bluuebunny/crossref_metadata_2025 huggingface dataset:
Impacts of transfusion in β-thalassemia major patients receiving multiple blood transfusions
Authors: Singh Virendra , Meena Battilal , Bihari Naseem A. , Sharma Mahendra
Published: December 2018

Background: Beta-thalassemia major is one of major public health problems in India. Thalassemia major is a transfusion-dependent severe anemia and these children experience various problems if the transfusion is inadequate but at the same time repeated blood transfusions are associated with hazards like iron overload.Methods: This study was conducted at thalassemia ward of S.M.S Hospital and J.K.LON paediatrics Hospital, Jaipur from April 2012 to Nov. 2013. 145 thalassemia patients on transfusion therapy attending outdoor or being admitted were assessed after obtaining due permission from the authorities and consent from the guardian or parents of patients.Results: Present study comprised 145 beta-thalassemia major patients with 51 (35%) females and 94 (65%) males in which youngest patient is 3 years old and the oldest 33 years. 104 (72%) were Hindus and 41 (28%) were Muslims. Consanguinity was found in a significant proportion 16% (23) of the parents of the patients. 137 (94%) patients had serum ferritin ³1000ng/ml. Out 145 thalassemic patients, 108 (74.5%) have total serum bilirubin >1(mg/dl), 103 (71%) have SGPT level >35IU, 103 (71%) have SGOT level >40IU), 38 (26.2%) have serum alkaline phosphatase level >390 IU, 35 (24.1%) have serum creatinine level >1.6mg/dl, 42 (29%) have serum urea level >45mg/dl, 28 (19.3%) have serum uric acid level >6mg/dl.Conclusions: It is suggested to revise and devise suitable transfusion regime so that a balance between adequate transfusion and minimum side effects of multiple transfusions is maintained. Systemic effects of multiple transfusions should be rigorously and meticulously studied.
Prevalence of burnout among the health team workers at paediatric intensive care unit
Authors: Al Sofyani Khouloud Abdulrhman
Published: December 2018

Background: Paediatricians work in the ICU have to deal with babies who have serious or chronic conditions associated with multiple problems and they have to interact with their stressed and often fatigued parents. This makes them more exposed to developed burnout. This study aimed to estimate the prevalence of burnout among the paediatric health team at King Abdulaziz University Hospital and to determine the stress predictors among them.Methods: This cross-sectional study utilized the Maslach Burnout Inventory (MBI) that was distributed to the all the target group who filled it anonymously. The data were analysed using the Statistical Package of Social Science (SPSS) Version 16.Results: About 58 % of the participants had moderate grade burn out and 61 % of them had high grade of exhaustion. "Being single" and "being married with children" were significant predictors of burnout among the participants. The top five stressors for the participants were the poor work life balance, patient education, salary, volume of work and decision making in ICU. There was significant positive correlation between the degree of burnout and the lack of institutional resources (p=0.001), poor work life balance (p<0.001), volume of work (0.012), complexity of clinical work (p=0.009) and on call requirement (p=0.004).Conclusions: Large percent of pediatric ICU health team experienced high grade of emotional exhaustion compared to their national or international peers. There should be an interventional preventive plans to deal with such phenomenon.
Is obesity among medical students a matter of concern? a cross-sectional study in MKCG medical college, Berhampur, Odisha, India
Authors: Sahoo Bimal K. , Tripathy Radha M. , Jena Dhaneswari , Sahoo Sanjaya K.
Published: December 2018

Background: Overweight and obesity are the precursor of most of the non communicable diseases. Body mass index is an important indicator to measure obesity. Though medicos have the requisite knowledge on the morbidities associated with overweight and obesity, they are not in an advantageous position as compared with the common man due their life style.Methods: A cross sectional study was conducted among 372 undergraduate students attending the classes at Department of Community Medicine, MKCG Medical college, Berhampur, Odisha. BMI of the students was measured, and socio-demographic characteristics and other risk factors were assessed during the study with the help of a semi structured, pretested questionnaire.Results: Out of 372 students, 67.7% were males. Mean BMI of the students was 23.68 ranging from 14.96 to 43.70. The overall prevalence of obesity and overweight was 4.8% and 24.2% respectively. Overweight and obesity were significantly (p<0.05) associated with age, family history of obesity, place of residence, frequent fast food consumption. However other variables like use of electronic gadgets and vehicles, place of food consumption didn’t show any significant association.Conclusions: Medical students being the future physicians, greater emphasis should be laid among them in terms of prevention of obesity and overweight and on reinforcing all preventive measures like physical activities, correct diet, and maintenance of correct BMI. This will in the long run help in enhancement of control of many non-communicable diseases which are associated with overweight and obesity.
Correlation between 6-minute walk distance and spirometry parameters in stable chronic obstructive pulmonary disease patients
Authors: Hajare Ruchita B. , Nagarwala Raziya , Shyam Ashok , Sancheti Parag
Published: December 2018

