Objective: To study the correlation of hearing loss with depression, anxiety and stress in patients suffering from chronic suppurative otitis media in local population of Pakistan. Methods: This is a cross-sectional study conducted from May to September 2018 at tertiary care hospital of Karachi. One hundred and twenty patients of chronic suppurative otitis media were divided into three groups: Group-1 (maintained on ciprofloxacin), Group-2 (maintained on co-amoxicillin) and Group-3 (did not subject to the treatment).The measurement of hearing loss was carried out by pure tone audiometry (PTA) and the depression, anxiety and stress were scored taking depression, anxiety and stress scale (DASS) as tool. To observe the effect of hearing loss on different groups one way ANOVA was applied and Spearman correlation was used to find correlation of depression with hearing loss. Results: There was no significant difference found for hearing loss and severity among the groups treated with ciprofloxacin, co-amoxicillin and not maintained on antibiotic therapy. Positive correlations found between hearing loss and depression, anxiety and stress in patients of the three groups. Conclusion: Depression induced by hearing loss as a result of CSOM in patients need to be monitored during and after treatment and scored so that can be treated by counseling and antidepressant (if required). Information regarding this topic on population of Pakistan will be helpful for health care takers and policy makers to manage mental stress with hearing loss in CSOM. How to cite this:Mehboob S, Rafi SMT, Ahmed N, Mehjabeen. Association of hearing loss with depression, anxiety and stress in patients suffering from Chronic Suppurative Otitis Media. Pak J Med Sci. 2019;35(2):---------. doi: https://doi.org/10.12669/pjms.35.2.152 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract:The objective of the study was to evaluate the drug-drug interaction studies of levoceterizine with atenolol. Calibration curve studies of working standard solutions of levocetirizine and atenolol (0.01~0.1 mmol) were scanned. Maxima appeared at 231 nm for levocetirizine and 224 nm for atenolol. The calibration curve obeyed Beer Lambert's Law. Lone availabilities of both the drugs were studied in pH 1, pH 4, pH 7.4 and pH 9 at 37 °C on B.P. (British Pharmacopoeia) dissolution apparatus. To study the drug-drug interaction of levocetirizine (5 mg tablet) and atenolol (100 mg tablet), both the drugs were introduced to the dissolution apparatus in simulated gastric juice (pH 1), pH 4, pH 7.4 and pH 9 at 37 °C at zero time and measured the absorbance maxima of both the drugs at the corresponding wavelength. Graphs were plotted for availability percentage (%) of drug versus time at each set of experiment. The availability percentage (%) of levocetirizine in the buffers of pH simulated to gastric pH 4, pH 7.4 and pH 9 in the presence of atenolol was 436.78%, 376.90%, 436.78% and 436.78%, respectively, but the availability of atenolol was increased up to 214.80%, 212.96%, 214.93% and 231.51% in simulated to gastric pH and in the buffers of pH 4, pH 7.4 and pH 9, respectively. On the basis of these studies, it is concluded that levocetirizine forms a charge-complex with atenolol; therefore, co-administration of these drugs should be avoided.

Introduction: Chronic suppurative otitis media (CSOM) is middle ear infection, perforation and inflammation usually with purulent middle ear discharge. Different immune markers such as IgE and interferon were proved to be elevated in CSOM. Aim/Objective: The aim of the study is to evaluate of these inflammatory biomarkers (IL6, IL8 and TNF gamma) in patient of CSOM to suggest future therapy of chronic infections with inflammations. Methodology: This is a case-control study conducted in ENT ward in a tertiary care hospital in Jinnah Post Medical centre, Karachi during November 2017 to May 2018. Patients or healthy volunteers were divided into two groups as G1 (without any disease) and G2 (CSOM patients without treatment), G3 (CSOM patients treated with co-amoxicillin) and G4 (CSOM patients treated with ciprofloxacin). The serum was subjected for the quantitative measurement of IL6, IL8 and TNF Gamma by ELISA Kit method via antibody-antigen-enzyme complex formation and measured at 450 nm. Result: Study shows that IL6, IL8 and TNF gamma concentration was significantly high in G2 (positive control), G3 (ciprofloxacin) and G4 (co-amoxicillin) in contrast with G1 (negative control). Moreover, IL6 concentration was significantly low in G3 (ciprofloxacin) and G4 (co-amoxicillin) as compare to G2 (positive control). Conclusion: Elevated levels of IL6, IL8 and TNF gamma in CSOM showed alteration of immune response in chronic suppurative otitis media. Moreover, anti-inflammatory role of ciprofloxacin and co-amoxicillin in CSOM may provide additional benefit beside attenuation of infection.

Objective: The aim of the current study was to evaluate the risk of hepatic and renal toxicity in patients with chronic suppurative otitis media (CSOM) and the effects of antibiotics (ciprofloxacin and co-amoxicillin) on it. Methods: This is a case–control study conducted on patients and healthy volunteers divided into four groups; G1 (negative control), G2 (positive control), G3 (patients treated with ciprofloxacin), and G4 (patients treated with co-amoxicillin). The study was conducted in Jinnah Postgraduate Medical College in Karachi, Pakistan, from May 2018 to October 2018. Results: There was a significant (P < 0.05) increase in total bilirubin, direct bilirubin, alkaline phosphatase, Serum glutamic pyruvic transaminase (SGPT), and Gamma-glutamyl transferase (GGT) in patients of G2 (positive control) as compared to G1 (negative control). However, the treatment with antibiotics may recover the normal liver enzyme levels except direct bilirubin and SGPT. An insignificant increase in blood glucose levels and urea was found in G2, G3, and G4 with insignificant increased creatinine levels. Conclusion: Hepatic toxicity may be induced in patients with CSOM, particularly if not properly treated. Therefore, precautions with proper follow-up of liver function test should be taken in CSOM.

ABSTRACT Objective: To determine the diagnostic accuracy of FNAC in the diagnosis of thyroid neoplasm among patients with thyroid swelling in local population of Pakistan. Method: It was a retrospective study conducted in ENT and endocrinological department of   JPMC Karachi and Khuzdar district between 1st august 2018 to 20th march 2019. The current study was performed to collect data for last five years patients in ENT and endocrinological departments. FNAC in all these patients was performed either by residents or consultants without local anaesthesia, using a 23-gauge needle. Smears were immediately fixed with 95% ethyl alcohol solution, and staining was performed using Papanicolaou, Hemacolour, and Haematoxylin and Eosin (H and E) stain. The results were classified into four groups: inadequate, benign, suspicious, and malignant.  A proforma was used for data collection, including registration number, age, gender, FNAC opinion , FNAC category , biopsy number and histology opinion. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of FNAC were calculated using the standard formulae Results: The overall evaluation of FNAC technique as primitive tool reflected the accuracy of te method up to 87.7%, sensitivity 87.5% and specificity of 88% in local population of Pakistan. The presented study showed the safe use of FNAC with low rate of false negative results and few complicated cases. Conclusion: FNAC helped to reduce the unnecessary surgery in the subjects with benign lesions and to produce better follow up investigations, therefore, improve the quality of life of the patients with thyroid lesions.