bluuebunny/crossref_metadata_2025 huggingface dataset:
The incidence of postpartum hemorrhage after spontaneous and induced vaginal delivery versus elective and emergency caesarian section
Authors: Mousa Al-Turiahi  Azhar , Mohamed Sadiq Alla
Published: November 2020

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality. All women who carry a pregnancy beyond 20 weeks’ gestation are at risk for PPH and its sequel. Although maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of maternal mortality elsewhere.The aim of this study is to investigate the incidence of PPH in patients delivered by different modality and identify the importance risk factors. A Cross sectional study of 9674 patients admitted to the labor or obstetrics word and theater unit during the period of 5-months duration from 2nd of January to the 31th of December 2015. The results of this data indicated that the identified risk factors of PPH are essential to increased effective care and eventually increased the maternal survival.
Submersible Pump Vortex Detection Using Image Processing Technique and Neuro-Fuzzy
Authors: Durdu Akif , Orhan Nuri , Celtek Seyit Alperen , Aslan Muhammet Fatih , Sabancı Kadir
Published: November 2020

The vortex means the mass of air or water that spins around very fast that often faced in the agriculture irrigation systems used the pump. The undesired effects like loss of hydraulic performance, erosion, vibration and noise may occur because of the vortex in pump systems. It is important to detect and prevent vortex for the economic life and efficiency of the agriculture pump. The image processing and neuro-fuzzy based novel model is proposed for the detection of a vortex in the deep well pump used in the agriculture system with this paper. The used images and data -submergence, flow rate, the diameter of the pipe, power consumption, pressure values and noise values- is acquired from an experimental pump. The proposed approach consists of three steps; Neuro-Fuzzy Learning, Image Processing and Neuro-Fuzzy Testing. In the first step, the eighty-two data have employed for the training process of the Neuro-Fuzzy. Then, the images derived from a camera placed near the experimental pump are used to detect vortex in the image processing step. Finally, the relevant data to vortex cases have employed for the testing process of the Neuro-Fuzzy. The result of this study demonstrates that image processing and neuro-fuzzy based design can be successfully used to detect vortex formation. This paper has provided novel contributions in the vortex detection issue such as find out vortex cases by using image processing and Neuro-Fuzzy. The image processing method has shed light on the studies to be done in the classification of vortexes and the measurement of their strength.
A study of etiological and clinical profile of short stature in a tertiary care center
Authors: Penugonda Nagajyothi , Selvarajan Ramkumar , Ramakrishnan Balasubramaniam
Published: November 2020

Background: Short stature is the common finding in pediatric endocrine practice with diverse etiology. However, compared to western world, data addressing the etiological and clinical profile of short stature in India are limited. The present study aimed to evaluate etiological and clinical profile of short stature in children. The primary objective was to identify children with short stature and evaluate various causes of short stature and secondary objective was to identify the gender and height differences among the different causes of short stature.Methods: This prospective observational study analysed the data of 100 children aged 2-16 years, who presented to the department of paediatrics, Apollo Hospital, Chennai for the evaluation of short stature and poor growth during the period of April 2016 to April 2017.Results: The predominant causes of short stature were growth hormone deficiency (GHD; 28%), normal variant short stature (26%), followed by chronic disease (8%), syndromic short stature (8%), Turner syndrome (7%), and hypothyroidism (6%). The most common causes of short stature in males were GHD (28%), constitutional delay of growth and puberty (CDGP; 24%) and familial short stature (FSS; 16%), whereas in females GHD (28%), Turner syndrome (14%) and FSS (12%). Beside this, 96% children had <3rd height centile and 4% children had >3rd height centile, of which 3 cases of GHD and 1 case of syndromic short stature were identified.Conclusions: The most common causes of short stature identified in our study were GHD and normal variant short stature.
Effectiveness of an information booklet regarding home based management on knowledge of caregivers of children with thalassemia
Authors: Verma Rupali , Kumari Rina , Verma Nishant , Charan Anugrah
Published: November 2020

Background: Thalassemia is one of the most common inherited diseases worldwide. It is (mediterranean anemia, cooley's anemia) inborn hemolytic anemia characterized by a drop in the synthesis of hemoglobin. It produces hypochromic microcytic anemia due to imperfect hemoglobinization of RBCs, hemolysis, and futile erythropoiesis. It is due to mutations on chromosome 11 which leads to the synthesis of abnormal or absent beta globin chains. Recently there has been increasing cases of thalassemia worldwide. Hence, current study was planned to assess the knowledge of caregivers regarding homebased management of children with thalassemia.Methods: We assessed caregivers’ knowledge regarding home-based management of children with thalassemia in thalassemia day care department of pediatric KGMU Lucknow, using a self structured questionnaire. Statistical analysis was performed using SPSS software version 24.Results: The level of knowledge regarding pretest and posttest mean scores is 9.50 and 14.17 respectively. Paired t test calculated value was -9.808 which was much higher than the table value at p<0.05 level of significance.Conclusions: The study concluded that information booklet teaching was effective in improving the knowledge level of caregivers of children with thalassemia. More studies need to be done with larger sample size to empower cargivers regarding thalassemia.
Cardiac murmur in a neonate: how significant is it?
Authors: Pathak Gargi H. , Chauhan Anuya V. , Nayak Kesha
Published: November 2020