Background: Six minute walk test (6MWT) is a sub-maximal exercise test, used as a clinical indicator of the functional capacity, in patients with cardiopulmonary diseases. It is simple, objective and reproducible test. The present study was designed to assess correlation of six minute walk test with spirometry parameters, in patients with chronic obstructive pulmonary disease.Methods: In this cross sectional study, fifty patients diagnosed with chronic obstructive pulmonary disease (GOLD criteria) coming to tertiary center were recruited according to inclusion and exclusion criteria. All patients underwent spirometric measurement. Spirometric indices including FEV1, FVC, FEV1/FVC and MVV were tested using computerized spirometer. 6MWT was performed following American Thoracic Society (ATS) guidelines. Percent (%) predicted 6MWD was calculated. Correlation between spirometry and 6MWT was assessed.Results: It was found that correlation between 6MWT and spirometry is statistically significant. There is significant strong positive correlation between percent predicted 6MWD and FEV1 (r=0.850 and p= <0.001), whereas there is significant moderate correlation between percent predicted 6MWD and FVC (r=0.554 and p= <0.001), FEV1/FVC (r=0.509 and p= <0.001) and MVV (r=0.615 and p= <0.001).Conclusions: In chronic obstructive pulmonary disease, percent predicted 6mwd significantly correlated with the spirometry parameters (FEV1, FVC, FEV1/FVC, and MVV). 6MWD decreases as there is decline in the pulmonary function. 6MWT can be a useful replacement of spirometry in assessment of severity of COPD.
Morphologic and morphometric analysis of glenoid cavity of human scapula
Authors: Raaj Manisha S. , Felicia Christilda , S. Sundarapandian , A. Ashma K.
Published: December 2018

Background: To study the morphometry and morphology of glenoid cavity of dried scapula bone and in CT scan of glenoid cavity. The present study aimed at calculating three dimensions i.e. vertical diameter, horizontal diameter of the upper segment and horizontal diameter of the lower segment of the glenoid cavity and describing the incidence of its different shapes.Methods: This study was done on 100 dry, unpaired adult human scapulae of unknown sex. 50 scapulae belongs to right side and 50 scapulae belongs to left side obtained from Department of Anatomy, SRM Medical College and Research Institute. The above mentioned diameters are measured using Vernier caliper and the mean dimensions are calculated, morphological variations are studied. 3D CT images of scapulae, obtained from Department of Radiology, SRM Medical college and Hospital, Potheri, were also analysed.Results: In the current study, various dimensions and incidence of various shapes of glenoid cavity were measured. The incidence of both pear and inverted comma shape in right side is greater than in left whereas the incidence of oval shape in left side is greater than right side. The SI diameter of right glenoid is greater than the left, which is statistically significant. The Antero-posterior diameters (AP-1, AP-2, AP-3) of right glenoid is greater than the left, but not statistically significant.Conclusions: The knowledge of the above said variations of glenoid cavity is important in manufacturing the glenoid component of shoulder prosthesis, repair of Bankart’s lesion, procedures like posterior glenoid osteotomy.
The implementation of prevention of mother-to-children HIV transmission program by private midwife practice at Denpasar city
Authors: Widiastuti Ni Made Rai , Adnyani Ni Wayan Sukma
Published: December 2018

Background: HIV infection is one of the top health concerns and contagious diseases which could lead to the death of mother and child. Based on the Health Department of Bali Province data (2014), the number of pregnant women who willingly did PMTCT test is 5,029 (42.91%) out of 11,719 pregnant women. This shows that the achievement is still below the national target which is 78% of HIV-tested pregnant women. This research sought to find out the factor which affects the implementation of PMTCT care by BPM at Denpasar city in 2018.Methods: This research was an analytical research using cross-sectional approach. The selection of sample used total sampling technique in which 73 BPM fulfilled the inclusion criteria. Data analysis utilized univariate analysis, bivariate analysis with chi-square test correlation test which was followed by multivariate analysis with logistic regression.Results: This study showed there was a significant relation (with p value <0.05) between the variable of working period, training and motivation with midwife compliance in PMTCT care. The most dominant variable which affected midwife compliance was working period variable (>5 years).Conclusions: Supervision from policy makers from Health Department and Public Health Center (Puskesmas) was essential in conducting a review regarding on PMTCT regularly to increase the scope of PMTCT at BPM.
Correlation nutritional status with uric acid level in Minangkabau men ethnicity
Authors: Desmawati Desmawati , Lestari Yuniar , Fasrini Ulya Uti , Sulastri Delmi
Published: December 2018

Background: Hyperuricemia is a predictor of metabolic syndrome influenced by many factors, one of which is nutritional status. A highly prevalence overweight and obesity in ethnic Minangkabau is quite high which can increase the prevalence of hyperuricemia. This study aims to determine the relationship of nutritional status intake with Minangkabau ethnic male uric acid levels.Methods: This study used a cross-sectional design, done in August to November 2016. Nutritional status was obtained through the measurement of body mass index (BMI) based on height and weight. The uric acid level examined in the Prodia laboratory. Data were analyzed by using chi-square test.Results: Most of subject were obesities. A total of 21% subjects suffers hyperuricemia. Statistic test results showed that there was a significant relationship between nutritional status and serum uric acid levels (p <0.0001).Conclusions: There was a significant relationship between nutritional status and serum uric acid levels in Minangkabau ethnic men in Padang city.
Haemostatic abnormalities in solid malignancies
Authors: Joshi Supriya D. , Murdeshwar Hemant G. , Pandit Gopal A.
Published: December 2018

