bluuebunny/crossref_metadata_2025 huggingface dataset:
Apache II score in predicting surgical outcome in patients of secondary peritonitis: a prospective and observational study
Authors: Jeelani Shaukat , Aziz Asgar , Kumar Irshad A. , Dar Waseem A. , Nowreen Farzanah
Published: March 2020

Background: Peritonitis is defined as inflammation of the serosal membrane that lines the abdominal cavity and the organs contained therein. Secondary peritonitis presenting as acute generalized peritonitis is a common surgical emergency often associated with significant morbidity and mortality. Many scoring systems have been found useful in predicting the outcome in critically ill patients, thus allowing application of resources for effective use. Amongst them acute physiology and chronic health evaluation score (APACHE II), have a strong relationship to the outcome than previous groupings without consideration for systemic effect of the intra-abdominal sepsis.Methods: This study was conducted in the Department of General surgery, Sri Maharaja Hari Singh (SMHS) Hospital an associated hospital with the Government Medical College Srinagar, J&K, India. The prospective study was conducted over a period from October 2016 to September 2018 (Two Year) on 108 patients diagnosed with secondary peritonitis. Data was collected and analysed using SPSS v 20.Results: study included 108 patients with males involving 74.1% (80). The mean age of our study was 34 yr. (2-88 yr.), and 21-40 yr. (44.5%) group was mostly involved. Pain abdomen was present in 100% patients followed by nausea/vomiting (88%). Higher the APACHE VII score higher were post-operative complications (31+ score group 100%), mortality (31+ score group 100%) and less hospital stay (31+ score group 1.5 days) due to increased mortality.Conclusions: APACHE II score correlated well with postoperative complications, outcome, hospital stay. However, in patients with very high Apache score more than 30, the mean duration of hospital stay is less due to associated increased mortality during early Hospital stay.
Lipid profile pattern in controlled and uncontrolled diabetic patients in a tertiary care centre
Authors: Gupta Smita , Mangal Rajat , Grover Ankit
Published: March 2020

Background: Diabetes Mellitus is a metabolic disorder characterized by hyperglycemia with disturbances of carbohydrate, lipid as well as protein metabolism virtually affecting every organ in the human body. Dyslipidemia is a group of biochemical disorders, which is frequently seen in diabetic individuals. Dyslipidemia associated with diabetes has a major role in atherosclerosis and cardiovascular complications.Methods: This cross-sectional study was conducted in diabetic patients visiting OPD of Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly over a period of 6 months. A total of 320 patients were randomly selected for the study and divided into 2 groups depending on HbA1c levels.Results: BMI of controlled diabetics was 26.2±1.91 kg/m2 and of uncontrolled was 27.56±4.36 kg/m2 respectively with a statistically significant p value. Total Cholesterol levels in controlled group was 185.63±52.32 mg% and 217.83±61.33 mg% in uncontrolled group with a p value of 0.0005 which is highly significant. Same was seen in triglyceride and VLDL levels in controlled group which was 173.88±101.77 mg% and 31.5±12 mg% respectively and 203.33±83.7 mg% and 40.67±17.66 mg% in uncontrolled group respectively.Conclusions: The diabetic patients with poor glycemic control had statistically significant high values of Total Cholesterol, Triglycerides, VLDL levels and significant low HDL Levels. Good glycemic control can result in improvement in the lipid panel and the patients can be prevented from the high cardiovascular and neurological risk.
Perinuclear anti neutrophil cytoplasmic antibody vasculitis with nonspecific muscle pain
Authors: Dihingia Prasanta , . Harikishore , Jha Anshu Kumar
Published: March 2020

This is a case report describing p-ANCA vasculitis presenting with nonspecific muscle pain. It is a very uncommon finding seen in p-ANCA vasculitis patients which they usually present with palpable purpura alone. In this case, along with nonspecific muscle pain, renal involvement of the disease has been explained and there are no upper and lower respiratory tract complaints which favours more towards microscopic polyangitis.
Fatal pulmonary embolism after middle ear surgery: a case report
Authors: Patel Khyati Ramesh , Vyas Varsha , Patel Kaushal , Mehta Misha
Published: March 2020

Pulmonary thromboembolism is a complication of underlying venous thrombosis. Factors contributing to thrombus formation include venous stasis, hypercoagulable state, immobilisation, surgery and pregnancy. Authors present the challenges authors faced in diagnosing pulmonary embolism in a post-operative patient. 35-year-old female with complaint of decreased hearing for 2 years along with tinnitus and giddiness was admitted for stapedectomy. She also gave history of dyspnoea and pedal oedema one month back for which she was hospitalized and underwent investigations which were normal. Patient was discharged as her clinical symptoms improved. On postoperative day 5, she developed sudden dyspnoea after getting up and walking a few steps. Dyspnoea along with falling saturation and bradycardia progressed to cardiopulmonary arrest. Intensive care was started. Bilateral lower limb venous doppler showed deep venous thrombosis. Clinical diagnosis of pulmonary embolism was made, and patient was lysed with Tenecteplase 30 mg. Echocardiography showed signs of resolution of embolism after lysis, but gradually patient deteriorated and developed cardiogenic shock. Intra-aortic balloon pump was inserted via right femoral artery and inotropic support was continued. However, patient’s condition worsened, and she developed cardiopulmonary arrest the next day and could not be revived. Prevention of pulmonary embolism is a major clinical problem for which prophylactic measures like early ambulation in post-operative periods, elastic stockings, graduated compressive stockings for bed ridden patients and preventive anticoagulation therapy in high risk patients should be considered.
Laparoscopic cholecystectomy in a patient with pneumonectomy
Authors: Sharma Nisha , Chandel Ankita , Kanwar Manjit Singh
Published: March 2020