Background: There is a popular belief that cardiac murmurs are common in neonate and most are innocent or physiological. However, a cardiac murmur may be the first sign of a serious structural cardiac disease in neonate. Objective of study was conducted to determine the clinical significance of cardiac murmur as a sole clinical sign in neonate.Methods: 100 neonates having cardiac murmur were selected from neonatal intensive care unit of department of pediatrics BJMC Ahmedabad from June to November 2019. Murmurs were clinically classified as innocent or significant murmur. Echocardiography was done at UN Mehta institute of cardiology for confirmation of the diagnosis and then patients were reclassified as innocent murmur and structural heart defect.  structural heart defects were further subdivided into physiological variant or significant heart defect.Results: Amongst 100 neonates studied, sixty two percent cases with murmur were found to have structural heart defect and 38% had innocent murmur. Among the cases with structural heart defect. 65.3% were found to have significant heart defect and 34.7% were physiological variant. Clinical suspicion was able to differentiate innocent murmur or structural heart defect (p<0.05) as well as physiological variant versus significant heart defect (p<0.05).Conclusions: Confident diagnosis of heart disease in the newborn period on clinical examination is probably possible by pediatricians or neonatologists. However, for confirmation of diagnosis, early echocardiographic evaluation is necessary.
Alymphoid cystic thymic dysgenesis - FOXN1 gene mutation: a rare case report of two siblings
Authors: Sohail Abdus Subhan , Krishnamurthy Vidya , Sanikam Hareesh , Kariyappa Pushpalatha , Rao Udayakumar Seetharam
Published: November 2020

Alymphoid cystic thymic dysgenesis is a severe combined immunodeficiency (SCID) syndrome caused b y   a   mutation   in fork head box N1 gene (FOXN1) on chromosome 17. It is a transcriptional factor regulating the development, differentiation and function of thymic epithelial cells; maintaining T-lineage progenitors in bone marrow; promoting terminal differentiation of epithelial cells of hair follicles. Mutation in FOXN1 is known to cause a rare disorder characterized by rudimentary thymus gland (primary lymphoid organ for T-cell differentiation), T-cell immunodeficiency, congenital alopecia totalis and nail dystrophy. Here we report two affected siblings from a non-consanguineous family with similar features of alopecia totalis, nail dystrophy and failure to thrive. The first child was a 7-month-old female baby, with history of two hospitalization in the past for lower respiratory tract infection, had left axillary lymphadenopathy (BCG adenitis), alopecia totalis, nail dystrophy and hepatosplenomegaly. Bronchoalveolar lavage secretion was positive for Mycobacterium tuberculosis and Pneumocystis carinii pneumonia by gene Xpert and polymerase chain reaction respectively. Immunodeficiency panel workup revealed combined T cell and B cell immunodeficiency, genetic analysis by whole exome sequencing revealed   recessive missense mutation in exon 6 of FOXN1 gene on chromosome 17. Due to lack of sufficient literature it was reported as variant of unknown significance and to establish its clinical significance the carrier status of both the parents was established. Second child presented to us at 3 months of age, also had similar phenotypic features and on evaluation had very low lymphocyte subset count however mutational analysis could not be done in this child due to parent’s denial. Hence, we conclude this child also was affected.
Alternative therapies for children’s with autism spectrum disorder
Authors: Govindaraju Asvitha , Lakshminarayanan Preethi , Sabarathinam Sarvesh , Meganathan Haripritha
Published: November 2020

Autism is one of the major public health concerns in children around the world. Sudden behavioral changes and improper communication is considered to be most common public health hazards. Speech therapy, occupational therapy, acupuncture, chiropractic therapy and music therapies are the most recommended treatment patterns. A complete cure is not achieved by the existing conventional therapies. Patients and caretakers choose alternative therapies like herbs as a final hope in management of autism spectrum disorder (ASD). Most of the people are not aware of the drawbacks of alternative therapies. However, the selection of alternative therapies might help in communication balance as well as behavioral changes and speedy recovery. However, not all the alternative therapies lead to complete cure and Food and Drug Administration (FDA) warns false claims over the chelation therapy practice in ASD since it causes hypocalcaemia. A combination of herbal medicines with conventional treatment is known to have a positive effect in treating ASD children as well as some under-reported adverse reactions. Herbal medication, along with integrative therapy as an adjunctive to traditional treatment, also have an impact in treating children with ASD. Since the majority of the patients/caretakers are not disclosing their complementary and alternative medicines (CAM) use to their respective physicians. Physicians should give extra care and encourage the parents/caretakers to disclose their CAM practice in order to avoid false claim which results in serious adverse effects and life-threatening complications.
Chronic rhinosinusitis with nasal polyps: predictive factors for recurrence and revision surgery
Authors: Salvador Pedro , Lombo Catarina , Silva Francisco Moreira da , Fonseca Rui
Published: November 2020

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory condition which may have a significant impact on quality of life. Endoscopic sinus surgery (ESS) is indicated for patients refractory to maximal medical treatment and presents high recurrence and revision surgery rates. Aim of the study was to evaluate ESS outcome in CRSwNP management and to assess independent predictive factors for recurrence and revision surgery.

Methods: Retrospective medical chart review of patients who underwent ESS for recalcitrant CRSwNP, from January 2013 to December 2017, with a minimum follow-up time of 12 months.  