Background: Though the actual symptoms of any haemostatic abnormalities in patients of solid malignancies are not seen commonly screening in all such cases can guide us to correct those abnormalities in time and improve the outcome. The present study is undertaken with an objective to find out coagulation disorders in patients of solid malignancies and compare their levels according to the stage of the cancer.Methods: A prospective study was undertaken in a tertiary care centre in Maharashtra, India from December 2010 to September 2012. Total 102 cases with malignancies diagnosed on histopathology/cytological examination were tested for BT, CT, Platelet count, PT, APTT, TT and D-dimer levels. These tests were repeated on first postoperative or post chemotherapy day wherever possible. Early and advanced stages of cancer were divided according to the spread of the tumor. Results were compared between the two. DIC cases were also noted.Results: Out of 102 cases studied, haemostatic abnormalities were more common in adenocarcinomas that too in mucin secreting adenocarcinomas. The percentage of cases with increased D-dimer values was higher in the advanced disease compared to early disease. The PT, APTT, TT and platelet count showed statistically significant differences between the early and advanced disease groups. Compared to preoperative values, postoperative values were abnormal but the change was not statistically significant.Conclusions: Screening for coagulation profile in all solid malignancies can help to predict the chances of complication and therapeutic interventions can be done.
Seroprevalence of HIV in blood donors at tertiary care center, M.Y.H. Indore, India
Authors: Solanki Priyanka , Yadav Ashok , Likhar Khushboo
Published: December 2018

Background: Transfusion of blood has become an important mode of transmission of infections such as human immunodeficiency virus and hepatitis B to the recipients. Blood transfusion is a boon in medical era if properly screened. The aim of study was to determine the seroprevalence of HIV donors in blood bank at M.Y.H. Indore.Methods: The study was conducted in the blood bank, M.Y.H. Hospital, Indore. Total 115775 donors attending blood bank were included in the study. All the donor samples were screened for detection of antibodies for human immunodeficiency virus by microwell Enzyme Linked Immunosorption Assay (ELISA) method. The seroprevalence of HIV infection among the donors was determined over a period of five years since January 2013 to December 2017.Results: Total 115775 blood donors were recorded. Out of total 115775 blood donors included in the study, replacement donor were 10766 (9.29%) while voluntary donor were 105009 (90.70%). In the duration of five-year study period, total 80 cases (0.06%) were reactive to HIV. Out of total 115775 blood donors included in the study, maximum cases i.e. 22 (0.08%) cases were found to be positive for HIV infection in year 2017. Out of 10766 replacement donors included in the study, 64 cases (0.59%) were reactive to HIV infection. While out of 105009 voluntary donors, 16 cases (0.01%) were found to be reactive to HIV infection. Voluntary donors are more as compared to the replacement donors. Number of HIV positive patients were found to more in replacement donor as compared to the voluntary donors.Conclusions: The seroprevalence of HIV is low in this study and hence it is concluded that the more the number of voluntary donors, the less the number of HIV positive cases. Voluntary donors can be motivated by proper health education and high quality screening programs.
Ultrasound guided fine needle aspiration cytology of space occupying lesions of liver
Authors: Rastogi Naincy , Bhake Arvind , Agarwal Deepika , Wankhede Akanksha
Published: December 2018

Background: The liver is a common site for primary and secondary tumors; most often from malignant tumors within the abdomen and from extra-abdominal primary malignant neoplasm, but also for sarcomas and lymphomas. The main indication of fine-needle aspiration cytology (FNAC) of the liver is diagnosis of single or multiple space occupying lesions. This study aims to evaluate the cyto-morphology of primary and secondary neoplasms of liver and non-neoplastic conditions in the smears of ultrasound guided fine needle aspiration of SOL of liver, to evaluate the cytomorphologic features and to evaluate the erroneous diagnosis when compared with cell block preparation of aspirate (tissue diagnosis).Methods: This study is hospital-based prospective study including 57 patients with space occupying lesion of the liver mass. FNAC were carried out under the guidance of sonography and/or computed tomography. The staining performed were conventional for smears of the aspirate. The cell blocks were prepared from the aspirates by the established procedures. The values of correlation were bought out.Results: Males predominated over females. The distribution of cases for cyto-diagnosis were as follows; cirrhosis with hepatic granulosa (3 cases),pyogenic abscess (3 cases), hepatic adenoma (2 cases), Focal nodular hyperplasia (2 cases), hepatoblastoma (1 case), hepatocellular carcinoma (17 cases), adenocarcinoma deposits (20 cases), deposits of small cell carcinoma (3 cases), deposits of ductal carcinoma (2 cases) and 1 case each of deposits of squamous cell carcinoma, non-Hodgkin’s lymphoma, neuroendocrine tumor and adeno-squamous carcinoma. Values of correlation were as follows: sensitivity 97.61%, specificity 100%, PPV 100%, NPV 97.82% and diagnostic accuracy of 98.85%.Conclusions: FNAC is concluded to be first rank diagnostic procedure in diagnosis of SOL of liver of varied etiology with high values of NPV and PPV. It is also concluded that it helps in staging of metastatic malignancies.
Description of clinical factors for suicide attempts in a tertiary care hospital of northern part of India
Authors: Sharma Ravi C. , Sharma Dinesh D. , Gupta Vikesh , Gupta Rahul , Kumar Vineet , Verma Kushel
Published: December 2018