Post pneumonectomy patients pose a challenge to the anaesthetist owing to the altered respiratory mechanics and decreased respiratory reserve. Performing laparoscopic surgery in such patients further deteriorates the already compromised lung functions. Authors report a case of laparoscopic cholecystectomy performed in post pneumonectomy patient. A clear understanding of respiratory mechanics and post pneumonectomy physiological changes helped us to administer a safe anaesthesia and safe perioperative outcome.
A comparative study between harmonic scalpel hemostasis and conventional hemostasis in total thyroidectomy
Authors: El Sherpiny Waleed Yusif
Published: March 2020

Background: Thyroidectomy is the most commonly performed procedure in endocrine surgery. Since the thyroid gland is highly vascular, therefore, rapid and absolute hemostasis is extremely required. Conventional thyroidectomy is commonly used with acceptable outcomes, however, it is time‑consuming and resulted in significant intraoperative blood loss with the possible risk of postoperative hemorrhage, injury to parathyroid glands and laryngeal nerves. The advent of focus harmonic devices was encouraging for improving safety, effectiveness, and reduction of operative time, especially in thyroid surgery. Aim of this study: The purpose of this study was to analyze the effectiveness and surgical outcomes of using ultrasonic harmonic scalpel for thyroid surgery compared to conventional techniques.Methods: This was a prospective, randomized study in which 60 patients with various types of goiters presented for thyroidectomy. The patients were divided into two comparable groups. Group A (30 patients) included patients who had focus harmonic thyroidectomy and Group B (30 patients) included patients who underwent conventional thyroidectomy.Results: Focus harmonic thyroidectomy showed a significant reduction in operative time, intraoperative blood loss, volume of postoperative fluid drainage and meantime for hospital stay compared with conventional thyroidectomy. There were no significant differences in the incidence of postoperative hypocalcemia, seroma, hematoma, wound infection and laryngeal nerve injury between both groups.Conclusions: Focus harmonic thyroidectomy was a safe, effective, faster, and appealing alternative to conventional technique since it reduced the operative time, intraoperative blood loss, postoperative drainage and hospital stay with comparable postoperative complications.
Surgical practices during cholecystectomy in Algeria: results of a survey
Authors: Tidjane Anisse , Serradj Nabil Boudjenan , Ikhlef Nacim , Benilha Soumia , Benmaarouf Noureddine , Tabeti Benali
Published: March 2020

Background: The cholecystectomy is one of the most practiced surgeries; the learned societies published guidelines to improve surgical practices. Guidelines are sometimes not followed, either by negligence, by lack of means or adequate professional environment. So, to know the real practices of surgeons, a survey was conducted.Methods: An anonymous national survey involving all practicing Algerian surgeons was conducted. At the end of the survey, all data were captured and processed using the SPSS v20 software; χ2 tests were used to compare different groups of surgeons.Results: Only 122 responses were retained, twenty-two percent of surgeons perform open cholecystectomy. No surgeon performed routinely cholangiography, 43% extracted the gallbladder using extraction disposal, 18% performed systematic abdominal cavity drainage, all surgeons send the gallbladder to histology for examination and postoperative antibiotic prophylaxis was routinely prescribed by 69% of surgeons. The average postoperative hospitalisation recommended by surgeons was 1.65 days (0-5) days. The experience of the surgeon or his position was associated with lower rates of systematic prescription of antibiotic prophylaxis, and with a lower duration of postoperative hospitalisation.Conclusions: We recommend publication of guidelines of good practices adapted to the socio-professional and economic context of countries.
Evaluation of new technique of mesh fixation in laparoscopic inguinal hernia repair
Authors: El Deep Ahmed , Zeineldein Ashraf A. , Soltan Tamer A. , Fawzy Ahmed N.
Published: March 2020

Background: Hernia is a common problem of the modern world with an incidence ranging from 5 to 7%. Of all groin hernias, around 75% are inguinal hernias. Recently with the advancement in laparoscopy, endoscopic repairs seem to offer better quality of life, decreasing hospital stay and early return to work. Aim of the work was to evaluate a new technique for mesh fixation by Zein method of suturing and compare it with stapled mesh fixation in laparoscopic inguinal hernia repair transabdominal preperitoneal approach.Methods: The study is a randomized, prospective single group study. The study was conducted after the approval of the ethical committee of the surgical department, Menoufia University. It was conducted in Menoufia University Hospital on 50 patients with inguinal hernia who were operated upon between September 2018 and September 2019 with a minimal follow-up of 6 months.Results: Age of studied patients ranged from 27 to 55 years with mean 42.82±7.90 age/years. Regarding sex of studied patients, more than half (74%) of studied patients were males and (26%) were females. Regarding comparsion between high and low overall cost burden on the patient, it was interestingly found that high cost is associated with presence of complication like hematoma, prolonged stay in the hospital and prolonged use of antibiotics.Conclusions: Both the use of sutures and fixation of mesh by absorbable tacks approaches are similarly effective in terms of operative time, the incidence of recurrence, complications, and chronic pain coinciding with all the available literature.
Safety and efficacy of percutaneous nephrolithotomy in paediatric age group: our 3 year experience in Western Rajasthan
Authors: Sharma Pradeep K. , Baweja Shekhar , Aggarwal Vikas , Katti Pawan , Nagori Rupesh , Chhabra M. K.
Published: March 2020