Results: This study enrolled 132 patients, 62.1% of whom were males, with a mean age of 43.4±11.5 years. Asthma was the most common comorbidity (39.4%, n=52) and aspirin exacerbated respiratory disease (AERD) was present in 9.8% (n=12) of the study population. We found a recurrence rate of 34.1% (n=45) and 9% (n=12) of patients required revision surgery. Multivariate analysis identified as independent variables of recurrence (95% CI): a history of asthma (OR=8.81, CI 3.87-20.03; p<0.001) and a severe Lund-Mackay score (17-24) (OR=5.85, CI 2.73-12.51; p=0.001). Revision surgery was related to a severe endoscopic Lund-Kennedy score at presentation (OR=4.05, CI 1.91-8.01, p=0.001).

Conclusions: CRSwNP presents a high tendency to recur after ESS. Asthma, severe sinus opacification and severe endoscopic score are poor prognostic factors that hallmark a more aggressive disease. A more extensive surgical procedure and/or middle turbinate resection with a rigorous postoperative compliance should be considered to improve long term results.
Otitis externa in a tertiary hospital in the South-South region of Nigeria: a three year review
Authors: Ibekwe Matilda Uju , Adiekwue Ijeoma Frances
Published: November 2020

Background: Certain climatic conditions tend to favor the development of some ear infections and inflammations especially of the external ear. Otitis externa connotes the inflammation of the external ear and tends to occur commonly. This study is aimed at determining the frequency of occurrence, the type of otitis externa and management of patients seen in an ear nose and throat clinic in Port Harcourt.

Methods: A retrospective review of all patients diagnosed with otitis externa within the period of January 2017 to December 2019. The diagnosis was mainly clinical. The clinic registers and patient’s case files were the source of data. Data sought included demographics, clinical features, forms and management of otitis externa. Patients with incomplete data were excluded. Data extracted were then analyzed using IBM statistical package for social sciences (SPSS) 25 version. Results were presented in scientific tables and figures.

Results: There were a total number of 1296 of patients with otitis externa. Prevalence of otitis externa in the study was 28.77%. There were 54.2% females and 45.8% males with a ratio of 1.4:1. The age group 21-30 years was the age group most affected; n= 404 (31.2%). Chronic otitis externa was the commonest form seen; 74.8%. Unilateral affectation was commoner, seen in n=1073 (82.8%). Debris in the ear was found to be the commonest clinical feature followed by otalgia; 31.1% and 29.6% respectively. The treatment was mainly medical; comprising systemic and topical broad spectrum antibiotics, topical antifungal and steroidal drops, and aural toileting with wick dressing and analgesics. There were no major complications noted.

Conclusions: Otitis externa is common in the ORL clinic and the diagnosis is often based on history and physical examination. The chronic form is the commonest type encountered and treatment is mainly empirical.
A study of sensorineural hearing loss in hypothyroidism patients and its association with thyroid stimulating hormone levels
Authors: K. Srirangaprasad , S. Pruthvi Raj
Published: November 2020

Background: The most common symptom of hypothyroidism regarding ear, nose and throat is hearing insufficiency accompanied with cochleovestibular symptoms such as tinnitus, dizziness.

Methods: This was a hospital based observational clinical study conducted in Rajarajeswari medical college between December 2016 to June 2018. Patients with hypothyroidism attending department of ENT-HNS that satisfied the inclusion and exclusion criteria were included in the study. Patients were subjected to pure tone audiometry, thyroid function test after detailed history and physical examination. PTA was recorded and average of 500 Hz, 1 kHz and 2 kHz were taken as the pure tone average.

Results: 150 patients were included in the study. Mean age of patients with hearing loss was 37.2 years. 84.3% were females. 41 patients presented to us with unilateral hearing loss and 10 patients had bilateral hearing loss. 43 (84.3%) patients had mild degree of hearing loss, 8 (15.7%) had moderate hearing loss. Patients with hearing loss had altered TSH levels. Significant correlation (p<0.001) was found between hearing loss and duration of hypothyroidism, mean TSH levels.

Conclusions: It was found that hy­pothyroidism affects the hearing producing hearing impairment, ranging from mild to moderate in severity and had significant correlation between duration of hypothyroidism and mean TSH levels with the severity of hearing loss.
Physicians perception in the management of allergic rhinitis: a Pan-India survey
Authors: Bhagat Sagar , Patil Saiprasad , Panchal Sagar , Barkate Hanmant
Published: November 2020

Background: Allergic rhinitis (AR) affects a wide proportion of the population across all age groups. There are several guidelines and consensus statements in AR management, the effect of this is implicit from a physician's perspective. The present cross-sectional survey was conducted to understand physicians approach to the management algorithm in the treatment of allergic rhinitis and medication choice.

Methods: Physicians from diverse specialties such as pulmonologists, consultant physician, paediatricians, Allergists, ENT specialists and general practitioners were invited to participate in the survey, which focused on recognizing the burden of disease, clinical presentation, and management methods.

Results: 1,261 Physicians participated in this survey, belonging to different specialties. Oral H1 antihistamine was favoured as a first-line therapy, followed by the combination of oral H1 histamine and leukotriene receptor antagonist. Fexofenadine was the most frequently prescribed. Majority believed, bilastine as antihistamine with the least sedative potential and was identified as the most effective treatment. Bilastine was preferred in patients with mild- moderate hepatic/renal impairment and in patients with persistent allergic rhinitis. Most physicians prefer bilastine in all AR clinical profiles. Aside from AR, bilastine is also use in management of upper respiratory tract infections and urticaria respectively.

