bluuebunny/crossref_metadata_2025 huggingface dataset:
Depression in cancer patients undergoing chemotherapy in a tertiary care hospital: a cross-sectional study
Authors: Vaidya Shivani S. , Sharma Sarita K.
Published: June 2019

Background: Cancer is the second most common cause of death after heart diseases and it accounted for 8.8 million deaths worldwide in 2015. The long course of treatment, repeated hospitalisations, and the side effects of chemotherapy along with the trauma of being diagnosed with cancer has a significant effect on psyche of cancer patient. Depression is the most frequent cancer related symptom and 15-25% of cancer patients are affected by depression. The aim of this study is to determine the levels of depression in cancer patients undergoing chemotherapy.Methods: Present cross-sectional study was conducted amongst cancer patients undergoing chemotherapy at Day Care Centre, Department of Radiation Therapy and Oncology, Government Medical College and Hospital, Nagpur. 95 participants were interviewed using predesigned and pretested questionnaire based on the Beck’s Depression Inventory.Results: Among the study subjects, 70 (73.69%) had depression of which 15 (21.42%) had borderline clinical depression, 44 (62.85%) had moderate depression and 11 (15.73%) had severe depression. None of the study subjects had extreme depression.Conclusions: Majority of the study subjects receiving chemotherapy were depressed.
Period prevalence of hypertension and risk factors in an urban slum of Maharashtra
Authors: Niwal Ajinkya J. J. , Tambe Muralidhar P. , Rao S. P. , Parande Malangori A.
Published: June 2019

Background: One in three adults worldwide has high blood pressure and proportion increases with age. Detecting high blood pressure is easy. Hence a study for prevalence of hypertension was conducted in an urban slum of Pune, Maharashtra.Methods: The study was conducted in an urban slum field practice area exclusively under the community medicine department of a tertiary care hospital during the period of February 2014- July 2014. Overall 1043 people fulfilling the inclusion and exclusion criteria were interviewed, and anthropometric measurements were taken, followed by blood pressure readings and awareness of own hypertensive status. Data was compiled, edited, classified, and analyzed. The prevalence of hypertensive patients was obtained and physical and behavioral risk factors were analyzed for association.Results: The prevalence of hypertension in adults above 18 years of age was 25.6% with mean age of hypertensive patients was 48.58±15.75 yrs. Hypertension was significantly associated with age, habit of adding extra salt to cooked food, family history, BMI and consumption of smokeless form of tobacco among the study participants. Hypertension was not significantly associated with gender and religion of the participants. Of the 267 hypertensives, 40.82% were aware of their hypertensive status and amongst those aware 61.46% were on anti-hypertensives.Conclusions: Hypertension is a public health problem affecting slum population as well. It is significantly associated with risk factors, which are modifiable. The awareness of hypertensive status is low, the under treatment is lower. The population in slum, with its poor literacy, low awareness and income levels provides an opportunity to make an intervention necessary as well as challenging.
Utilization of antenatal services by JSY beneficiaries in rural area of Pune district of Maharashtra
Authors: Gupta Sachin , Pore Prasad , Athavale Arvind
Published: June 2019

Background: To combat the reproductive and child health (RCH) problems, National Rural Health Mission (NRHM) had launched Janani Suraksha Yojana (JSY) in April 2005 in all states and union territories to promote institutional deliveries among the poor population through provision of antenatal, intra-natal and post-natal care services for women to have healthy outcomes of pregnancy and child birth. Hence this study has been undertaken on one of the important aspect of services that is antenatal care services with the objective to assess the utilization of antenatal care services among JSY beneficiaries in rural area.Methods: Cross sectional observational study done in the area under rural health training centre of a private medical college of Pune district. 1st October 2014 to 30th September 2015. Study sample: All JSY beneficiaries who delivered during study period (1st October 2014 to 30th September 2015). One to one interview with the all 155 beneficiaries was conducted using the pretested, questionnaire. The interview was timed at minimum 6 week interval after the delivery. Data analysis was done by using SPSS 20.0 statistical software.Results: Majority 78 (50.3%) of beneficiaries out of 155 got registered themselves within 12 weeks of pregnancy. Antenatal coverage was quite good. Coverage of injection tetanus toxoid was 100% and all essential investigation have been carried out. Association between literacy level (up to higher secondary level) of beneficiaries and number of ANC visits was found statistically significant (p<0.001).Conclusions: In present study utilization of ANC services was found to be good.
Synthesizing evidence on nutrition challenges among people living with HIV/AIDS in sub- Saharan Africa: a protocol for a scoping review
Authors: Dzinamarira Tafadzwa , Mashora Moreblessing Chipo
Published: June 2019

