ipsilateral limb injuries, displaced extra-articular supracondylar fractures, pathological fractures and most open fractures. Results: Among 30 patients, 16 cases (54%) sustained A type and 14 cases (46%) suffered type C supracondylar fracture as per AO classification. In DCS group, most (80%) of the patients had A type of fracture. In LCP group, most (75%) of the patients had C type of fractures. Bone grafting was done in 8 (24%) cases at the time of primary fixation of fractures. In DCS group bone grafting was done in two cases and in LCP group in 6 cases. In the DCS group, we had 2 cases (6%) in which only one inter fragmentary screw and 1 case in which 2 inter fragmentary screws were fixed in the distal fragment along with DCS lag screw and plate to give additional support. Conclusion: LCP is the implant of choice in comminuted fractures of distal end of femur and in elderly patients DCS can be used in distal femur fractures only when there is an uncomminuted bone stock of atleast 4 cm above the intercondylar notch. Key Words: Supracondylar, Intercondylar, Inter fragmentary screws, Bone grafting

Role of Routine Subhepatic Abdominal Drain Placement following Uncomplicated Laparoscopic Cholecystectomy: A Prospective Randomised Study.

Routine abdominal drainage after laparoscopy cholecystectomy is an issue of considerable debate. Reason for draining is to detect early bile/blood leak and allow CO2 insufflate during laparoscopy to escape via drain site thereby decreased shoulder tip pain and post-operative nausea and vomiting. But some studies show no difference in post-operative nausea /vomiting/pain between drain and no drain group. To assess the role of drains following uncomplicated laparoscopic cholecystectomy. This prospective randomized study was conducted in the Department of General Surgery, Government Medical College and Rajindra Hospital, Patiala. Hundred patients of symptomatic gallstones satisfying the selection and exclusion criteria, undergoing uncomplicated laparoscopic cholecystectomy were included in this study, 50 cases with drains in right subhepatic space (Group I) and 50 cases without drains (Group II). Both groups were compared in terms of post-operative shoulder pain, analgesic requirement, nausea and vomiting, hospital stay and analgesic requirement in patient with drains and without drains. SPSS version 16.0 (Chi-Square Test and Fisher-Exact Test) were used for statistical analysis. In this study, average operative time in both the groups was same (p-value 0.977). There was more incidence of nausea /vomiting in no drain group than in drain group. Shoulder tip pain was lower in drain group in first 12 hours post-operative. However, after 12 hours, drain group had higher shoulder tip pain than no drain group. Analgesic requirement was higher in no drain group upto 12 hours after which it was higher in drain group (statistically not significant). In terms of hospital stay patients in drain group had a longer stay in hospital as compared to no drain group (2.96 vs 2.26; p <0.001 statistically significant). Use of drains in uncomplicated laparoscopic cholecystectomy is not advantageous; its role in reducing post-operative nausea/vomiting is insignificant. It increases post-operative shoulder tip pain and hospital stay. Therefore, routine use of drains cannot be justified as it increases morbidity without significant advantage.

Patterns of Cancer: A Study of 500 Punjabi Patients.

The State of Punjab has been in focus because of aperceived increasing rate of cancer. Both print and electronic media have created an impression that Punjab, especially the cotton belt of Malwa Region, has become a high incidence cancer region. Actually the increased number of cancer patients might be at least partly because of increasing population and heightened health awareness and reporting. The purpose of this study is to find out the pattern of cancer amongst patients registered in Mukh Mantri Punjab Cancer Rahat Kosh Scheme (MMPCRKS), under cancer registry at Rajindra Hospital Patiala from the various districts of Punjab. The study covers 500 cancer patients registered under MMPCRKS at Rajindra Hospital Patiala, for free cancer treatment. Information regarding age, gender, religion, method of diagnosis and affected sites was obtained. Results were analyzed statistically. Of the 500 patients, 65% were females and 35% were males. The most affected female age groups were 50-54 and 60-64; while males in the age groups of 65-69 and 60-64 had the highest risk. The leading cancers in females were breast followed by cervix and ovary where as in males they were were colon followed by esophagus and tongue. The commonest histological type was adenocarcinoma followed by squamous cell carcinoma. The increasing trend of cancer in Punjab is alarming. Since this study is a preliminary investigation, it could provide a leading role in prevention, treatment and future planning regarding cancer in Punjab.