Conclusions: AR is still a growing challenge in India with majority of physician preferring oral antihistamine either as monotherapy or in combination. Bilastine is a preferred choice in patients with impaired liver and renal function and was also referred as least sedative antihistamine by majority of physicians across India.  
A study of factors affecting the success rate of type-1 tympanoplasty
Authors: Bhadesia Bhoomi , Joshi Hetal , Desai Nisarg , Hirani Narendra , Khilnani Ajeet Kumar , Sorathiya Rashmi
Published: November 2020

Background: Chronic otitis media (COM) (tubo-tympanic) is a common ear pathology for which tympanoplasty is done. Factors that affect the success rate of tympanoplasty can be patient related (age, gender, socio-economic status), disease related (duration and severity of symptoms) or technique related (equipment and surgical approaches). This study was undertaken to know the factors affecting success rate of type-1 tympanoplasty at our institute.

Methods: This was a prospective observational study conducted at ENT Department of Gujarat Adani Institute of Medical Sciences, Bhuj, from October 2017 to July 2019. All patients between 20 and 60 years of age with inactive mucosal COM operated for type-1 tympanoplasty were included in the study. Pre-operative, intra-operative and post-operative details were recorded as per the pre validated proforma and evaluated using Chi-square and paired t-test.

Results: 100 patients were included in our study. Females were more commonly affected (61%) than males (39%). In 78% of patients one ear was affected (left 40%, right 38%). Ear discharge was the most common symptom (99%). Maximum patients (55%) had a moderate perforation. The perforation was central in all cases. Microscopic surgery was done in 79% of patients. Post aural approach (Wilde’s incision) was the most common approach used (70%). The most common graft material used was temporalis fascia (96%). In 61% of patients graft was kept by underlay technique.

Conclusions: In our study, the success rate of tympanoplasty was significantly more when duration of discharge was less, microscope was used for surgery and post aural approach was used. Success rate was less when there was history of any previous nasal pathology. Other factors, like age, gender, socio-economic class, occupation, side of involvement of ear, size and site of perforation and grafting techniques, did not affect the success rate of tympanoplasty.
Extended high frequency hearing sensitivity in normal contralateral ears exposed to mastoid drill noise in patients undergoing mastoid surgery
Authors: Chakravarti Arunabha , Upadhyay Prabhakar , Bijarniya Rahul , Shukla Indu
Published: November 2020

Background: This study aimed at evaluation of extended high frequency hearing in non operated normal ear in patients undergoing mastoid surgery using otological micro drill.

Methods: A hospital based prospective observational study was carried out. Patients up to 40 years of age with unilateral ear disease were recruited and divided into two groups- mastoidectomy group comprising 30 patients who underwent mastoid surgery using high speed microdrill and tympanoplasty group who underwent surgery without using microdrill. Pure tone audiometry (conventional and extended high frequency) was performed preoperatively, on 3rd and 10th postoperative day.

Results: In mastoidectomy group, Air conduction thresholds in extended high frequency showed significant changes on 3rd postoperative day and showed recovery by 10th postoperative day. Recovery started by 3rd postoperative day and in majority of cases there was a complete recovery by 10th postoperative day.

Conclusions: Otological drilling has a significant effect on the extended high frequency hearing of normal contralateral ear. Extended high frequency audiometry till 16000 Hz is a sensitive modality for evaluation to monitor these cases on post-operative follow up.
Submandibular gland flap in reconstruction of head and neck cancer defects
Authors: Arora Viresh , Kathuria Bhushan , Arora Madhuri
Published: November 2020

Management of head and neck cancer defects has been challenging owing to the complexity of the created defects. Various local and regional flaps to free flaps have been described in the reconstruction of cancer defects, each of them having it’s own merits and limitations, therefore none of them appears as an ideal one. A Submandibular gland flap (SMGF) technique has emerged as a versatile flap having advantages of a regional and a free flap. In this study, eleven patients (four tongue, six buccal mucosa defects and one retromolar trigone defect) underwent reconstruction of oral cavity cancer defects with SMGF. The outcomes of the SMGF were evaluated in terms of the ease of harvest, functional outcome, and postoperative complications. The mean defect size and the flap dimensions were 4.4×3.9 cm and 3.6×3.3 cm respectively. One patient suffered wound infection resulting in partial flap necrosis with wound dehiscence. In the follow-up period one patient developed contra nodal recurrence and another patient developed a second primary on the contralateral base of the tongue. This study showed that SMGF is an excellent flap for the reconstruction of oral cavity cancer defects because of its reliability, versatility and its relative ease of application.
A polydrug regime for treatment of sudden sensorineural hearing loss
Authors: M. Muniraju , Killera Shambulinga , Kauser Safina
Published: November 2020

Sudden sensorineural hearing loss (SSNHL) is a very frightening and incapacitating event and it impairs the patient's quality of life. Steroids are considered the first line of treatment. Intratympanic dexamethasone produces a significantly higher perilymph concentration of steroids. The aim of our study was to assess the efficacy of multi-drug regimen in the management of SSNHL, to analyse the recovery and to assess use of intratympanic steroid injections (ITSI) as a primary treatment. This is a prospective study presenting as a case series of 5 cases of SSNHL. Our treatment included intratympanic steroids, oral steroids, antiplatelet drugs, rheological-agents and neuro vitamins. Complete recovery was seen in 2 (40%), partial recovery in 2 (40%), 1 patient was lost to follow up. In the patient with bilateral SSNHL, the ITSI was administered in the right ear only; which showed a significant improvement. SSNHL is described as a decline in hearing of 30 dB or more, on 3 or more frequencies over 3 days or less, with tinnitus and ear fullness. Early presentation and intervention within 72 hours is the ideal treatment. Since viral infections and vascular compromise are considered as probable theories for SSNHL, steroids, with anticoagulants, antiplatelet and rheological-agents are used as an effective therapy. Our study shows that a multi-drug treatment of SSNHL can be much more effective than a single drug treatment. We also conclude that using intratympanic steroid injections have a greater improvement as seen in the case of bilateral SSNHL.