Background: Good nutritional status is highly significant for individuals who are infected with HIV. However, they still face a number of nutritional challenges. The proposed scoping review will map literature on the nutritional challenges facing people living with HIV/AIDS (PLWH) and guide future research in nutritional management to improve health outcomes for PLWH. Here we outline a scoping review protocol designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P 2015 Guidelines).Methods: The Arksey and O’Malley’s 2005 scoping methodological framework further improved by Levac et al. 2010 will guide the search and reporting. Searches will be conducted for eligible articles from MEDLINE (PubMed), MEDLINE, CINAHL, Academic Search Complete and ISI Web of Science (Science Citation Index) electronic databases. Two independent reviewers will conduct the search guided by an inclusion and exclusion criteria. Quality appraisal of the included articles will be conducted guided by the mixed methods appraisal tool 2018 version. We will employ NVivo version 12 for thematic content analysis.Conclusions: The findings of this review will guide future research in nutritional management to improve health outcomes for PLWH in sub-Saharan African. This review will be disseminated electronically in a published peer reviewed article and in print.
Urinary incontinence among female patients attending a selected public hospital in Bangladesh
Authors: Begum Shima , Akter Halim Khondoker Mahmuda , Khatun Ratna , Islam Sharmin , Chowdhury A. B. M. Alauddin , Muhammad Faisal
Published: June 2019

Background: Urinary incontinence is a frequent public health problem with negative social consequences, particularly for women. Women are much more susceptible to urinary incontinence than men. Female susceptibility is the result of anatomical, social, economic and cultural factors.

Methods: A cross sectional study was conducted to find out the factors related to urinary incontinence, distribution of types of incontinence among female patients and their health care seeking behavior and socio-demographic characteristics among 121 adult female patients who attended the outpatient department of Gynae and Obstetrics department and Urology department of Dhaka Medical College and Hospital during the period of January to June 2016. Data were collected through face to face interview.  

Results: The mean age of the respondents was 43.42 years and the mean monthly income of the respondents was 17409.09 taka. Little above nine-tenths (91.7%) of the respondents were Muslim and the majority of the respondents (47.9%) were living in pacca house. More than seven-tenths (73.6%) of the respondents were married and over 35% of the respondents were illiterate. Among the respondents about 42.1% of them had pressure type of incontinence, followed by mixed incontinence (27.3%). Over 65% had some complication during delivery and little above six-tenths (61.2%) had gynecological problems.

Conclusions: Female urinary incontinence is a frequent and a major embarrassing healthcare problem in Bangladesh. Patients who had complications during labor, having multipara, recurrent UTI, gynecological problem such as uterine prolapse, urethral injury, had high percentage of urinary incontinence. Patients with urinary incontinence should be encouraged to seek treatment early as the problem can be treated. 
A study on dietary pattern of patients with type-2 diabetes
Authors: Bashet Md. Abdul , Dash Tushar Chandra , Rahman Md. Estiar , Moonajilin Most Sabrina
Published: June 2019

Background: Diabetes prevalence is increasing rapidly in middle and low income countries. According to the World Health Organization, diabetes was the seventh leading cause of death in 2016. The study aimed to assess dietary pattern of rural patients with type 2 diabetes (T2DM) in Bangladesh.

Methods: A descriptive cross sectional study was conducted on 149 patients with T2DM from Nagorpur, Tangail district in Bangladesh. The daily intake of foods was assessed by a prepared seven days food frequency questionnaire. Descriptive statistics were computed and chi square test was employed to signify association between variables.  

Results: Total 149 patients with T2DM were included in the study. The patient’s mean age and BMI was 46.68 (±10.05) years and 22.51 (±2.28) respectively. The average intake of calorie, carbohydrate, protein and fat of the patients was 1572 (±268) Kcal/day, 241 (±33) g/day, 85 (±15) g/day and 57 (±11) g/day respectively. Gender was associated with calorie (χ2=16.68, p<0.05), carbohydrate (χ2=10.63, p<0.05) and protein (χ2=9.42, p<0.05) intake. Age was also associated with calorie (χ2=13.54, p<0.05) and fat (χ2=13.16, p<0.05) intake. However, the study revealed that majority of the diabetic patients follows recommended dietary guidelines.

Conclusions: To prevent diabetes and manage its complications, dietary guideline should be followed appropriately. We found quite satisfactory results regarding dietary intake of patients with T2DM. Yet, continual interventions need to be provided. 
Effect of endotracheal intubation versus laryngeal mask airway on patient’s quality of voice and swallowing
Authors: Sõber Linda , Lepner Urmas , Kirsimägi Ülle , Kasenõmm Priit
Published: June 2019

Background: The aim of our study was to evaluate postoperative voice and swallowing disorders during the first postoperative week and to compare these findings between two anesthesia methods: endotracheal intubation tube (ETI) and laryngeal mask airway (LMA).

Methods: We conducted a prospective cohort study of patients who underwent laparoscopic cholecystectomy with ETI (n=103) and patients who underwent open hernioplasty or lower extremity varicectomy with LMA (n=100). All subjects underwent preoperatively and during the first postoperative week laryngeal imaging by videolaryngostroboscopy (VLS), filled in subjective evaluations of voice and swallowing complaints. In addition, acoustic voice analysis (AVA), maximum phonation time (MPT) measurement and perceptual voice evaluation were conducted.  

Results: VLS showed visual changes in pharyngeal and laryngeal anatomy in 4 (4%) patients of the LMA group and 14 (13.6%) patients of the ETI group (p=0.02). No statistically significant postoperative subjective voice and swallowing changes were found in either group. In female patients AVA showed a statistically significant increase of the SPI value in the ETI group (p=0.037). In male patients we noted an increase in mean fundamental frequency (F0) and decrease in MPT with both ventilation methods.