Serum zinc levels in children 6 months–12 years having tuberculosis

Abstract Background Tuberculosis is one of the most serious health problems in our country. The association between tuberculosis and malnutrition is well recognized. Tuberculosis can lead to malnutrition, and malnutrition may predispose to tuberculosis. The micronutrient status in tuberculosis is affected significantly. Among the micronutrients, zinc plays a very important role as far as cell-mediated immunity is concerned. Limited data are available on the relationship between zinc levels and tuberculosis in childhood. Aim The present study was designed to estimate the serum zinc levels in children with tuberculosis and in children with malnutrition, and to compare the serum zinc levels between them. Methods Our study was conducted on 100 children in the age group of 6 months–12 years reporting to Department of Pediatrics, Rajindra Hospital, Patiala, out of which 50 children were those affected by tuberculosis and 50 children were those with malnutrition without tuberculosis. 50 age- and sex-matched children were taken as control. Results It was observed that the mean serum zinc levels in TB were 45.18 ± 10.05 μg/dl, in PEM were 53.04 ± 7.13 μg/dl while in controls they were 86.84 ± 15.92 μg/dl. It was seen that serum zinc levels were significantly low in children with TB as compared to controls (p Conclusion Serum zinc levels are significantly affected in tuberculosis.

Role of Tracheostomy in Respiratory Distress: A Study of 50 Cases

ABSTRACT Tracheostomy plays a vital role in respiratory distress caused by different conditions, like respiratory passage of obstruction, head and neck tumor, surgeries, trauma patients and inflammatory conditions. Timing of the operation and postoperative care deserves more emphasis. Delay in the performance of this operation defeats the purpose of tracheostomy and if managed properly, it is a life saving procedure. The aim of the study was not only to give immediate relief to the patients of respiratory distress. But also to study age and sex distribution indication and evaluate factors associated with morbidity and mortality, intraoperative and postoperative complications associated with this procedure. This study was done on 50 cases of respiratory distress admitted in different department of Rajindra Hospital, Patiala, who underwent tracheostomy as an emergency or elective procedure. Most of the patients (24%) were of 50 to 60 years of age of which 60% were males. Emergency tracheostomy was done in most of the cases (64%). Most common complication was wound infection and granuloma formation (16%). Mortality due to primary disease (tumors of head and neck) was 34%. Followed by head injury (29%). Only one patient died of tracheostomy due to excessive bleeding. How to cite this article Sahni D. Role of Tracheostomy in Respiratory Distress: A Study of 50 Cases. Clin Rhinol An Int J 2015;8(1):20-23.

English

AIMS AND OBJECTIVES: The present study was carried out with the following aims and OBJECTIVES: To diagnose intrauterine causes of various gynaecological problems, to correlate between hysteroscopic and clinical findings, to treat the pathology hysteroscopically, if possible and to put the patient on treatment depending upon the diagnosis made by hysteroscope. MATERIAL AND METHODS: The present study was carried out on 100 patients between the age group 18-60 years admitted in the Gynaecology ward of Rajindra Hospital, Patiala. The present study was carried out to diagnose the intrauterine causes of various gynaecological problems like menstrual irregularities, infertility and post-menopausal bleeding. OBSERVATIONS: In the present study, majority of the patients (52%) were in the menstrual irregularities group. Normal cavity was found in 53.8% of the patients with menstrual irregularities and 52.7% of cases of infertility. Majority of the patients of post-menopausal bleeding had abnormal cavity (66.7%). Significantly more abnormal findings were diagnosed in the postmenopausal bleeding group (66.7%) as compared with pre- menopausal menstrual irregularities group (46.2%). On correlating clinical and hysteroscopic findings, the present study shows a higher accuracy of positive predictive value of hysteroscopy (93%). 49 out of 100 patients (49%) had positive findings making this investigation a necessary tool in the armamentarium of a modern gynaecologist. CONCLUSION: Hysteroscopy came out to be a better procedure than conventional clinical methods. It added a new dimension in the management of patients with menstrual irregularities, infertility and postmenopausal bleeding, increasing the accuracy of diagnosis and serving as an adjunct in the treatment of intrauterine problems.

Endometrial evaluation by ultrasonography, hysteroscopy and histopathology in cases of breast carcinoma on Tamoxifen therapy.