Background: Percutaneous nephrolithotomy (PCNL) has become a well-established procedure for the management of pediatric renal calculi. Paediatric PCNL has been performed using both adult and paediatric instruments. Objectives: To evaluate the safety, efficacy and complications using the Modified Clavien scoring system (MCSS) in children undergoing PCNL using adult sized instruments.Methods: All patients less than 16 years old were analyzed retrospectively in Western Rajasthan undergoing PCNL procedure at Dr. SN Medical College and Hospital from April 2016 to March 2019. All PCNL procedures were performed in prone position under general anaesthesia with fluoroscopic guidance and using adult size instruments. All the demographics, surgical data and perioperative information were collected.Results: Total 112 patients with 120 renal units (8 patients with bilateral stones), (66 boys and 46 girls), with a mean (range) age was 10.01±4.02 (2-16) years. The mean (range) stone size in our study was 28.94±1.10 (20-50 mm). Overall, stone-free rate after PCNL was 95%. Twenty five (25) children (20.8%) had operative complications; 23/25 (92%) had, Clavien grade I in 15 (60%), grade II in 8(32%) and all managed conservatively. 2 patients had hydropneumothorax, managed with ICD tube. Stone size, operative duration and haemoglobin drop were significantly associated with complications on Univariate analysis (p<0.05).Conclusions: In paedriatric age group PCNL is considered safe with MCSS showing grade I and grade II complications in majority (92%) of patients.
A comparative study of surgical site infection after single dose of preoperative antimicrobial prophylaxis versus multiple doses of antimicrobials in clean and clean contaminated abdominal surgeries
Authors: Vala Haresh , Vaja Maulik A. , Gohil Ajit B.
Published: March 2020

Background: The advent of antimicrobial therapy has offered an important adjuvant to the prevention of surgical infection. In spite of vast accumulation of research and review published there are still conflicting views. Some study shows multiple doses require for the eradication of microorganisms in the wound. While numerous authors have reported that single dose of an appropriate antibiotic is effective, but there has been no direct comparison of one dose against three doses regimens. Objective was to study about effect and safety of single dose of antibiotic against routine multiple dose regimens in clean and clean-contaminated abdominal surgeries.Methods: Patients recruited in the study according to specific inclusion and exclusion criteria. The participants were divided in two groups: group I and group II. Group I was given single dose of injection cefotaxime. While another group was given 5 days course of injection cefotaxime and injection amikacin or injection ciprofloxacin and injection metronidazole. Postoperative wound was assessed by Southampton wound grading system.Results: The rate of wound infection on 3rd day was for 16.30% for group I and 13.82% for group II. The infection rate decrease on 7th post-operative day and it was 13.04% for group I and 11.7% for group II.Conclusions: Long course of antibiotic as prophylaxis has no added advantage. Good operative technique plays a major role in preventing infections. Single dose antibiotic regimen has comparable infection rate for clean surgical cases and it saves lot of money in this era of cost containment.
Role of antibiotics in elective clean surgeries: limiting its use to single shot preoperative dose
Authors: Jamdade P. T. , Chawada Meghraj J. , Samant Apurva
Published: March 2020

Background: Conventional antibiotic therapy during operation not only increases the financial burden on patient, not only increases chances of adverse reactions among them but also not effective in reducing the infection rate after surgery. Single dose prophylactic antibiotic or maximum 24 hours dosing during or before surgery was found to be equally effective. Objective was the to study utility of single shot antibiotic prophylaxis in patients undergoing surgeryMethods: This prospective study includes 100 clean elective surgical cases randomized to groups of 50 each. Single dose prophylactic antibiotic was given to cases in the study group and conventional antibiotic therapy was given to cases in the control group. Study group cases received Injection Ceftriaxone in the dose of 2 gm intravenously. This was given at induction or half an hour before the incision was given. Second dose was given if there was delay in starting the surgery for more than three hours. Dose of the antibiotic was adjusted for children, underweight and obese persons. For cases in the control group. Injection ceftriaxone 1 gm was given intravenously twice a day for three days. Surgical site infection incidence was recorded.Results: Both the groups were comparable for age, sex, diagnosis and hence the type of surgery performed. The incidence of fever, redness, swelling and wound discharge which are the signs of surgical site infection after surgery was not found to be statistically significantly different. Management protocol was also not significantly different after the surgery.Conclusions: Single shot antibiotic before surgery is equally effective in reducing the incidence of surgical site infections (SSIs) compared to conventional antibiotic therapy.
Hospital based randomized prospective study outcomes in colorectal surgery after bowel preparation
Authors: Bhat Altaf Hussain , Mir Gh Hussain , Bhat Sajad Ahmad , Ali Muzaffar
Published: March 2020