Background: Suicide is the result of an act deliberately initiated and performed by a person in the full knowledge or expectation of its fatal outcome. Suicide attempts are a significant public health problem. The present study aimed to explore the variousclinical characteristics of suicideattempters in a tertiary care hospital of Shimla, Himachal Pradesh, a northern state of India.Methods: We conducted a descriptive study among patients with attempted suicide to the department of Psychiatry, Indira Gandhi Medical College (IGMC) Shimla. A structured, self-designed interview schedule and short-form revised Eyseneck personality questionnaire-Hindi (EPQRS-H) was used for data collection. Data was analyzed using Epi info software v 7.2.0.Results: There were total 77 participants in the study out of which 44 (57.1%) were females. Mean age (Standard deviation) of participants was 30.8 years (9.9 years). Relationship problems were the most common (48.1%) recent life event followed by health events (28.6%). Depression was found to be the most common diagnosis (62.3%). Pesticide consumption was the method of attempting suicide in 72.7% of females compared to 66.7% of males.Conclusions: Recent major life events especially relationship problems may lead to majority of suicide attempts. There is urgent need to focus on patients suffering from depression by health personnel as well as family members. The sale of the pesticides should be regulated to keep in check the misuse of the same.
Correlation between preoperative axillary ultrasound and histopathology of resected lymph nodes in patients with carcinoma breast
Authors: Wani Ab. Hamid , Gupta Anish , Dhigra Nasib Chand , Sing Narinder , Iqbal Javid
Published: December 2018

Background: Axillary Ultrasound is an important tool in assessing regional lymph node status in women who are node negative clinically as many of them will prove to have axillary lymph node involvement on histopathology. The aim of the present study was to establish the role of axillary ultrasound in preoperative assessment of lymph node status in women with carcinoma breast and to correlate the findings of axillary ultrasound with the histopathology of resected axillary nodes.Methods: Forty patients (all women) were included in this study and the preoperative axillary ultrasound was done to know the status of axillary lymph nodes and the findings were correlated with histopathological findings of the resected nodes.Results: The sensitivity of axillary ultrasound was found to be 66.67%, specificity was 87.5%, accuracy 75%, positive predictive value (PPV) of 88.89% and negative predictive value of 63.4%.Conclusions: Axillary ultrasound is very important tool in assessing preoperative axillary lymph node status in patients with carcinoma breast. It is also important in assessment after inadequate axillary dissection and for follow up of non-treated axilla.
Drug eluting stents versus bare metal stents in coronary artery disease patients: outcomes and complications
Authors: Kalburgi Veeraj
Published: December 2018

Background: To date, data regarding the long-term safety and efficacy of BMS and DES implantation in a real-world population are limited. Thus, this study was designed to study the complications, early and late outcomes of drug-eluting stents (DES) versus bare metal stents (BMS) after implantation in coronary artery disease (CAD) patients up to 6months follow-up period.Methods: This was a single-center, hospital-based, prospective study conducted at a tertiary care center in India. Records of 250 patients who underwent percutaneous coronary intervention (PCI) in the period of January to December 2007 were included in the study. Early outcomes were indications of coronary angioplasty, length of hospital stay, Killip’s classification at presentation, type of coronary lesions, cath-lab outcomes and acute stent thrombosis (ST). Patients were clinically followed-up till hospital discharge, 30days and in 6months.Results: Total 250 patients with an age range of 30-39years underwent PCI. Of the study population who underwent PCI 111 patients (44.4%) received DES, 104 patients (8%) received BMS, 20 patients received both DES and BMS and 15 patients underwent POBA, respectively. Complications like stroke and major bleeding were observed in 2 patients (0.8%) and 12 patients (4.8%) respectively. TIMI III flow and ST was observed in 215 patients (91.5%) and 6 patients (2.6%), respectively. Death was observed in 3 patients (1.2%) due to cardiogenic shock.Conclusions: DES and BMS have good procedural success in achieving early revascularization with PCI. The incidence of ST was almost equal in DES compared to BMS.
ETV in tuberculous meningitis with hydrocephalus and allergic reaction to VP shunt: a case report
Authors: Rosyidi Rohadi M. , Priyanto Bambang , Parenrengi Muhammad Arifin
Published: December 2018

Hydrocephalus is one of the most common complications of tuberculous meningitis (TBM) occurring in up to 85% of patients with the disease. The placement of a ventriculoperitoneal (VP) shunt is the most common form of treatment for hydrocephalus in tuberculous meningitis (TBM). Although allergic reactions to the silicone in shunt device are very rare, the authors describe a case of silicone allergy causing multiple VP shunt revisions. Alternative choice is endoscopic third ventriculostomy (ETV), but it is debatable. ETV has variable success in these patients and is generally not advisable in patients in the acute stages of the disease. A 19-year-old woman with hydrocephalus in tuberculous meningitis, who had undergone multiple VP shunt revisions, presented with shunt malfunction caused by allergic reaction of the tissue surrounding the shunt tubing. Laboratory examination demonstrated high level IgE, high level ESR, and PCR-TBC Positive, related to the allergic reaction. Patient with ETV success score of 50. Patients received ETV and release VSS Shunt. ETV has success in these patients. VP Shunts complications remain a difficult problem in neurosurgical clinical practice. The most typical complications are mechanical obstruction and infection. Allergy to the silicone shunt tubing is quite rare. Silicone allergy is an even more rare occurrence because of its high biocompatibility and low biological reactivity. It is a challenge for ETV when TBM has difficulty to recognize anatomical landmarks on this patient. It could also consider in patients who have shunt failure, and might be a better option than shunt revision.
Wheezy adult with chicken bone in the chest
Authors: Nagabhushna Rao Bhavana Venkata , Vatti Narmada , Tadikonda Balaraju , Ponnapalli Srinivasa Perraju
Published: December 2018