Conclusions: Both investigated ventilation methods can be regarded as practically equal. Although clinical signs showed more intense trauma in the ETI group, objective measurements and patient subjective evaluation of voice and swallowing function were similar in both groups.

 
Use of bacterial cellulose in closure of nasal septal perforation
Authors: Mandour Yasser Mohammad Hassan , Fahmy Shendy Mohammed , Badie Samer , Elrefai Ahmed , Mohammed Samira , Abdel Menem M. O.
Published: June 2019

Background: 30 patients with nasal septal perforation after surgical correction of septal deviation undergoing trials of septal closure were divided into 2 groups to compare between results of free inferior turbinate graft with bacterial cellulose and results of free inferior turbinate graft only in closure of nasal septal perforation. To compare between results of free inferior turbinate graft with bacterial cellulose and results of free inferior turbinate graft only in closure of nasal septal perforation.

Methods: Prospective randomized study in which 30 patients with nasal septal perforation after surgical correction of septal deviation undergoing trials of septal closure were divided into 2 groups; group I (15 patients) in which free inferior turbinate graft with bacterial cellulose would be used in closure of nasal septal perforation; group II (15 patients) in which free inferior turbinate graft only would be used in closure of nasal septal perforation.  

Results: Septal perforation healing (closure) would be in 10 patients in group I while in 6 patients in group II. Improvement in nasal obstruction, crustion, epistaxis and breathing sound in group I would be better than in group II.

Conclusions: Use of free inferior turbinate graft with bacterial cellulose would be an effective method than use of free inferior turbinate graft only in closure of nasal septal perforation.
The prevalence of thyroid ima artery and its clinical significance
Authors: Chin Justin , Zhou YaQun , Wan Peter J. , Lomiguen Christine M.
Published: June 2019

Background: The thyroid ima artery (TIA) is an anatomical anomaly that commonly functions as an accessory blood supply for the isthmus and inferior aspect of the thyroid. Limited research has been performed to investigate the relative prevalence and clinical implications of the TIA in present literature.

Methods: Dissections were conducted on cadavers in the anatomy laboratory at Touro College of Osteopathic Medicine, New York (Harlem Campus), with 94 subjects examined using standard methods to identify thyroid vasculature and to determine the presence of a thyroid ima artery. Known origins of the thyroid ima artery were also examined for possible branching.  

Results: Of the 94 cadavers, only one was found to have a thyroid ima artery present, suggesting a prevalence of 1.06 percent.

Conclusions: The thyroid ima artery is significant in its influence in head and neck procedures as well as emergent airway creation. With its relative rarity, its presence is worthy of consideration as a possible hematological source for hemorrhage.
Comparison of conventional temporalis fascia myringoplasty with fascia lata myringoplasty among patients with hearing loss
Authors: Verma Sumeer , Arora Anshu , Narvey Ved Prakash
Published: June 2019

Background: In selection of a graft tissue factors considered include its biological properties, probability of survival, its adequacy in size and ease of procurement The present study aims to preoperatively predict hearing improvement by paper patch test and compare with postoperative hearing improvement i.e. pre and post operatively hearing assessment.

Methods: The study was conducted on 25 cases undergoing myringoplasty with Fascia lata and Temporalis fascia as a graft material among the patients fulfilling the standard criteria for myringoplasty i.e. pars tensa perforation, good cochlear reserve, dry ear and normal eustachian tube function were considered for surgery. Myringoplasty was done from post aural route for harvesting fascia temporalis graft & from upper 1/3rd of thigh laterally to harvest fascia lata. Each case was followed up post operatively monthly for 3 months.  

Results: Factors which influence graft take up are the size of perforation and lack of infection at the time of surgery and postoperative. Large perforations were difficult to repair as it took more time to heal. Surgery performed postaurally underlay technique using temporal fascia was associated with less morbidity, better uptake and lesser postoperative complications but permeatal route also serve similar purpose and does not affect the result of study significantly.

Conclusions: This study compared both temporal fascia and fascia lata as graft materials for myringoplasty and proved that myringoplasty done by postaural underlay technique using temporal fascia holds best as per graft uptake, hearing improvement and postoperative complications when compared to fascia lata myringoplasty.
Evaluation of myiasis in hospital attending population in a tertiary care hospital in Jalgoan
Authors: Sheikh Shahnaz , Bajaj Anushree , Vaze Vikrant
Published: June 2019

Background: Human myiasis can present as aural myiasis, nasal myiasis, ocular, urogenital etc. Aural myiasis can lead to perforation of tympanic membrane, hearing loss, haemorrrhage and rarely the larva migrates into the meninges. Inflammatory reaction at the site if larviposition due to mast cell activation and IgE production may limit larval development. Flies are generally attractive to odour of decaying necrotic tissue, which can arise from chronic otorrhea or sinusitis.

Methods: The study was conducted at Dr. Ulhas Patil Medical College in the department of ENT from January 2017 to January 2019. On examination patients were irritable and blood stained ear discharge was noted in aural cases, while similar discharge from the nose in nasal cases.  

Results: Over the 2 year study period a total of 200 cases of myiasis were seen. The youngest child seen was 11months and the oldest 70 years of age. Females (57.89%) were affected more commonly than males (41.48%). Most cases (96.8%) were from a rural background. Aural myiasis occurred from May to December. The peak incidence for both was seen from September to October.