Background: Research of so many years from the procurable world data has shown that the reasons for most colorectal cancers occur due to change in life style the type of diet, smoking as well as the influence of the surrounding environment in which man lives and increasing age with only a minority of cases associated with genetic disorders. Colorectal cancer is the third most commonly diagnosed cancer. In the first half of the 20th century, mortality from colorectal surgery often exceeded 20%, mainly attributed to sepsis.Methods: The randomized prospective study was conducted on 202 colorectal cancer patients in the department of Colorectal division of General and Minimal Invasive surgery” Sher-i-Kashmir Institute of Medical Sciences, Srinagar.Results: Mean age of patients in Group 1 (with no mechanical bowel preparation (NMBP)) was 51±18.15 years while as same was 50±17.76 years for Group 2 (with mechanical bowel preparation (MBP)). Age range for Group 1 was 16-87 years and16-85 years for Group 2. Regarding outcomes, wound infections were 6.1% and 3.8% in Group 1 and Group 2 respectively. While disruption of anastomosis were 2.0% and 3.8% in group A and B respectively.Conclusions: Statistically no gross difference in terms of morbidity and mortality was found between the use of mechanical bowel preparation versus no use of mechanical bowel preparation in elective colorectal surgery. Elective Colorectal Surgery can safely be performed without enduring MBP in it as it does not possess any sorts of benefits.
Clinical study of fistula in ano with special reference to its surgical management
Authors: Ghose Sivaji Sankar , Chowdhury Mili Das , Dharmamer M. Y.
Published: March 2020

Background: The present study was undertaken to evaluate the results of “Lay open method” fistulectomy technique in treating fistula-in-ano in terms of relief of symptoms, healing of wound, recurrence rate and post-operative complications.Methods: Total 45 cases with definite history of fistula and clinically diagnosed cases of fistula in ano selected for the study. A final diagnosis was made after proctoscopic examination under anaesthesia during operation and by histopathological examination after completion of operation.  In all the patients, lay open method fistulectomy was done. Post-operative period was closely monitored and all the cases were meticulously followed for a variable period of time.Results: The common fistulas were low anal type (80%). External opening was mostly located in the posterior mid zone (44.44%). Internal opening was found in 30 cases (66.66%) during per rectal digital examination while proctoscopic examination revealed internal opening in 26 cases (57.77%). Pain (22.22%), retention of urine (8.88%) were the commonest immediate as well as incontinence (1; 2.22%) and recurrence (1; 2.22%) were the delayed post-operative complications. 90% of cases had a satisfactory healing of their wounds within 21 days. Excellent results were achieved in 77.77% cases and only one case of recurrence (2.22%).Conclusions: Encouragingly high success rates were achieved in our patients, but this series comprised a very small number of patients in a short period of time with limited amenities; also follow up of very short duration and irregular for which a definite conclusion is difficult to arrive at.
Stump appendicitis: an uncommon dilemma
Authors: Pereira Chirag , Tauro Leo F.
Published: March 2020

Stump appendicitis is one of the rare delayed complications post appendectomy with a reported incidence of 1 in 50,000 cases. Stump appendicitis can present as a diagnostic dilemma if the treating clinician is unfamiliar with this rare clinical entity. The purpose of this paper is to review current data on stump appendicitis and analyse published cases.
Management of chronic anal fissures: a narrative review
Authors: Sritharan Hariharan , Ashok Kumar Naren Kumar , Syed Ibrahim Mohamed Ismail
Published: March 2020

Anal fissures are often encountered in surgical practice in both sexes. It is a distressing disease impacting quality of life and causes profound morbidity among those affected. If left untreated, it may lead onto perianal abscess or even malignancy in long standing cases. Surgery is the gold standard management for chronic anal fissures. Recently the widespread use of pharmacologic agents for chronic fissures has increased. The management of chronic anal fissures has migrated to an era of multifaceted approach. This narrative review looks into various studies spanning over a period of 16 years. Various articles were shortlisted and analyzed for efficacy of various treatment methods, their impact in hospital stay, quality of life improvement, recurrence rate and complications among various treatment methods. We concluded from this review, that open lateral internal sphincterotomy is still the gold standard method of treatment for chronic anal fissure. Among pharmacological agents, 2% diltiazem has the best effectiveness with good compliance rate. Modern surgical techniques like VY plasty can be reserved for special situations. We do not recommend the practice of manual anal dilatation.
Correlation between clinical grading of adenoid or tonsil hypertrophy and adenoid or tonsil volume post adenotonsillectomy: a prospective cohort study
Authors: Kokong Daniel D. , Adoga Adeyi A. , Turaki Ishaku , Maan Nuhu D. , Yaro John P. , Innocent Emmanuel
Published: March 2020

Background: Measuring adenoid or tonsil volume in surgically removed specimens is likely the most accurate method for quantifying adenotonsillar hypertrophy severity which may predict the extent of surgery to curtail post tonsillectomy haemorrhage a potential lethal complication.

Methods: All patients with adenoid or tonsil hypertrophy were graded clinically while the objective grading by volumetric saline displacement in accordance with Archimedes’ principle; between August 1, 2017 to July 31, 2019 at the Jos University Teaching Hospital, Plateau State, Nigeria. Data analysis was by the SPSS version 21.0 Chicago IL, USA.  