A large foreign body aspiration in a healthy adult is rare in the literature. It is a frequent problem in children and adolescents. Adults are affected in altered sensorium, either due to sedation or neurological problems. Acute upper airway obstruction though rare in adults requires establishment of an airway using Laryngoscope or rigid bronchoscope. At times we have to recourse to tracheostomy to save the life. Foreign body often travels down the right sided airways, here we present a case of 30mm Chicken bone being lodged in the left main bronchus. The patient presented with unremitting cough and normal chest skiagram. Monophonic wheeze on auscultation and focused attention on the patient narration made us clinch the diagnosis. New onset wheezy chest or unremitting chronic airway disease on adequate therapy, with history of choking needs special attention. The CT scan is a better modality of the investigation. Three dimensional CT with multi-slice virtual bronchoscopy is advantageous. We discussed foreign body aspirations in adults, the various causes and presentations. Fiber optic bronchoscopy is the ideal method for visualization and extraction of non-life-threatening foreign bodies in adults. Once a foreign body is identified, it has to be removed as early as possible. Retained foreign bodies can precipitate many complications related to infection and inflammation. At rare incidence we may have to resort to thoracotomy to remove a complicated foreign body.
Maternal outcome following uterine rupture and its associated factors among mothers who delivered at Felege-Hiwot referral hospital, Amhara-Ethiopia
Authors: Wesson Alemtsehay , Assefa Enyew
Published: December 2018

Background: Ruptured uterus is one of the major causes of maternal and prenatal morbidities and mortalities in developing countries, particularly in Africa. Ethiopia is one of developing countries where maternal and prenatal mortalities are still high. The major objective of this study was to determine maternal outcomes of uterine rupture and its associated factors.

Methods: The study design was facility based retrospective cross-sectional study from all mothers who visit from 01 September 2011 to 31 August 2015 at Felege-Hiwot referral hospital delivery room for delivery service with ruptured uterus was conducted in the study. A total of 312 cases were enrolled in the study. The table, graph and binary logistic regression was found to be more appropriate for analyzing the data.  

Results: More than 39% mothers had severe complication. The common complication was severe anemia 24.4% followed by severe shock 14.7%. There were also 2.7% maternal deaths. The binary logistic regression model showed that incidence and its complication of uterine rupture in this study were remarkably high. Antenatal care visit, duration of labor and admission to laparotomy time and hospital stay had strong association with maternal outcome.

Conclusions: Improving access to antenatal care, proper monitoring of labor and early referral of high risk patients will contribute to the reduction of unfavorable maternal outcome.
Analysis of hearing improvement following fat graft myringoplasty
Authors: Panchal Ajay J. , Kumar Rakesh , Desai Megha
Published: December 2018

Background: Fat graft myringoplasty (FGM) is a procedure with a short learning curve, cost effective, with minimal morbidity in properly selected patients. It is useful to relieve the patient of annoyance caused by a small perforation in terms of ear discharge and hearing loss. The aim was to assess postoperative hearing improvement and investigate influence of factors like age, gender and location of perforation on audiological outcomes.

Methods: This study was a prospective study done on 25 patients at a tertiary care hospital who underwent FGM. All patients had small dry central perforation. Air and Bone conduction (AC/BC) thresholds and air-bone gap (ABG) were evaluated both preoperatively and postoperatively.  

Results: Mean hearing improvement was 14.4762 dB in <40 yrs age group whereas it was 11.2500 dB in >40 yrs age group. Mean hearing improvement in females was 13.75 dB whereas it was 14.154 dB in males. Mean hearing improvement was 15 dB in posterior, 14.7 dB in inferior and 14.46 dB in anteriorly located perforation.

Conclusions: FGM is effective in improving postoperative hearing thresholds hence it can be used in small dry central perforations of tympanic membrane in patients irrespective of patient variables such as age, gender, and location of perforation. As no significant statistical difference was observed in terms of gender, location or aetiology of perforation, we consider it a procedure to be recommended across all spectrums of patients.
Benign lesions of the nose: a comprehensive study
Authors: Khot Sunil N. , Priyadarshini G. , Patil Prajakta
Published: December 2018

Background: Benign lesions of the nasal cavity represent a diverse group of pathologies. Furthermore, each of these disorders may present differently in any given patient as pain and discomfort, epistaxis, headaches, vision changes, or nasal obstruction.

Methods: This study was carried out in a tertiary care center in India from October 2016 to March 2018. A total of 80 patients of age 10 years to 80 years were included. Detailed history and complete ENT examination including radiological studies was done. Patients were subjected to diagnostic nasal endoscopy and biopsy followed by histopathological examination. Depending on the diagnosis, medical or surgical treatment or combination of both was administered.  