Conclusions: Myiasis is a rare and benign manifestation with zero mortality rate. Meanwhile as it has been hypothesized in otolaryngology that intracerebral myiasis can be caused by the transcanal migration and invasion of fly larvae, there was no association between aural myiasisis and intracerebral pathology of any kind observed in the study. The overwhelming majority of cases can be successfully managed without the need for surgical intervention.
Hemostatic alterations in patients with obstructive sleep apnea: an observational study
Authors: Belaldavar Basavaraj P. , J. S. Tejaswini , Soni Samanvaya
Published: June 2019

Background: Obstructive sleep apnoea (OSA) is characterized by repetitive partial or complete collapse of the upper airway during sleep, which results in disruptions of normal sleep architecture. It is associated with cardiopulmonary consequences like hypertension, myocardial infarction and stroke. Although the pathogenesis of this association remains unclear, an alteration in coagulability is suspected as a linkage. Hence, the present study aims at the reliability of Bleeding time, platelet count, PT, aPTT and INR to assess the effect on OSA patients’ cardiovascular system.

Methods: This is an observational study done on 32 individuals diagnosed with OSA after level I polysomnography from time period of January 01, 2018 to December 31, 2018. The blood coagulation parameters studied for each individual were platelet count, bleeding time (BT), activated partial thromboplastin time (aPTT) and prothrombin time (PT/INR).

Results: Out of a total 32 subjects, 17 (53.13%) were male and 15 (46.87%) were female. There is a significant difference in mean prothrombin time (p=0.022). Kruskal-Wallis test showed a significant difference in the median of the PT/INR (p=0.01) and AHI (p<0.001) for different categories of OSA. Prothrombin time is the only factor which is affecting the OSA.

Conclusions: Patients with severe OSA may have elevated coagulability levels, particularly in the length of prothrombin time. The potential for anticoagulant and antiplatelet medications to reduce mortality in patients with OSA merits exploration, particularly for patients who are unwilling or unable to achieve full control of OSA with currently available treatment options.
Immediate and delayed complications of adenotonsillectomy
Authors: Sebastian Gerald P. , Thiagarajan Balasubramanian , Devadason Pethuru
Published: June 2019

Background: Tonsillectomy with or without adenoidectomy is the commonest pediatric otorhinolaryngological procedure. The aim of the present study was to compare the intraoperative (immediate) and postoperative (delayed) complications between in conventional and coablation tonsillectomy in children.

Methods: This observational study was conducted among 100 children between 5 and 15 years who had conventional tonsillectomy and 50 children who had coblation tonsillectomy. Intraoperative and postoperative complications were observed and compared between two groups.  

Results: Of the total 150 children, 64 (42.7%) were males and 86 (57.3%) were females with mean age of 9.42±2.67 years. Common preoperative symptoms were odynophagia (96.0%), throat pain (95.3%) and difficult swallowing (89.3%). Among the intraoperative anesthetic complications, compression of endotracheal tube was observed in 19 (12.7%), accidental extubation in 10 (6.7%) and dislodging of loose tooth in 9 (6.0%) patients. Regarding intraoperative surgical complications, primary hemorrhage was seen in 43 (28.7%), edema uvula in 39 (26.0%) and pillar injury in 33 (22.0%) patients. Commonest postoperative complication was oropharyngeal pain (18.7%) followed by primary hemorrhage (14.0%) and nausea, vomiting (13.3%). Immediate complications like primary haemorrhage (p value 0.0001) and uvula edema (p value 0.018) were significantly associated with conventional tonsillectomy group while delayed complications like secondary haemorrhage (p value 0.011) and referred otalgia (p value 0.0001) were with coblation tonsillectomy group.

Conclusions: Compression of endotracheal tube and primary hemorrhage were the commonest intraoperative anesthetic and surgical complication respectively. Immediate complications were significantly associated with conventional tonsillectomy group while delayed complications were with coblation tonsillectomies.
Comparative study of colour Doppler vs. FNNAC findings in WHO grade II thyroid enlargement in adult females
Authors: M. S. Sudhakar Rao , T. P. Navneeth , C. J. John
Published: June 2019

Background: Thyroid gland disorders form one of the most common endocrinal and surgical problems encountered in clinical practice. FNNAC is widely accepted as the primary and better method than FNAC for investigation but has its disadvantages. Colour Doppler is a non-invasive, low cost, easily available and repeatable investigation with least patient discomfort and can be valuable in detection of benign and malignant thyroid enlargements.

Methods: Forty cases of adult females with WHO grade 2 thyroid enlargement attending the department of otorhinolaryngology selected on simple random basis were included in this study. Following written consent, Colour Doppler scanning and FNNAC test were done on the thyroid swelling and the results were analysed.  

Results: The mean age of patients was 32.44 years. The mean age of malignancy was 44.66 years and showed statistically significant association. The Resistive and Pulsatility index and combination of both were found to have statistically significant results in detecting malignant and benign lesions The sensitivity, specificity, positive and negative predictive values of RI and PI were 83.33%, 94.12%, 71.43%, 96.97% and 50%, 94.12%, 60% and 91.43% respectively. On combining both the indices, the sensitivity was 91.67% and the positive predictive value was 97.06%.