 
Q-tip ear injury with stapes luxation into the vestibule-a case report
Authors: Lame Cheikh Ahmedou , Ndiaye Cheikhna Ba , Loum Birame , Fall Amat , Goumba Alice , Diallo Thierno Boubacar
Published: November 2020

Stapediovestibular luxation by Q-tip ear injury is a rare occurrence. The traumatic context associated with cochleovestibular symptoms should lead to a high index of suspiscion. Temporal bone CT scan confirms the diagnosis. The authors report a case of stapediovestibular luxation and discuss the management of this condition. An 8-year-old boy presented to our department for otalgia, hearing loss, and dizziness. The history revealed a penetrating right ear injury by Q-tip, which had occurred 5 days previously. ENT examination found a right peripheral vestibular syndrome with ipsilateral tympanic perforation. Tonal audiometry noted right cophosis. Temporal bone CT scan showed right side internal stapediovestibular dislocation. Middle ear inspection with oval window fistula repair and tympanic closure were performed. Postoperative outcomes showed complete resolution of vestibular symptoms without  improvement of sensorineural hearing loss thresholds. Traumatic stapediovestibular dislocation by Q-tip ear injury is unusual. Early diagnosis, with precise lesion assessment and appropriate management resolve vestibular symptoms, prevent infectious complications. But, hearing outcomes are variable.

 
The challenges of a Lemierre’s syndrome in COVID-19 times
Authors: Bhat Vikram Kemmannu , Lalitha Jino Johns , Desai Suhas Suresh , Sreedevi Nidhi Mohan
Published: November 2020

Lemierre’s syndrome is a type of necrotizing fasciitis of the head and neck that is an uncommon rapidly spreading infection involving the skin, subcutaneous tissue and the fascia leading to life-threatening complications like septicaemia, bone marrow suppression, disseminated intravascular coagulation and multi-organ failure. The management of this disease, especially in COVID-19 pandemic is a challenge as it is associated with high morbidity. A 46-year-old male presented to us with complaints of swelling in the neck with discoloration of skin in the neck and chest. Computed tomography (CT) scan of the neck revealed thrombosis of the right internal jugular vein (IJV) and diffuse abscesses on both sides of the neck. A high index of suspicion is required for the diagnosis of Lemierre’s syndrome in the absence of typical clinical features. The rapid, unpredictable dissemination of infection and occult thrombus within the IJV make both diagnosis and management a challenge especially, during COVID-19 times.
Cavernous haemangioma of the thyroid mimicking benign nodule- a diagnostic dilemma
Authors: Kumar Balkrishna , Thangavel Saranya , Raja Kalaiarasi , Ganesh Rajesh Nachiappa , Saxena Sunil Kumar
Published: November 2020

Cavernous haemangioma of the thyroid usually presents as a benign, solitary nodule mimicking colloid goitre. Depending upon the size, the symptoms may vary. Here we present a similar case report of a patient for whom we couldn’t make a definite diagnosis clinically or radiologically or by cytology. The patient underwent surgery and biopsy was reported as cavernous haemangioma of thyroid. Post-operative period was uneventful.
Fluorodeoxyglucose positron emission tomography-computed tomography base response assessment in primary thyroid lymphoma
Authors: Jain Tarun Kumar , Punia Anushree , Dhal Shikha , Singh Guman , Malhotra Hemant , Punia Ankur , Gupta Naveen
Published: November 2020

Isolated primary thyroid lymphoma and lesion in the thyroid gland presenting as a lymphoma, both are uncommon entities. This subgroup of thyroid malignancies is managed in different ways as compared to common thyroid malignancies. A 63-year-old male diagnosed as non-Hodgkin’s lymphoma of the thyroid gland underwent for F-18 fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT). It revealed isolated FDG avid soft tissue mass in left lobe of thyroid gland. After two and six cycles of chemotherapy, PET-CT was perfomed and response assessed in Deauville scores.  
Bimodal intervention in cystic lesions of the maxillary antrum
Authors: Munjal Manish , Tilavat Venus , Rishi Porshia , Munjal Shubham , Sidhu Harjinder , Sharma Salony , Dosanjh Jigisha
Published: November 2020

Intrinsic or extrinsic cysts are common maxillary antral lesions as there is close proximity between the maxillary antrum and maxillary teeth. Main stay of treatment is complete surgical excision. Endoscopic trans nasal middle meatus corridor and the canine fossa approach facilitate 360-degree access, resection and removal of cystic lesions of the maxillary antrum. Bimodal technique to treat maxillary cysts that have expanded into the maxillary sinus is discussed here.  
Traumatic cavernous internal carotid artery pseudoaneurysm presenting with massive epistaxis-a morbid clinical entity
Authors: Swain Santosh Kumar
Published: November 2020