Results: In present study the commonest presenting complaint was found to be nasal blockage found in 76% of cases, followed by rhinorrhea in 40%, nasal mass in 30%, epistaxis in 16%, cheek swelling in 5%. Out of 80 benign lesions, polyp was noted in 65 cases, hemangioma in 8 and inverted papilloma in 3 cases. Out of 65 cases of polyps, 52 were antrochoanal, 10 ethmoidal and 3 maxillary. Medical treatment was given in ethmoidal polyp cases, out of which 5 were cured. Most common surgery was polypectomy. Lateral rhinotomy was done in 6 cases

Conclusions: Patients with benign lesions of the nose commonly presented in the second and third decade with slight male preponderance.Antrochoanal polyps are most common. Medical treatment works to a certain extent in patients with ethmoidal polyposis and surgery is the mainstay of treatment in the benign lesions of the nose.
Traumatic perforations of tympanic membrane: our experience
Authors: Bhargava Anuja , Faiz Syed M. , Shakeel Mohammad , Singh Nafas J. , Gaurav Kumar
Published: December 2018

Background: The aim of the study was to evaluate various etiological factors, clinical presentation in patients presenting with Traumatic ear perforations.

Methods: 27 patients were taken in our study who reported within two weeks of history of trauma with no previous history of middle ear pathology. Data was collected and patients were treated.  

Results: 27 patients were studied (11 males and 16 females); age ranging from 15 years to 56 years. Laterality of trauma was found to be more in left ear. Aural Fullness & pain in ear were the most common presenting complaints. Most common etiology was found to be assault and poster inferior quadrant was found to be most commonly involved.

Conclusions: Traumatic perforations have a very good prognosis if they are treated at the right time. We would also like to stress on the fact that domestic violence is still prevalent in our society leading to patients of traumatic perforation.

 
Clinico-microbial profile in chronic suppurative otitis media and its management in tertiary care centre
Authors: Ramashesh Rashmi , Wajid Samira Abdul , Chandra Smitha
Published: December 2018

Background: Chronic suppurative otitis media (CSOM) is an ever growing concern of preventable hearing loss and is a major health concern especially in tropical countries. Lack of cleanliness, overcrowding, poverty, malnutrition and medical ignorance are few of the contributing factors. The microbiological flora is constantly changing due to indiscriminate use of antibiotics with rapid change in the antibiotic sensitivity patterns. Hence, this study was undertaken to determine the epidemiological profile, bacteriological profile and the antibiotic sensitivity pattern which would help in establishing a protocol in management of CSOM patients in the hospital.

Methods: A total of 100 patients of CSOM attending the ENT Outpatient Department of The Oxford medical College, Hospital and Research Centre were included in the study. The samples were immediately sent to the Microbiology laboratory for further processing according to standard procedure.  

Results: Out of 100 cases, 74 were active mucosal type and 26 were active squamous, with Pseudomonas species (33.6%) being the predominant organism. Staphylococcus aureus was the next common organism with MSSA (16.3%) and MRSA (12.5%), CONS were 6.7%. Among the 28 gram-negative bacilli, Klebsiella pneumoniae (7.7%), was followed by Escherichia coli (5.7%), and Proteus mirabilis (4.8%).

Conclusions: Pseudomonas species and Staphylococcus aureus are the commonest organisms of CSOM. Ciprofloxacin can be used as a topical agent for treating gram-negative bacilli. Among systemic antibiotics- Linezolid, Amikacin and Imepenam remains the drug of choice.
Allergic fungal rhinosinusitis: a clinical study in Srikakulam
Authors: Jeevan Pradep K. , Ramesh S. , . Hareesh
Published: December 2018

Background: Allergic fungal rhinosinusitis is one of the differential diagnoses for chronic bacterial rhinosinusitis. Recognition and understanding of this unique disease will lead to efficient diagnosis and treatment of this curable process. India being a tropical country, provides an apt environment for fungal growth, the clinical diagnosis of Allergic fungal rhinosinusitis should not be missed and should be thoroughly investigated and managed to prevent recurrence. The objective of the study was to verify the management protocol for allergic fungal rhinosinusitis, after surgical clearance with functional endoscopic sinus surgery and postoperative histopathological examination and to see the efficacy of steroid and antifungal treatment

Methods: A one year prospective study was considered with 28 patients from July 2016 to July 2017. Clinically suspected cases of rhinosinusitis depending upon their clinical presentation were subjected to nasal endoscopy, radiological examination and functional endoscopic sinus surgery. Postoperative histopathological examination was performed. Patients were followed up after giving steroid and antifungal treatment.  

Results: 28 cases were non-invasive. Aspergillus was found to be the most common isolate. The criteria responsible for good prognosis of allergic fungal rhinosinusitis management were mainly found to be functional endoscopic sinus surgery followed by topical corticosteroid therapy.

Conclusions: Allergic fungal rhinosinusitis is a disease entity on the rise. Prompt diagnosis and intervention prevents recurrence and complications.
Comparison between microdebrider assisted surgery and the conventional methods in the surgical treatment of nasal polyps
Authors: Bellad Shama A. , Manjunath N. , Ravi Shilpa
Published: December 2018

Background: Microdebrider is emerging as a convenient tool for various ENT surgeries that helps in easier disease clearance and reduced morbidity. Though it requires some surgical expertise initially to master the skill of handling it, it is worth procuring and using in endoscopic sinus surgery. The present study was conducted to compare the microdebrider assisted endoscopic surgery and conventional methods using sinus endoscopes in the surgical management of nasal polyps.