Conclusions: Colour Doppler can differentiate between benign and malignant thyroid enlargements using Resistive index (of>0.75) and Pulsatility Index (of>1.5) and can be a complementary diagnostic tool in the thyroid enlargement lesions, considering its accuracy, cost-effectiveness, easy availability and non-invasive repeatable nature.
A clinical study of complications of diphtheria
Authors: Arya Pooja , Maharia Manphool S. , Kadela Ramesh K. , . Deepchand
Published: June 2019

Background: Diphtheria is an acute infectious preventable disease of childhood caused by C. diphtheriae. Diphtheria is a localized infection of mucous membrane or skin.

Methods: The present study was carried out in the Department of Otorhinolaryngology S.P. Medical College and associated group of hospital. In this study all cases of diphtheria and all age groups which attended ENT OPD and emergency department during period from 1/1/2010 to 31/12/2010 were included.  

Results: In the present study highest numbers of cases were recorded among 5-10 years of age followed by 0-5 year of age group. 57.59% patients were male and 42.41% patients were female. It was found that occurrence of diphtheria was highest in month November and October and was quit frequent during September and December. No cases during April, June and July. It was observed that most common post diphtheria complication was myocarditis (23.42%) followed by neurological complication.

Conclusions: In order to prevent complication of the disease active immunization is customary and in order to detect the disease at early stage and for prompt treatment masses should be educated regarding the dreadful nature of the disease.
Varied orbital manifestations of paranasal sinus disease
Authors: Harugop Anil Kumar S. , Mudhol Ramesh S. , Bhimanapati Deepthi , Soni Samanvaya , Bellad Shama A. , Achuta Aparna , . Suhasini
Published: June 2019

Background: Even though sinusitis is a common clinical entity, its complications are seen rarely after the advent of antibiotics. Hence we aimed to analyse varied clinical presentations and manifestations of orbital involvement in paranasal sinus diseases and their outcome.

Methods: Hospital based prospective study done from January 2007 to December 2017. We selected 65 patients in our study based on our inclusion and exclusion criteria. Type of orbital involvement was analysed by computed tomography scan. Immediate aggressive medical management was started and surgery was undertaken if there is no clinical improvement in 48 hours. Endoscopic sinus surgery done along with orbital decompression and drained pus was sent for culture sensitivity. Patients were followed up regularly and suction clearance was done.  

Results: Out of 65 patients, 50 were male and 15 were female. 24 patients had bacterial pathology, 40 had fungal pathology and 1 patient had non specific inflammatory disease consistent with mucocoele. Out of 24 bacterial sinusitis, 2 had bilateral disease and 1 patient had scalp and neck extension. Out of 40 fungal sinusitis, 2 patients had 6th cranial nerve palsy with sphenoid disease, 5 patients had palatal extension and 8 patients had intracranial involvement.

Conclusions: All cases of orbital oedema and proptosis should be thoroughly evaluated for sinus disease. Computed tomography aids to know the extent of disease, deciding about the type and mode of intervention. Early diagnosis and immediate intervention reduces significant mortality and morbidity. However regular follow up, counselling the patients and relatives helps in achieving appropriate outcome.
Otorhinolaryngological manifestations in Down syndrome: MERF experience
Authors: Anto Ronald , Natarajan Kiran , Sampathkumar Raghunandhan , Kumar Anand , Kameswaran Mohan
Published: June 2019

Background: Syndromic children often pose a spectrum of challenges to the paediatric otolaryngologist. Syndromes like the Down syndrome present with a multitude of manifestations in the head and neck region and require careful management.

Methods: A retrospective study of thirty patients with Down syndrome presenting from January 2013 to January 2018 in a tertiary care setting was done. All patients were evaluated by ENT examination and further investigations based on the complaints. The aim was to study the various ENT disorders in Down syndrome patients and their management.  

Results: The most common disorder was hearing loss in eleven patients followed by rhinosinusitis in ten patients, adenoid hypertrophy and otitis media with effusion (OME) in six patients and obstructive sleep apnea in three patients. Most of the patients had medical management; very few needed surgery. Successful outcomes were possible for all patients.

Conclusions: Dealing with otorhinolaryngological disorders may pose a management challenge in Down syndrome and this requires a well experienced ENT, medical and rehabilitative team to provide optimal management and good quality of life to these children.
Cervical thymic cyst in adult: a rare entity
Authors: Japar Jaafar Rohaizam Bin , Kemps Glen Johannes Franciscus , Tan Ing Bing , Postma Alida Annechien
Published: June 2019

Cervical thymic cysts in adults are rare and seldom diagnosed preoperatively as it may mimic other cystic cervical swellings like a branchial cleft cyst. We present our first encounter with an adult-onset cervical thymic cyst presenting as a lateral neck mass as the sole symptom. Clinical, radiological and cytological evaluations are excellent tools to approach and assess cervical thymic cysts. Histopatholgical examination is the only mean to provide a definitive diagnosis. Adult-onset cervical thymic cyst is a rare entity but should be included in the differential diagnosis for lateral neck swelling. Surgical excision is both diagnostic and therapeutic, once malignancy has been exluded.
Neurofibroma in the external auditory canal
Authors: Saleh Mona M. , George Pola E. , Mohsen Mohammad M. , Eldakiky Amir M. , Makarious Irinie G.
Published: June 2019