Epistaxis is commonly encountered by clinicians in emergency department. However, severe and recurrent epistaxis is very uncommon especially that arise from the cavernous internal carotid artery (ICA) pseudoaneurysm. Traumatic cavernous internal carotid pseudoaneurysm is a rare cause of the epistaxis but is a fatal and life-threatening clinical condition if left untreated. Massive epistaxis following head injury should alert the clinician to rule out traumatic cavernous ICA pseudoaneurysm. Traumatic pseudoaneurysm of the cavernous part of the ICA is a challenging clinical entity both in diagnosis and treatment. This clinical diagnosis may be suspected in case of patient with history of head injury, massive recurrent epistaxis and delayed onset of blindness. Massive epistaxis after head trauma should alert the clinician for possible cavernous ICA pseudoaneurysm. Carotid angiography confirms the site of pseudoaneurysm. The treatment options are endovascular stent and coil embolization, arterial balloon occlusion and surgical trapping. Timely diagnosis and treatment of this condition give a favorable outcome. In this review article, we discuss the epidemiology, etiopathology, clinical presentations, investigations and current treatment of the traumatic cavernous ICA pseudoaneurysm.
Guidelines for the endoscopic nasal surgery during COVID-19 pandemic
Authors: Husain Parvez , Ahmed Shaheen Khalil , Husain Benazeer
Published: November 2020

COVID-19, the respiratory illness caused by the novel SARS-CoV-2 virus has rapidly emerged as a serious global health concern. The world health organization (WHO) and has enacted various protocols for healthcare institutions internationally in an attempt to slow the spread of disease, including adjustments for procedures performed by otolaryngologists. Based upon published evidence we highlight different strategies to reduce infection transmission during endoscopic sinus surgery. All patients undergoing endoscopic sinus surgery should be discussed with health care staff to be involved in procedure. The patients should be divided into elective, semi-elective, and urgent/emergency. COVID-19 test should be done in all patients prior to surgery along with high resolution computed tomography (HRCT) chest. Irrespective of COVID screening results, it is advisable to treat all patients undergoing aerosol generating procedures as COVID-19 positive, and the whole theatre team should wear personal protection equipment (PPE) as per current national guidelines. Preoperative nasal decongestion to be undertaken with atomization devices. Consider telephone/video clinic follow up appointments unless clinical examination is considered essential. Considering the current health crisis caused by COVID-19, the following guidelines are recommended for performing nasal surgeries: patient visits must be limited to only urgent/emergent cases for the time being. Only vital personnel should remain in the OT while performing any nasal endoscopic procedure as this will both reduce exposure and conserve vital personal protective equipment. Five levels of protection are recommended for the person performing the procedure.
To evaluate the efficacy between 0.15mg/Kg and 0.25mg/Kg of iv labetalol in the suppression of haemodynamic response to extubation
Authors: S Sindhu , Srinivas V Y
Published: November 2020

Tracheal extubation process evokes stress response which causes autonomic variations such as tachycardia, rise in systolic arterial blood pressure and diastolic arterial blood pressure which is potentially lethal in high risk patients.

Thus this study is conducted to compare the efficacy between 0.15mg/kg and 0.25mg/kg of iv Labetalol in the suppression of haemodynamic response to Extubation.

60 participants aged between 18-55 yrs belonging to ASA 1 or 2 were randomly allocated into 2 groups. Group Lb received injection Labetalol 0.15mg/kg and Group Lt received injection Labetalol 0.25mg/kg. Heart rate, systolic arterial blood pressure and diastolic arterial blood pressure were recorded at basal, two, five, eight minutes after drug infusion, at extubation and one, three, five, eight, ten and fifteen minutes post extubation.

Group Lt showed a better lowering values in heart rate, systolic arterial blood pressure and diastolic arterial blood pressure after drug infusion, at Extubation, and fifteen minutes post Extubation compared to Group Lb.

Injection Labetalol 0.25mg/kg showed a effective suppression of haemodynamic response to Extubation compared to injection Labetalol 0.15mg/kg.
Comparison of the efficacy of ultrasound guided adductor canal block versus intra-articular infiltration in providing post-operative analgesia after arthroscopic anterior cruciate ligament repair surgery
Authors: Bangal Kedar , Ghodki Poonam
Published: November 2020

Ultrasound guided adductor canal block (ACB) is a modality for providing analgesia after arthroscopic anterior cruciate ligament repair surgery. Intra-articular infiltration of analgesics in the knee joint acts on the free nerve endings at the operative site and provides analgesia. We aim to compare the analgesic efficacy and opioid consumption between these two modalities.

Sixty patients were randomized to receive either ACB under ultrasound guidance (group A) or intra-articular infiltration (group B). Post-operatively time of rescue analgesia and opioid consumption were noted. Quality of analgesia was assessed every 2 hours until 6 hours, then every 6 hours until 24 hour post-operative period between the two groups. Data was analysed statistically and P value < 0.05 was considered significant.

: Time of rescue analgesia was comparable in both the groups (p value 0.4317). NRS scores in ACB group and intra-articular infiltration group were comparable till first 6 hours (p value 0.4519) but increased in intra-articular infiltration group at 12 hour (p value <0.0001) and 18 hour (p value <0.0117) as compared to group receiving ACB. The opioid consumption was more in intra-articular infiltration group than ACB group although not statistically significant (p value 0.6319).