Methods: 30 patients diagnosed with nasal polyposis between the age group of 5 to 60 were equally randomized into 2 surgical groups- powered endoscopic sinus surgery group and conventional endoscopic sinus surgery group with 15 patients in each group. The study aimed at comparing the intra operative (blood loss, duration of surgery) and post operative results (crusting, scarring, discharge, symptoms, recurrence) between the two groups using Lund–Mackay scoring system and visual analogue scale. The data was statistically analysed.  

Results: A significant statistical evidence for a shorter operative time, dryness of the field, better surgical conditions and improved VAS scoring at 3 and 6 months postoperatively was observed in the powered endoscopy group than using conventional techniques.

Conclusions: The use of microdebrider in endoscopic sinus surgery has the advantage of complete clearance of disease, smoother intra operative course and better post operative healing when compared to conventional instruments in the treatment of nasal polyps.

 
Correlation between histological grading, LVI and PNI of carcinoma oral tongue to lymph node metastasis
Authors: C. Viswanatha Sumana , Hedne Naveen , Hasan Suhel
Published: December 2018

Background: Squamous cell carcinoma (SCC) of oral tongue has a higher predisposition to lymph node metastasis which reduces survival by 50%. In clinical practice, TNM classification is used for treatment planning which does not provide information on the biological characteristics of the tumor.

Methods: This prospective cross sectional observational study included 30 patients with T1 to T3, N0/+ oral tongue SCC from 1st March 2014 to 30th April 2015. Incisional biopsy was taken from the primary tumour, pathological evaluation for differentiation of the tumour and assessment of lymphovascular (LVI) and perineural invasion(PNI) was carried out. Post operative histopathological examination included differentiation, LVI and PNI. The pathological findings were correlated using chi square test.  

Results: Majority presented with T2 stage. 27% had nodal metastasis. There was higher incidence of lymph node metastasis in moderately differentiated (MD) and poorly differentiated (PD) SCC which was not statistically significant. Significant correlation was seen between LVI and PNI to lymph node metastasis (p≤0.001).

Conclusions: There is a higher incidence of lymph node metastasis seen in moderately and poorly differentiated SCC of oral tongue, which can be assessed on the preoperative biopsy, guiding us to be more aggressive in the management of cervical nodes in early tongue cancer. LVI and PNI are good predictors of nodal metastasis, help in assessing aggressiveness and prognosis of the disease, and are soft indicators for considering adjuvant / concurrent RT.
A study of head and neck space infections and their sensitivity pattern at tertiary care hospital
Authors: Jindal Simmi , Parmar Suchina , Davessar Jailal , Bawa A. G. S. , Singh Gurbax , Prinja Sumit , Bali Alisha
Published: December 2018

Background: Head and neck space infections including submandibular, buccal, diffuse neck space, peritonsillar, parapharyngeal, parotid, submental, retropharyngeal, result in frequent hospital visits. Infection can be mild or severe life threatening infection.

Methods: 40 patients with head and neck space infections were considered. Pus samples were collected with aseptic precautions and sent to department of microbiology for culture and antibiotic sensitivity.  

Results: The most common head and neck space infections are submandibular followed by buccal, diffuse neck abscess, peritonsillar, parapharyngeal, parotid, submental and retropharyngeal. Incidence of aerobic growth is 60%, fungal 10%, anaerobic 7.5%, tubercular 7.5% and no growth 15%. Predominant aerobes are Staphylococcus aureus, Pseudomonas aeruginosa, Methicillin Resistant Staphlococcus aureus, Klebsiella species and anaerobes are Peptostreptococcus and bacteroides and fungal species is Candida. Aerobic organism showed maximum sensitivity to Amikacin, Vancomycin, Linezolid, Piperacillin+Tazobactum, Clindamycin, Erythromycin, Cefoperazone, Ceftriaxone and maximum resistant to Levofloxacin, Cefoperazone, Ceftriaxone, Meropenem. Anaerobic bacteria showed sensitivity to Clindamycin, Metronidazole and Colistin and resistance to Vancomycin.

Conclusions: Bacteriological examination and culture of head and neck abscesses helps to identify causative organisms. It helps to isolate even rarest of organisms and by knowing their sensitivity pattern we can detect specific therapy against them. Thus it helps in more effective treatment and fast recovery.
Pilomatricoma in the pinna: a case report
Authors: Timna C. J. , Chandrika D.
Published: December 2018

Benign calcifying epithelioma of Malherbe or pilomatricoma is rare benign skin tumours, typically seen in head and neck region. This is supposed to arise from hair follicle matrix cells. Though head and neck is the commonest area involved by this tumour, only 4.5% cases have been reported in the pinna. Neck is most commonly involved followed by cheek, scalp, pre auricular and peri orbital areas. Here we report a case of pilomatricoma over medial surface of pinna in a 20 years old female. She had the swelling which was gradually increasing for the past 5 years. Histopathological examination following excision biopsy confirmed the diagnosis.