Neurofibromas are relatively common tumours of the nervous system, but only few cases involving the external ear have been reported. We are reporting here a case of a 30-year-old male with neurofibroma of the external auditory canal. The primary complaint was cosmetic deformity and mild conductive hearing loss. There was total occlusion of the external auditory canal. The swelling was excised by postauricular approach. Surgery resulted in an superb purposeful and cosmetic outcome. Neurofibromas of the head and neck do not seem to be uncommon, however they seldom have an effect on the external ear and only a few such published reports are available.
Infraorbital approach for retrobulbar orbital neurofibroma: a case report
Authors: N. Harshitha , S. M. Azeem Mohiyuddin , C. S. Supreeth , Prasad K. C. , H. S. Brindha , Kumar H. Mohan
Published: June 2019

Retrobulbar orbital tumours are rare and treatment is challenging. These tumors include cavernous hemangioma, neurofibroma, A-V malformations, glioma etc. A variety of approaches have been used in resection of these tumours. The various approaches in literature include endoscopic transethmoidal and sphenoidal, lateral orbitotomy, transmaxillary infraorbital, and cranial and sub cranial approaches. Such tumours located inferior to the optic nerve can be reached through infraorbital approach avoiding traction on optic nerve or pressure on globe. We are reporting a retrobulbar orbital neurofibroma in a middle aged lady who presented with unilateral loss of vision, episodic giddiness, severe left sided headache, left orbital pain and epiphora on exposure to sunlight. MRI showed well defined 1.8×1.8×1.7 cm enhancing lobulated solid left intraorbital mass extending along the substance of inferior aspect of left optic nerve with mass effect. With transmaxillary infraorbital endoscope assisted approach, the retrobulbar tumor was exposed and enucleated. Floor of orbit was reconstructed with tensor fascia lata and nasal septal cartilage graft. The patient had uneventful recovery and immediate post operative visual acuity was perception of light and likely to improve further. Histopathology revealed neurofibroma. This case report highlights the advantages of infraorbital approach as it is a simple approach along the suture lines through the orbital floor with the help of endoscopic guidance. It has the advantages of avoiding traction on optic nerve or optic chiasma, no retraction of brain, no communication with cranial cavity, no pressure on globe and easy reconstruction of orbital floor.
Clival chordoma presenting as a parapharyngeal mass: a diagnostic challenge
Authors: Pradhan Prita , Biswal Rudra Narayan , Rout Khageswar , Panigrahi Ranjita , Misra Pranati , Senapati Urmila , Rath Jayasree
Published: June 2019

Though the parapharyngeal space is sites of primary involvement by neoplastic process, they can rarely house masses descending from a base of skull tumour. Chordoma is an uncommon tumour of the skull base and sacrococcyx. Originating from the notochordal remnants, they are locally aggressive causing lytic destruction of the adjacent bony structures, particularly in the base of the skull. The use of surgery and adjuvant high-dose proton RT is documented to produce best results. Here we report a diagnostic challenge posed by a chordoma occurring as a parapharyngeal mass in a 68 year old male.
Bilateral concha bullosa with right sided extensive rhinolith: a case report
Authors: Prinja Sumit , Davessar Jailal , Singh Gurbax , Jindal Simmi , Bali Alisha
Published: June 2019

Anatomic variations of the paranasal sinuses can lead to various diseases per se. The paranasal sinus anatomy should be carefully examined prior to performing endoscopic sinus surgery in terms of both existent pathologies and anatomic variations. The anatomy of the paranasal sinuses and its variations have gained importance, along with advances in coronal paranasal sinus computed tomography and extensive use of endoscopic sinus surgery. Rhinolith is a mass resulting from calcification of an endogenous or exogenous nidus within the nasal cavity. It is an uncommon disease that may present asymptomatically or cause symptoms like headache and nasal obstruction. A 24 year old woman was admitted in ENT department of GGS Medical College and Hospital, Faridkot with complaints of nasal obstruction, anosmia and headache persisting for 5 years. Right sided rhinolith was detected on anterior rhinoscopy. Bilateral concha bullosa with right sided rhinolith was reported on preoperative paranasal computed tomography scan. It is known that the paranasal sinuses have a number of anatomical variations. Sometimes severe anatomic variations predispose to rhinosinusitis. Herein we report a rare case, along with a review of the literature, to emphasize that severe anatomical variations should not be ignored.
Recurrent sinonasal teratocarcinosarcoma treated with IMRT: a case report
Authors: Tudu Rajanigandha , Kumar Anup , Singh Rashmi , Raina Payal , Munda Praveer Kumar Singh
Published: June 2019

Sinonasal teratocarcinosarcoma is a rare malignant tumour displaying aggressive growth .It is known to have poor prognosis with locoregional recurrence. So far, the most widely accepted therapeutic plan for its management has been surgery followed by adjuvant radiation. This study reports a case of 35 year old male diagnosed with sinonasal undifferentiated carcinoma who presented with neck node recurrence after 15 months of definitive radiotherapy. A 35 year old patient presented with nasal obstruction and epistaxis. CECT PNS revealed mass in ethmoid sinus with adjacent bony destruction and infiltration into maxillary sinus and nasal cavity. Biopsy revealed poorly differentiated carcinoma. Patient underwent neoadjuvant chemotherapy followed by definitive radiotherapy by IMRT. On follow up at 15 months, the patient presented with nodal recurrence. Biopsy from neck node revealed metastatic sinonasal teratocarcinosarcoma. The patient underwent neck dissection followed by adjuvant chemoradiation. The patient is currently on follow up and is disease free till date. Surgery alongwith adjuvant chemoradiation is a reasonable therapeutic approach of management for sinonasal teratocarcinosarcoma.