Results: The study had 96 participants with a M:F=1.7:1. Age range was 9 months to 51 years, median was 3 yrs, mean was 9.5 yrs±15.5 yrs with 83 (86.5%) who were ≤18 yrs. Main features of this study, no. of patients in snoring was 83 (86.5%), nasal obstruction 71 (74.0%), rhinorrhoea 32 (33.3%), noisy breathing 23 (24.0%), dysphagia- 18 (18.8%), mouth breathing 18 (18.8%). Grading of this study was 78 (81.2%) were Brodsky grade III & IV while 72 (75.0%) had ANR of ≥0.5. Blood loss was range 10 ml to 250 ml, median 35 ml, mean 52.7±46.9 ml while 51 (63.0%) had blood loss of ≤50 ml. Volume of surgical specimen of adenoid; range 0.20-4.50 ml, mean 1.56±0.83 ml while tonsil; (Rt)-range 1.00-12.50 ml, mean 3.18±1.97 ml. There was a positive correlation between adenoid or tonsil grade and volume at 99% CI; (r)=0.409, (p=0.000) and grade (mean) 3.11±0.78, volume (mean) 3.18±1.96.

Conclusions: This study establishes a positive correlation between clinical grading of adenoid or tonsil and volume with a certain level of accuracy which may predict extent of surgery to avoid post tonsillectomy hemorrhage, a life-threatening/lethal complication from excessive, partial or suboptimal surgery commonly.
Comparative study of outcomes of type-1 tympanoplasty with and without anterior tucking
Authors: Gangadar S. Kiran , Priyadarshini G.
Published: March 2020

Background: Tympanoplasty is a surgical procedure for closing the tympanic membrane perforation and reconstructing the tympanic membrane and hearing, commonly after trauma and chronic otitis media. The aim of the study was to compare the clinical and audiological outcomes of tympanoplasty with or without anterior tucking.

Methods: In this prospective study, 50 patients with chronic otitis media (COM) were divided into two groups. Group 1 underwent type 1 tympanoplasty with anterior tucking method, and group 2 underwent type 1 tympanoplasty without anterior tucking. The result was measured on graft uptake and hearing outcome at 6 months postoperatively by performing pure tone audiometry.  

Results: The hearing improvement was almost the same in both the groups. Graft uptake was good in type 1 tympanoplasty with tucking (96%) when compared to without tucking tympanoplasty (92%). Complications like residual perforation were seen in both groups equally. Anterior marginal blunting was noted (8%) in type 1 tympanoplasty with tucking.

Conclusions: The hearing improvement of type-1 tympanoplasty with anterior tucking and without anterior tucking is the same. Type-1 tympanoplasty with anterior tucking has a better graft acceptance. The only disadvantage of type-1 tympanoplasty with anterior tucking is anterior marginal blunting.
A descriptive study to determine the bacterial flora and antibiotic sensitivity of lower respiratory tract in tracheostomised patients
Authors: Rao Kulkarni Manik , . Panchami
Published: March 2020

Background: Tracheostomy is one of the commonest operations performed by an otorhinolaryngologist for various indications and in different age groups and tracheo-bronchitis is a common complication in tracheostomised  patients. This study designed to determine the bacterial flora and antibiotic sensitivity of lower respiratory tract following tracheostomy in hospitalized patients.

Methods: This is a descriptive study of 50 tracheostomised patients carried out from December 2017 to May 2019, at VIMS Ballari.  

Results: Stridor was the most common indication for tracheostomy (70%). Tracheal aspirate was sent for bacterial culture and sensitivity on day 0, 1 week and 3 weeks post tracheostomy. Majority of the patients showed no growth in the day 0 and 3weeks post tracheostomy bacterial cultures of the tracheal aspirate. Bacterial cultures yielded growth in majority of the patients in the 1-week post tracheostomy cultures. The sensitivity pattern, intermediate response pattern and resistance pattern to the first line antibiotics that are regularly used in our hospital were studied in all the 3 samples of tracheal aspirates that were sent for bacterial culture from all the 50 tracheostomised patients.

Conclusions: It is a good practice to send the tracheal aspirate for culture and sensitivity following Tracheostomy. If the patient is started on suitable antibiotics based on the culture postoperative recovery will be hastened, risk of postoperative infections like tracheitis, tracheobrochitis, stoma site infection and other lower respiratory tract infections can be reduced.
Study of bacterial pathogens causing chronic suppurative otitis media and the antibiotic susceptibility pattern of the isolates at a tertiary care centre in Kochi
Authors: Nair Geetha , Mampilly Tanya Tonny , Vasudevan Bindhu , Lancy J.
Published: March 2020

Background: Chronic suppurative otitis media (CSOM) is defined as chronic inflammation of middle ear and mastoid cavity presenting with recurrent ear discharges through a tympanic membrane perforation. Complications of CSOM were frequent in pre-antibiotic era. Injudicious use of antibiotics led to the emergence of multi-drug resistant strains and complications in return. To isolate the organisms associated with CSOM in a tertiary care centre and to detect their antibiogram.

Methods: In this clinical, prospective, cross sectional study, a total of 100 patients clinically diagnosed with CSOM were enrolled from January to December 2019 (1 year).  

Results: Of the 100 samples collected, predominant bacteria were isolated in 58 patients (58%). The most common isolate was Pseudomonas aeruginosa (29 isolates) followed by Staphylococcus aureus (24), Klebsiella species (3) and 1 isolate each of Pneumococci and Acinetobacter species. Among the 29 isolates of Pseudomonas aeruginosa, 8 (28%) were multidrug resistant. Sensitivity was 100% to imipenem followed by 97% to meropenem,79% to gentamicin, 76% to amikacin, 66% to ciprofloxacin, 41% to piperacillin tazobactam and 17% to ceftazidime. Of the 24 isolates of Staphylococcus aureus, 4 (16%) were methicillin resistant Staphylococcus aureus (MRSA).