 
Osteoma of mastoid part of right temporal bone with right nasochoanal polyposis: a rare case report
Authors: Lokanath K. V. , Basu Debaditya , Kuthiala Abhinav
Published: December 2018

Osteomas are benign mesenchymal osteoblastic tumors of lamellar bones. In our practice, they are usually seen in the paranasal sinuses, mainly involving the frontal and ethmoidal sinus. Osteoma of the temporal bone is uncommon and when they occur, they are most commonly seen in the external auditory canal. Mastoid osteomas are a rare entity with incidence of 0.1 - 1% of all benign tumors of skull. They are slowing growing and usually asymptomatic. We report a rare case in a 28 years female patient who presented to us with right postauricular bony swelling of size 2.5×3 cms along with bilateral nasal obstruction. Patient was analyzed for her clinical condition, imaging details, treatment and surgical plan. Diagnosis of right mastoid osteoma with right nasochoanal polyposis was made after non-contrast computed tomography of temporal bone and paranasal sinuses respectively. Complete surgical excision of the osteoma along with endoscopic removal of the polypoidal tissue was done with good cosmetic outcome without recurrence.
A case series of laryngeal papilloma management in children
Authors: Reddy Anil Jangam
Published: December 2018

Squamous papillomata caused by the human papillomavirus (HPV) are the most common benign neoplasms seen by laryngologists. I hereby presenting a case series of laryngeal papilloma in pediatric age with varied outcome following surgery. Microlaryngoscopy guided excision using cold steel instruments and cautery (if required) was the treatment of choice in our cases. Of the 2 cases one did not recur but the other 2 had recurrence who underwent second surgery with oral antivirals post operatively. Papilloma treatment should be individualized/ tailor made because recurrence rate varies.
Actinomycosis of antrochoanal polyp: a rare entity
Authors: Pol Shashikant A. , Dass Arjun , Gupta Nitin , Mahajan Aditi
Published: December 2018

Antrochoanal polyp is a benign lesion, originating from the mucosa of the maxillary sinus, grow into maxillary sinus, nasal cavity and posteriorly to involve the choana. Nasal obstruction and nasal discharge are their main symptoms. Epistaxis is rare as seen in infected cases. Clinical assessment along with radiology helps in the diagnosis of antrochoanal polyp. We hereby describe a case of infected antrochoanal polyp in a 20-year-old female who presented with unilateral nasal obstruction, nasal discharge and intermittent epistaxis. Complete excision was done through endoscopic approach. On histopathology it showed secondary infection caused by actinomycosis which is extremely rare finding. This might be the first case report of actinomycosis infection in antrochoanal polyp as it was not found previously in any antrochoanal polyp case. Patient was followed till 6 month without any symptom.
Isolated sphenoid polyp: a cause of headache
Authors: Galagali J. R. , Singh Roohie , Kumar Santosh
Published: December 2018

Isolated sphenoid sinus polyp is a rare clinical situation. It might be an incidental finding while investigating a case of headache. We report a case of 21 years old male who presented with history of headache since 6 months. Diagnostic nasal endoscopy (DNE) revealed a right nasal mass which was confirmed by computed tomography (CT) of paranasal sinuses (PNS). The patient underwent Functional endoscopic sinus surgery (FESS).This paper emphasizes importance of correct diagnosis and consideration of sphenoid sinus disease as differential diagnosis of patients with headache.
A rare cause of acute tympanic membrane perforation: a case report
Authors: Timna C. J. , Kumar Abhijit
Published: December 2018

This is a case report of 57yrs old gentleman who presented to accident and emergency department with complaints of sudden onset of left earache, tinnitus, feeling of fullness in the ear which he claimed to start following an episode of sudden sneezing, while he was trying to blow his nose by pinching it with 2 fingers. The tympanic membrane was ruptured. He was managed conservatively with analgesics. Spontaneous and complete healing of the perforated tympanic membrane occured within one month of follow up. It was shown that an episode of sneezing with nose closed can build up such a high pressure in the middle ear which can perforate a tympanic membrane.
Evaluation of correction of kyphotic deformity in dorso-lumbar spinal injuries by posterior stabilization with pedicular screw rod fixation
Authors: Srinivasan N. , Prabhakar Y. V. S.
Published: December 2018

Background: Acute injury to dorso-lumbar spine is the second most frequent site after cervical spine in adults. The injury, although not associated with high mortality, causes severe morbidity. The management of the traumatic dorso-lumbar spine injuries has improved considerably in the last few years. The objective of the study was to evaluate correction of kyphotic deformity in dorso-lumbar spinal injuries by posterior stabilization with pedicular screw rod fixation.

Methods: The study includes 52 patients with dorso-lumbar spinal injuries with or without neurological deficit treated between 2006 and 2014. Pre and postoperative kyphosis was measured by Cobb’s method on plain radiographs. Pre and postoperative neurological status was evaluated based on Frankel’s classification. All un-stable dorso-lumbar spine injuries where two or more columns are involved on X-ray and CT scan were included in the present study.

Results: Majority of the patients were in the age group of 20-30 years (38.5%) followed by 31-40 years (30.8%). Males were more than females. The most common mode of injury was road traffic injury in 71.2% of the cases. The most common level of injury was at L1 in 28.8% of the cases followed by at level D12 in 25% of the cases. In all the groups the mean kyphosis angle is reduced significantly. Overall the improvement rate was 94.2% and failure rate was only 5.8%.

Conclusions: In conclusion the posterior reduction and internal fixation is a useful procedure in the treatment of the acute injuries of the dorsolumbar spine. 