ACB is a better modality for postoperative analgesia after arthroscopic anterior cruciate ligament repair surgery as analgesia of intra-articular infiltration wears off in 12-24 hour period which is crucial for early ambulation and from rehabilitation point of view.
Effect of 2% dextrose in ringer lactate on incidence of nausea and vomiting in laparoscopic cholecystectomy-Prospective randomized control study
Authors: Singh Yashpal , Verma Surabhi , Singh A P , Bhartiya S K
Published: November 2020

Post-operative nausea and vomiting (PONV) is the distressing situation for patients & caregivers. Various groups of pharmalogical agents are used for prophylaxis in high risk patients for PONV but they have their own advantage and disadvantages. Recent metaanalysis on intravenous use of 5% dextrose showed conflicting results with risk of hyperglycemis. So in this study we plan to use intravenous 2% dextrose in ringer lactate for prevention of PONV in laparoscopic cholecystectomy patients.

This prospective randomized double-blind controlled study was conducted in 60 American Society of Anaesthesiologist 1 & 11 patients, age 20-55 years undergoing elective laparoscopic cholecystectomy under general anaesthesia. Patients were randomly divided into two groups: group DRL received 2% dextrose in ringer lactate and group RL received ringer lactate. Allocate fluid was started at induction of anaesthesia and continued post-operatively up to 6hr. Incidence and severity of PONV was measured as a primary outcome. Secondary outcome includes comparison of blood sugar level, requirement of rescue antiemetic, time of oral acceptance of food & time of discharge between two groups. Mean between two groups were compared with student t test. The critical value of ‘p’ indicating the probability of significant difference was taken as<0.05 for comparison.

Incidence and severity of PONV was less in group DRL than group RL. Blood sugar level was higher in group DRL but within the normal range. Time of oral feed and time to discharge was early in group DRL.

Intravenous 2% dextrose in ringer lactate reduces the incidence and severity of PONV in laparoscopic cholecystectomy patients.
Supraclavicular brachial plexus block with and without dexamethasone as an adjuvant to local anesthetics - An observational study
Authors: Marathe Radhika M , Shende Sunita Y , Khairmode Ujwala B , Gorgile Rupali N
Published: November 2020

Brachial plexus block with bupivacaine provides very effective intraoperative anaesthesia and also analgesia. It was found that when dexamethasone was added as an additive to bupivacaine, it increases the duration of anaesthesia and also the duration of analgesia. This study was carried out to compare onset and duration of sensory and motor blockade and duration of postoperative analgesia on addition of dexamethasone to local anestheic and local anesthetic alone in supraclavicular brachial plexus block.

After obtaining the approval from the Institutional Ethical committee and written informed consent from the patients, 60 patients were included in our study.

We included 60 ASA I & II patients who were aged between 18 years & 60 years, underwent elective upper limb surgeries. They were divided into two equal groups.

Group 1 (cases) who received 15 milliliter of 2% lignocaine with adrenaline and 15 milliliter of 0.5% bupivacaine + dexamethasone 8mg(2ml).

Group 2 (controls) who received 15 milliliter of 2% lignocaine with adrenaline and 15 milliliter of 0.5% bupivacaine + 0.9% normal saline(2ml).

We observed the Onset of sensory and motor blockade, duration of sensory and motor blockade and postoperative analgesia between the two groups.

The onset of sensory blockade was within 7.3 min in group 1. In group 2 the onset of sensory blockade was 13.66 minutes.

The onset of motor blockade was within 3.93 min in group 1. In group 2 the onset of motor blockade was 18.66 min.

The duration of intra operative analgesia was 654.33 minutes in group 1. In group 2 the duration of intra operative analgesia was 292.6 minutes.

The duration of post operative analgesia was 815±13.57 minutes in group 1. The duration of post operative analgesia in group 2 was 393.8±42.88 minutes.

There were no complications in both the groups in intra operative period and post operative period.

Dexamethasone, when added to 15 millilitre of 0.5% bupivacaine and 15 millilitre of 2% lignocaine plus adrenaline, very effectively enhances the onset of sensory and motor blockade. It dramatically prolongs the duration of sensory and motor blockade and duration of analgesia. There were no untoward side effects with the use of dexamethasone as an additive in the brachial plexus block.
Patient-reported outcomes after femoral nerve block versus periarticular injections in patients undergoing total knee arthroplasty: A randomized controlled study
Authors: Ismail Tarek I , Elshafie Mohamed H
Published: November 2020

Total Knee Arthroplasty (TKA) is one of the most advanced surgical solutions for pain relief and mobility improvement in patients with end stage osteoarthritis. TKA patients experience severe postoperative pain. Recently, peripheral nerve blockade and Peri or intra-articular injections have been used successfully with fewer side effects when compared to the conventional analgesic techniques. Measuring quality of recovery (QoR) using QoR-15 scale is considered as an accepted and efficient scale for clarification the success of surgery and anaesthesia.

One hundred and thirty adult patients scheduled for TKA were randomized into 2 groups: Femoral nerve block (FNB) group and periarticular injections (PAI) group. All patients completed the QoR before or on the day of surgery and at the end of the first post-operative day. Postoperative pain scores, opiod consumption and adverse effects of the drugs and techniques were also measured.

Periarticular injectionsresulted in better analgesia at rest and on movement and less postoperative morphine consumption during the first 24 h postoperatively when compared to femoral nerve block. Global QoR-15 score was significantly higher in PAI when compared to FNB group.