 
Rigid ventilating video bronchoscope with forceps for bronchoscopic foreign body removal in children
Authors: Jawale Sagar , Gupta Parthapratim , Kulkarni Bharti
Published: June 2019

Bronchoscopic foreign body removal is a potentially dangerous and challenging procedure in pediatric surgery. bronchoscopy under general anaesthesia is the gold standard of diagnosis and management of foreign body aspiration. A large ventilating channel and better control over the tip of the instrument and cheaper instrument are the merits of rigid bronchoscopy over flexible one. Traditionally a rigid tube alone is used for this purpose which has extreme limitations of vision and it is risky. Foreign body aspiration typically occurs in 6 to 18 month age and the size of glottis is very small at this age. In Indian children who are small and malnourished the large assembly of sheath and telescope mounted forceps does not pass through the glottis. To overcome the limitations of the traditional equipment I designed my own bronchoscopy equipment by my 15 year of experience in bronchoscopy. This type of device is reported for the first time in medical literature and patent is filed for it at Mumbai office.

 
How anatomical is our tunnel? A three dimensional CT evaluation of femoral tunnel in anatomic anteromedial single bundle anterior cruciate ligament reconstruction
Authors: Dutt Saurabh , Kumar Vinod
Published: June 2019

Background: ACL reconstruction has become a common orthopaedic procedure. The anatomy and biomechanics of ACL have been one of the most researched and debated topics in the orthopaedic literature. This has implication on the surgical procedure too with shift from traditional transtibial to more anatomic anteromedial ACL reconstruction. Anteromedial technique results in more anatomic femoral tunnel with graft positioned at the native insertion site. The tunnel position is crucial for better outcome after ACL reconstruction. The purpose of the study was to ascertain the femoral tunnel position made by anatomic single bundle reconstruction with the help of three dimensional computer tomography.

Methods: A prospective case series involving thirty patients with ACL tear who underwent anteromedial single bundle ACL reconstruction. Computer tomography scans were performed on thirty knees that underwent single bundle anteromedial ACL reconstruction. Three dimensional models were created and the data was analyzed according to coordinate system method. Femoral tunnel position was measured in proximal to distal and posterior to anterior directions. This data was compared with the already published reference data on anatomical tunnel position.

Results: Femoral tunnel centre on the medial wall of lateral femoral condyle was located at 35±9% in the posterior to anterior direction. In the proximal to distal direction, the tunnel was placed at 30±12%. Femoral tunnel was placed anteriorly as compared to anatomic anteromedial and posterolateral tunnel position. There was no significant difference in tunnel position in proximal to distal direction.

Conclusions: Femoral tunnel centre on the medial wall of lateral femoral condyle was located at 35±9% in the posterior to anterior direction. In the proximal to distal direction, the tunnel was placed at 30±12%. Femoral tunnel was placed anteriorly as compared to anatomic anteromedial and posterolateral tunnel position. There was no significant difference in tunnel position in proximal to distal direction.
A clinical study: management of distal tibial fractures with minimally invasive plating osteosynthesis
Authors: Singla Gaurav
Published: June 2019

Background: Distal tibial fractures of bone poses major challenge to the trauma orthopaedic surgeons as this bone is subcutaneous associated with soft tissue injuries and precarious blood supply. Distal tibial fractures require accurate reduction, perfect articular restoration with stable fixation with minimal stripping of soft tissues, thereby preserving the blood supply. Minimally invasive osteosynthesis using locking plates has emerged as viable option of fixing such fractures due to poor results associated with open plating which leads to extensive soft tissues stripping and subsequently poor blood supply.

Methods: 27 patients with closed distal tibial fractures with or without articular involvement without vascular compromise were treated with LCP fixation using MIPO technique studied from June 2017 to December 2018.

Results: All fractures in our series united well at the end of 5 months with mean time to clinical and radiological union was 17 weeks. There was no case of implant failure while 2 patients had varus angulation. Very few soft tissue complications with excellent functional outcome were seen.

Conclusions: We concluded that distal tibial fractures can be effectively managed with LCP using MIPPO technique with excellent functional outcome and avoiding the complications associated with other treatment methods. 
Comparative study between transforaminal epidural selective nerve root block versus interlaminar epidural in the treatment of lumbar radicular leg pain
Authors: Sadiq Mohammed , Hussain Syed Azher , Nayeemuddin Mohammed
Published: June 2019

Background: Sciatic neuralgia is a result of nerve root oedema because of the inflammatory, immunological and mechanical factors. Steroid injections play an important role in the management of sciatic radiculopathy. Steroids act by reducing the oedema around the nerve roots and decreasing pain. Locally administered steroids have the advantage of reduced dosage and targeted delivery around the nerve roots. This forms the basis of epidural steroid injections. This can be given around the nerve root in the transforaminal space or in the interlaminar space. There is a paucity of literature comparing the two techniques of epidural steroid injections. We have done a randomized comparative trial, to compare the effectiveness of the two modalities of injection in the management of a single level unilateral foraminal disc herniation.