Introduction:Tamoxifen, a nonsteroidal antiestrogenic agent, is used widely as adjunctive therapy for women with breast cancer. Most studies have found that the increased relative risk of developing endometrial cancer for women taking Tamoxifen is two to three times higher than that of an age-matched population. So we designed this study to assess the endometrial status in patients taking Tamoxifen for breast carcinoma.Material and Methods:The study was conducted at Govt. Medical College and Rajindra Hospital, Patiala, India. A total of 50 patients of Ca Breast taking Tamoxifen were selected as per study criterion and TVS performed. If endometrial thickness was more than 5 mm hysteroscopy and endometrial HPE was done and data analysed.Results:On ultrasonography 35 patients (70%) had an endometrial thickness up to 5 mm. 15 patients (30%) had an endometrial thickness more than 5mm. Out of these, 11 patients, i.e. 22% of total, had an endometrial thickness of 5.1 to 10 mm and 2 patients, i.e. 4% of total had an endometrial thickness of more than 20 mm. Hysteroscopy was done on 11 patients. Out of these 8 patients had a normal hysteroscopic appearance whereas 3 patients had an abnormal hysteroscopic picture. Endometrial HPE of these 11 patients revealed 2 patients had secretory changes, 1 had polyp change, 1 had atrophic endometrium, 3 had simple endometrial hyperplasia, 1 had endometrial adenocarcinoma and 4 patients were reported to have scanty curetting.Conclusion:The duration of Tamoxifen therapy turned out to have a relationship with the incidence of endometrial carcinoma (P < 0.0001). Also, a relationship was observed between the duration of Tamoxifen therapy and symptom status of the patients (P < 0.0001). This correlation did not extend to duration of Tamoxifen therapy and endometrial thickness. (P = 0.190). This correlation did not extend to duration of Tamoxifen therapy and endometrial thickness. (P = 0.190).

A study to establish the relation of antibiotics and steroids in fungal growth occurring in CSOM patients

Background: Otitis media is known to be one of most common childhood infections and a leading reason for antibiotic prescriptions in the developed world. Fungal infections superimposed over chronic suppurative. Otitis media is suspected when the discharging ear does not respond to local antibiotic ear drops. The aim of the study is to analyze the relation of antibiotics and steroids in fungal growth occurring in CSOM patients. Methods: Total 150 cases were selected from OPD of ENT department, Government Medical College, Rajindra Hospital, Patiala and divided under two groups: Control group and study group. Results: The antibiotic drop apart from moist and alkaline medium of discharge appears to be mainly responsible for fungal growth and when steroids are added the fungal growth incidence is increased. Thus local drops should be used with great care in treating chronic suppurative otitis media. Conclusions: Local drops with some anti-fungal agents may be the ideal treatment in chronic suppurative otitis media.

Prevalence of sexually transmitted infections in HIV positive and HIV negative females, in a tertiary care hospital - An observational study.

The presentation and course of Sexually transmitted diseases(STI) may be altered by presence of coexisting HIV status. Aim of the study was to study the prevalence of STI in 50 females with HIV infection and 50 females without HIV infection and to study the pap smear of patients to look for any cellular changes (dysplasia) due to sexually transmitted infections. The present study was an observational study, which was undertaken on 100 females with STIs (50 females with coexistent HIV infection and 50 females without HIV infection), in the age group 15-49 years attending Skin and VD OPD of Rajindra hospital, Patiala. In our study, the commonest presenting complaint in case of both HIV positive (66%) and HIV negative (80%) women was vaginal discharge. PAP smear abnormalities were present in 28 (56%) HIV positive women and 11 (22%) HIV negative women. In case of HIV positive women, the inflammation was trichomonal in 4 (8%), bacterial in 2 (4%), fungal in 2 (4%) and non-specific in 20 (40%) patients. In HIV negative women, the inflammation was trichomonal in 2 (4%) patients, bacterial in 2 (4%) patients and non-specific in 7 (14%) patients. The difference in abnormality seen in PAP smear between HIV positive and HIV negative women is statistically significant only in case of non-specific inflammation which is more common in case of HIV positive women. From the present study, it was concluded vaginal discharge was the commonest presenting complaint in both HIV positive and HIV negative women, though the commonest cause of vaginal discharge was candidiasis in HIV positive females and bacterial vaginosis in HIV negative females. Also, PAP smear abnormalities were significantly higher in HIV positive women than HIV negative women. So it is important that HIV positive women should have complete gynecological evaluation including a PAP smear with aggressive screening of STIs.