Conclusions: Pseudomonas aeruginosa was the most common isolate, of which 28% were multi drug resistant. This calls for the judicious use of antibiotics and alternative measures for treatment of drug resistant strains. Formulating an antibiotic policy based on the local antibiogram can help in preventing the emergence and spread of resistant pathogens.
Endoscopic versus microscopic type 1 tympanoplasty in chronic suppurative otitis media- tubotympanic type
Authors: Deshmukh Kiran A. , Kurle Vinayak
Published: March 2020

Background: Chronic suppurative otitis media attributes to 71.6% of hearing impairment in which most of them only have central perforations without any ossicular erosion or middle ear pathology. There are insufficient explanations to conclude which technique is better for type 1 tympanoplasty. Hence the study was conducted to compare and analyze the endoscopic technique with conventional microscopic technique for performing type 1 tympanoplasty.

Methods: This prospective study was done at Basaweshwara teaching and general hospital attached to MR medical college, Kalaburagi from December 2015 to June 2017 after obtaining institutional ethical clearance. Patients were selected according to inclusion and exclusion criteria and randomly posted for surgery by either endoscopic or microscopic technique and results were analyzed.  

Results: There were 60 patients in the study between 11-65 years with mean age of 28.85±10.87 years in which were 28 females and 32 were males. All patients were divided into 2 groups in which 30 underwent endoscopic and 30 underwent microscopic type 1 tympanoplasty. In this 46.7% of the patients had left ear conductive hearing loss whereas 31.7% of patients had right ear conductive hearing loss and 21.7% of the patients had bilateral conductive hearing loss which included 22 small perforations, 33 medium size perforations and 5 large perforations of pars tensa.

Conclusions: We conclude that endoscope can be a better alternative for microscope in type 1 tympanoplasty as it provides a wide panoramic view, less operating time and hospital stay with negligible scar post operatively.
Clinicopathological study of thyroid swelling and its management
Authors: Patel Seema , Gattani Varsha J. , Nitnaware Ashok Z.
Published: March 2020

Background: There is high prevalence of thyroid lesions in India. In this study, an attempt is made to find out the clinical spectrum of thyroid swellings in central India, diagnostic accuracy of fine needle aspiration cytology (FNAC), appropriate surgical management and to compare it with postoperative histopathological diagnosis so as to determine its role in surgical management.

Methods: In this prospective study, 100 subjects presenting to ENT OPD of GMC, Nagpur during the period from September 2017 to August 2019 with thyroid swelling who were fit to undergo surgery and willing to participate in the study were selected. After detailed evaluation and routine investigations, thyroid function test (TFT), FNAC, ultrasonography (USG) neck, all the subjects underwent required thyroidectomy. The postoperative histopathological examination (HPE) report was correlated with cytological report.  

Results: In 100 subjects, majority of subjects were from 4th decade (32%) with female: male ratio=6.14:1. FNAC findings were colloid goiter (61%), nodular goiter (19%), follicular neoplasm (10%), and papillary carcinoma (9%). On HPE, colloid goitre (57%) was most common non-neoplastic lesion and papillary carcinoma (65.21 %) was most common malignant lesion. Hemithyroidectomy (70%) was most common procedure done. Transient hypocalcemia (5%), recurrent laryngeal nerve (RLN) paresis (2%) were the postoperative complications encountered. Sensitivity, specificity, accuracy, positive and negative predictive values of FNAC to diagnose malignancy were 55.6%, 100%, 91%, 100% and 90% respectively.

Conclusions: FNAC is an easy, rapid, reliable, cost-effective, minimally invasive and readily repeatable technique for diagnosis of thyroid swellings. The common false negative diagnosis is seen in follicular pattern cases, cystic papillary thyroid carcinoma (PTC) and papillary microcarcinoma.  
Granular cell tumour (Abrikossoff's tumor) in the ENT region: about two cases report
Authors: Hicham Mimouni , Safaa Touihmi , Ilham Rkain
Published: March 2020

Granular cell tumors also named Abrikossoff’s tumors, are very rare soft tissue tumors, almost always benign and can affect different organs. The head and neck location are the most common, particularly skin and the tongue. The larynx is concerned in 7 to 10% of the cervico-facial locations of this tumor (1, 2). In this article we report two cases of Abrikossoff’s tumor. The first case is of a 27 years old man, with no particular features in his medical history, who consulted for dysphonia, progressively evolving over 6 months. The nasal endoscopy found a whitish nodular lesion of almost 20 mm of diameter, involving the middle third of the right vocal cord. The tumor was removed under microlaryngoscopy. The second case is of ten days old newborn female, who presented dyspnea and dysphagia while breastfeeding, the clinical exam showed a round shaped lesion of 4 cm of diameter, implanted in the dorsal face of the tongue. The lesion was rooted out with electrocautery under general anesthesia. Anatomopathology examination with Immunohistochemistry of both patients’ surgical samples confirmed the diagnosis of granular cell tumor. The Origin of the Abrikossof’s tumors is uncertain. The recent immunohistochemical studies are orienting toward neurogenic origin. These tumors usually arise in the adult, between the ages of 20 to 60 years old, with female predominance. The symptoms are diverse and non-specific, only the anatopahtological examination permits to confirm the diagnosis. The main issues of these tumors are the compression of the adjacent structures and the high risk of recurrence, which requires long term surveillance.
Unusual presentation of a unilateral choanal atresia in an adult: a case report
Authors: K. C. Sunil , Praveen Kumar B. Y. , Mali Kiran , M. K. Varna Ravindran
Published: March 2020