Periarticular injection of local anesthetics provides better quality of recovery and sufficient level of analgesia than does single shot femoral nerve block for patients undergoing total knee arthroplasty in early postoperative period.
Anaesthesiologist’s perspective of laparoscopic adrenalectomy - A case report with current concepts in management
Authors: Nair Venugopal Achuthan , Gladston Divya V , Valasareddy Sunil Kumar , J Sivaranjith
Published: November 2020

Pheochromocytoma is a rare tumor of adrenal gland, treatable, curable cause of hypertension and may lead to premature death if not treated early. Medical management by multidisciplinary team is essential for hemodynamic stability during the perioperative period. General anaesthesia with thoracic epidural block offers adequate stress control as hemodynamic fluctuations are quite common and significant during induction, peritoneal insufflation and tumor manipulation. Newer modalities of diagnosis, short acting drugs to control hypertension, vigilant anaesthetic management with beat to beat monitoring of hemodynamics significantly improves patient’s safety. Laparoscopic mobilisation of the adrenal helps in minimal manipulation of the tumour and thus minimising the resultant catecholamine surge. However, hypotension upon ligation of adrenal vein is inevitable. Noradrenaline (NA) remains the vasopressor of choice which has to be continued post operatively. A thorough pre-anaesthetic evaluation, preparation and execution with a multimodal analgesic pain management in a high dependency unit aid in early ambulation and discharge of the patient.
The super-protect box- An armour during dealing with Covid -19 patients
Authors: Saseedharan Sanjith , Kuril Rohit , K Vaijayanti , Karanam Roopa
Published: November 2020

As of 1 may more than 4.1 million cases have been reported in the pandemic starting from Wuhan in China and spreading across 202 countries worldwide. The mortality of the disease has remained around 1 to 7% as per various studies around the world. Covid 19 primarily involves the respiratory tract and may lead to severe acute respiratory illness in patients who are elderly with co morbidities. Many patients require airway management which includes intubation, suctioning, nebulisation, at times bronchoscopy and tracheostomy. This may expose the healthcare workers to aerosols generated during the procedure. Various techniques invloved in mitigating this have been published in recent literature. The authors of this article institute have indigeniously constructed a device to ensure safety during aerosol generating procedures called the super protect box the setails of which are mentioned in the main article.
Historias conceptuales
Authors: Cortes Manresa Enriqueta Lorena
Published: November 2020

Zermeño Padilla, Guillermo (2017) Historias conceptuales, México, El Colegio de México/Centro de Estudios Históricos, 401 p.
El espectador pensante. El cine de Jorge Sanjinés y el grupo Ukamau
Authors: Belmonte Grey Carlos Alejandro
Published: November 2020

David M. J. Wood, El espectador pensante. El cine de Jorge Sanjinés y el grupo Ukamau, México, UNAM- Instituto de Investigaciones Estéticas/La Carreta Editores E.U., 2017, 187 pp.
Fotografía y memoria. Conversaciones con Eduardo Longoni
Authors: Velarde Martínez Luis Francisco
Published: November 2020

Alberto Del Castillo Troncoso, Fotografía y memoria. Conversaciones con Eduardo Longoni, Colombia, Fondo de Cultura Económica/CONACyT/Instituto Mora, 2017, 303 pp.
La Guerra Fría en América Latina
Authors: Bravo Rosete Héctor Saúl
Published: November 2020

Vanni Pettiná, La Guerra Fría en América Latina, México, El Colegio de México, 2018, 260 pp. ISBN 978-607-628-249-6
María Teresa de Landa. Una Miss que no vio el Universo
Authors: Pezzat Sánchez Paulina
Published: November 2020

Rebeca Monroy Nasr, María Teresa de Landa. Una Miss que no vio el universo, México, Secretaría de Cultura/Instituto Nacional de Antropología e Historia, 2018.
De súbditos del rey a ejidatarios posrevolucionarios. Los subalternos en la historia de México: territorio, gobierno y resistencia
Authors: Xochihua García Brehnis Daniel , Ayala Flores Hubonor
Published: November 2020

Michael T. Ducey y Luis Juventino García Ruíz (coords.), De súbditos del rey a ejidatarios posrevolucionarios. Los subalternos en la historia de México: territorio, gobierno y resistencia, Universidad Veracruzana, Xalapa, Ver., 2019.
Los patriotas en escena (1862-1869)
Authors: Barrueta Rath Juan de Dios
Published: November 2020

Miguel Ángel Vásquez Meléndez, Los patriotas en escena (1862-1869), México, El Colegio de México, 2018, 159 pp. ISBN 9786076282434.
Trabalho esclavo contemporáneo: tempo presente e usos do passados
Authors: Pensado Leglise María Patricia
Published: November 2020

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Resignificar el mestizaje tierra adentro Aguascalientes, Nueva Galicia, siglos XVII y XVIII
Authors: Camacho Sandoval Salvador
Published: November 2020

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Ensayo sobre la servidumbre. El fracaso del “capitalismo” en México
Authors: Aréchiga del Río Kevin
Published: November 2020

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San Miguel y el oriente salvadoreño. La construcción del Estado de El Salvador, 1780-1865
Authors: Méndez Zárate Armando
Published: November 2020

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Donativos, préstamos y privilegios. Los mercaderes y mineros de la ciudad de México durante la guerra anglo – española de 1779 – 1783
Authors: Alcántara López Álvaro
Published: November 2020

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Revolución y rebeliones en el istmo de Tehuantepec
Authors: Arias Gómez María Eugenia
Published: November 2020

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