Methods: Patients were randomized in two groups Group A: Transforaminal epidural (SNRB) and Group B: interlaminar epidural. Same dose of steroid was used in each group.

Results: Immediate post injection, 2 week and 1 month transforaminal epidural (SNRB) was better compare to interlaminar epidural however at the end of 3 months the difference was not significant (p=0.08).

Conclusions: Both transforaminal and interlaminar epidural injection are effective form of treatment in mild to moderate grade of disc disease. Both the technique provide short lasting relief in the symptoms associated with disc pathology, however pain management is better in transforaminal group compared to interlaminar group. Thus these techniques can be considered for delaying surgery and providing intermitant relief. 
An outcome analysis of intertrochanteric fracture of femur managed with proximal femoral nail antirotation II
Authors: Harshwardhan Hemeshwar , Jain Shubhanshu , Sharma Manish
Published: June 2019

Background: Intertrochanteric fractures are common osteoporotic fractures in adults above 60 years with high mortality and morbidity. Common techniques for fixation of these fractures are sliding hip screw and plate or intramedullary nailing. Intramedullary nailing has advantage of short incision, less operative time, rapid rehabilition & thus decreased medical complications. PFNA II is newer intramedullary implant developed to obtain better fixation strength in osteoporotic bones. Biomechanical studies has demonstrated that PFNA II blade has a significance of higher cut out resistance than other commonly used screw systems.

Methods: Prospective follow up study carried out at J.L.N. Medical College Ajmer from 1 March 2017 to 31st October 2018. 30 patients with unstable intertrochanteric fractures were included and operated on fracture table in supine position with PFNA2. We measured operative time, duration of hospital stay, modified Harris hip score and complications.

Results: The mean age of the patients was 70.83 years of age. The mean time in surgery was 38.2 minutes. The mean amount of blood loss in surgery was 110.8 ml. In implant related complications, 2 patients had cut out and 1 patient had pull - out of the implant. Functional results according to modified Harris hip scores was found to be excellent in 8 (30%) patients, good in 12 (40%) patients, fair in 7 (20%) patients and poor in 3 (10%) patients.

Conclusions: Elderly patients treated with PFNA2 has good outcome as less operative time, minimal blood loss, early weight bearing, less union time and very few cases of medial penetration and back out of spiral blade. 
A study on management of tennis elbow by local platelet rich plasma injection
Authors: Jan Wazir Fahad , Jahan Alamgir , Dar Mohd Yahya , Khan Umer Mushtaq
Published: June 2019

Background: Lateral epicondylitis (tennis elbow), a familiar term used to describe myriad symptoms around the lateral aspect of the elbow can occur during activities that require repetitive supination and pronation of the forearm with the elbow in near full extension. This condition can cause severe discomfort to the patient resulting in debilitation and impairment of routine activities. The purpose of this study was to evaluate the effectiveness of local autologous platelet rich plasma injection in the treatment of tennis elbow.

Methods: This was a prospective observational study conducted on 50 patients of either sex with an average age of 45.92 years, presenting to the Orthopaedic OPD of SHKM Government Medical College Hospital, Nalhar, NUH, Haryana between November 2016 and February 2018, with a diagnosis of lateral epicondylitis. All the patients were treated with local platelet rich plasma injection and the results were analysed through the assessment of visual analog score (VAS) and disability of arm shoulder and hand (DASH) score. The patients were followed up for a period of 6 months after the local injection of platelet rich plasma.

Results: Majority of the patients had significant relief with this method. The VAS and DASH score improved from the pre-treatment values of 8.7 and 74.6 to 2.6 and 29.8 respectively, which was found to be statistically significant (p<0.001).

Conclusions: Thus results of our study demonstrate that the local injection of platelet rich plasma is a safe and effective method of treatment of lateral epicondylitis.
A comparative study between proximal femur locking compression plate and dynamic hip screw fixation in management of pertrochanteric fracture
Authors: Harshwardhan Hemeshwar , Mali Sawai Ingh , Sharma Manish
Published: June 2019

Background: Pertrochanteric fracture is common in elderly people. Dynamic hip screw is still considered the gold standard for treating intertrochantric fracture. Proximal femoral locking compression plate is newer device. The purpose of the study was to compare the outcome of surgical treatment of trochanteric fracture by dynamic hip screw and proximal femoral locking compression plate.

Methods: We study 60 patient admitted and followed up at J.L.N. Medical College Ajmer from June 2016 to April 2018 for minimum 6 month or till the bony union. Every fracture classified according to AO classification and functional result will be assessed according to Harris hip score using unpaired t test.

Results: The mean operative time and average intraoperative blood loss was more in PFLCP group when compared with DHS group it was statically significant. DHS group has marginally better functional result then PFLCP group. There was no difference in the radiological outcome between two group.

Conclusions: DHS is best implant for stable intertrochantric fracture but PFLCP can also be good alternative for unstable IT femur fracture.