Choanal atresia is an uncommon congenital abnormality of nasal airway characterised by the complete obliteration of choana. Unilateral choanal atresia is more common as compared to bilateral choanal atresia. A case of unilateral nasal obstruction in an adult which was initially diagnosed as chronic rhinosinusitis and was posted for endoscopic sinus surgery at a secondary referral hospital. Increased nasal bleeding during the surgery led to the surgeon abandoning the procedure and was referred to Mysore Medical College and Research Institute. On detailed evaluation, unilateral choanal atresia of right sided was noted. It was subsequently managed by endoscopic recanalization of the posterior choana. This case of unilateral choanal atresia in an adult is being reported here for the rarity of its presentation. A high level of clinical suspicion is necessary to diagnose such cases and to prevent avoidable complications during routine endoscopic surgeries. Resection of posterior part of nasal septum to create uni-choana negates the need for stenting post-operatively.
Intramuscular hemangioma in masseter muscle: a rare presentation
Authors: Kumar E. Siva , Swapna C. A. , Karanam Lavanya
Published: March 2020

Intramuscular hemangioma contribute to less than 1% of all hemangioma forming around 0.8%. It is commonly located in trunk and extremities. Only 10 to 20% can be found in the head and neck region arising from masseter and trapezius. We present a rare case of a young male with intramuscular hemangioma of masseter muscle. A 20 year old male patient presented to the OPD with complaints of swelling over right side of face over parotid region for the past 6 years. On clinical examination, there was a oblong swelling of about 3×2 cm around the right parotid region. In MRI neck the features were suggestive of intramuscular hemangioma in the right masseter muscle. The patient was planned for an excisional biopsy. Histopathological examination confirmed the diagnosis of intramuscular hemangioma. Although intramuscular hemangioma of masseter is a very rare possibility, still it should be kept in consideration in the list of differential diagnoses of the tumours around parotid region. As this diagnosis will make a difference in the work up plan and management of the patient.
When you hear hoof beats, it may also be a Zebra: a case report in a malignancy glottis
Authors: M. Mohamed Abdul Kathar , Manikantan Kapila , Sharan Rajeev , Pattatheyil Arun
Published: March 2020

Laryngeal cancer is one of the leading causes of death in Indian males. Papillary thyroid carcinoma is the most common subtype of thyroid cancer in 80% of cases and has a tendency to metastasize to lymph nodes. Patients with laryngeal cancers undergoing laryngectomy might have other occult primaries including thyroid carcinoma especially in patients with recurrent laryngeal carcinomas. We report a case of recurrent laryngeal carcinoma with incidental carcinomas. This study was conducted at TATA medical center, Kolkata.
Foreign bodies of submandibular gland and Wharton’s duct: a review of literature
Authors: Dar Waseem Qadir , Nisar Jasif , Ain Batool Qurat Ul , Qazi Sajad M.
Published: March 2020

Foreign bodies of submandibular duct are rarely but consistently reported in literature. They usually present as obstructive submandibular sialadenitis. The diagnosis can be challenging because of rarity of such an event, and inability of traditional diagnostic methods to detect the foreign body. We sought to assemble the previous published literature to delineate the presentation, investigation and management of submandibular gland foreign bodies. We performed a comprehensive systematic literature review of PubMed, and Google Scholar, databases from 1960 to 2019, and analyzed the case reports and research articles proclaiming detection of foreign body in the submandibular gland or its duct. We also included a case found in our hospital in the review. A total of 28 articles full filled our criteria. The earliest article found was from year 1962 and latest in 2019, amounting to 28 research articles on this topic in last 58 years. The age ranged from 9 years to 78 years, with average age of 38.7 year. The left Submandibular gland was involved in 18 cases (75%), and right in 6 cases (25%). There was a varied array of foreign bodies retrieved. Patients underwent sialadenectomy, duct excision, intervention by milking, probing or with a forceps or more recently interventional sialendoscopy. To approach an early diagnosis, a patient history needs to be believed. High resolution oral ultrasonography with interventional sialendoscopy can become the hallmark of a future approach to submandibular duct foreign bodies.
Vacuna de dengue
Authors: Reyes Cadena Armando
Published: March 2020

El dengue es la enfermedad transmitida por vector de más rápida propagación en el mundo. Según una estimación reciente, se producen 390 millones de infecciones por dengue cada año (IC95%: 284-528 millones), de las que 96 millones (67 a 136 millones) se manifiestan clínicamente (cualquiera que sea la gravedad de la enfermedad).1 Otro estudio de prevalencia del dengue estima que 3900 millones de personas de 128 países, cerca de la mitad de la población mundial, habita en zonas endémicas y están en riesgo de infección por este virus.2 En los últimos 50 años, la incidencia del dengue se ha incrementado 30 veces, con las tasas más altas en la población infantil.
Construcción del imaginario de una ciudad mediante tecnologías digitales
Authors: Holguín Arodi Morales
Published: March 2020

Para um indivíduo, uma cidade ou região se torna uma manifestação para onde convergem elementos materiais e imateriais, sustentados pela cultura e identidade forjadas através das gerações em um determinado espaço, que adquire forma e significado nas mentes dos habitantes formar o imaginário; refletido em símbolos e outros conceitos expressos na cidade, definindo sua essência. No entanto, as cidades dia a dia recebem o ataque de símbolos externos. Na busca por preservar e exaltar a cultura e a identidade do grupo social frente aos outros, a mídia digital surge como um canal promotor, onde a comunicação mediada por diferentes tecnologias, principalmente sistemas como Facebook e YouTube, se tornou um promotor de cultura e identidade, consolidando assim os significados imaginários e direcionadores, por ser uma marca própria e representativa. Este texto aborda esta situação, explorando o caso de uma cidade no noroeste do México, um país caracterizado pela riqueza histórica, cultural e patrimonial reconhecida em outras partes do mundo, e como a tendência dos vídeos culturais editados e compartilhados pelos usuários para através de plataformas sociais, eles se tornaram participantes do acima. O texto finalmente nos convida a refletir sobre como, a partir do efeito que as ferramentas digitais trazem ao processo de comunicação, é possível determinar se a geração dos benefícios imaginários, bem como os costumes e tradições que estão sendo esquecidos.
Programas federais de preservação ao patrimônio histórico em Pelotas/RS.
Authors: Neto Dary Pretto , Serres Juliane Conceição Primon
Published: March 2020

Há uma gama de projetos, ações e programas federais de preservação relevantes na história da preservação do patrimônio brasileiro, uma vez que possibilitam maior visibilidade, principalmente, por serem políticas de requalificação, na busca de melhorias das condições econômicas, culturais e sociais. O presente artigo buscou descrever a atuação de programas federais de preservação ao patrimônio histórico em Pelotas/RS, a saber: o Programa Monumenta e o PAC Cidades Históricas. Ambos atuaram na preservação e restauração de imóveis públicos e privados, na elaboração de projetos e ações voltadas à preservação do patrimônio histórico e cultural.
Evaluación de tres métodos de injertación in vitro en la especie Erythrina edulis (Fabaceae)
Authors: Bonilla Sánchez Adriana Paola , Mesa López Neftalí
Published: March 2020

Erythrina edulis Triana ex Micheli, es considerada una especie promisoria, gracias a los valores proteicos de sus hojas y semillas. El estudio fue encaminado a la reducción del período vegetativo y el aumento en la producción mediante técnicas de injertación. El tratamiento para la desinfección de semillas y germinación in vitro de embriones, consistió en la inmersión de las semillas en alcohol 70%, durante 15’, seguida de Tween ® 80% por 15’, Benlate (1 g/L) durante 20’ y HgCl2 (0.2%) por 20’. Como porta injertos se tomaron epicótilos mayores a 3 cm y como injertos yemas axilares, provenientes de embriones germinados in vitro en medio MS½ + ANA (2 mg/L). Los injertos se realizaron a través de los métodos (Aproximación lateral, Púa y T invertida) sin modificar el medio. Se realizó una comparación de proporciones evaluando la desinfección y el prendimiento de los injertos (éxito) y para la variable crecimiento el  promedio de tamaño (cm). Los injertos se afectaron por contaminación fúngica y microbiana. El método T. invertida presentó altos niveles de oxidación. Se eligió el método Aproximación lateral por obtener el mayor porcentaje (29%) de prendimiento. Para los métodos (aproximación lateral y púa) se observó un crecimiento promedio de 2.58 cm.
Rola etylenu i zmiany na poziomie transkryptomu w odpowiedzi na stres niedotlenienia u roślin
Authors: Górka Sylwia , Olszewska Dorota , Kubiak Dawid , Niedojadło Janusz
Published: March 2020

Niedotlenienie (hipoksja) u roślin jest zazwyczaj wynikiem intensywnych opadów deszczu i następujących po nich powodzi. Obecne modele klimatyczne wskazują na znaczny wzrost tych zjawisk w najbliższym latach. W zależności od gatunku i miejsca występowania, rośliny podczas ewolucji wykształciły dwie strategie adaptacyjne do stresu hipoksji: ucieczki i uśpienia. Pierwsza polega na jak najszybszym wynurzeniu przynajmniej część pędu nadziemnego nad poziom wody, natomiast druga na silnym obniżeniu tempa metabolizmu w celu przeczekania niekorzystnych warunków środowiska. Procesy te są regulowane głównie przez etylen oraz czynniki transkrypcyjne ERF (ang. ethylen response factor), które aktywują geny odpowiedzi na niedotlenienie. Większość ERFów ulega konstytutywnej transkrypcji niezależnie od stężenia tlenu. Jednak potranslacyjne  modyfikacje N-końca ERFów prowadzą do ich degradacji u roślin rosnących w warunkach fizjologicznych. Podczas niedotlenienia następuje wzrost poziomu ekspresji genów związanych z metabolizmem węgla, azotu, glikolizą czy oddychaniem beztlenowym. Jednak jak wykazały badania z zastosowaniem profilowania rybosomów, w celu oszczędzania energii, rośliny poddane stresowi hipoksji silnie hamują proces inicjacji translacji. Na regulację ekspresji genów w warunkach stresowych ma wpływ także kumulacja poli(A) RNA w jądrze komórkowym i w cytoplazmatycznych granulach stresowych.
Struktura lipopolisacharydów rizobiowych i ich znaczenie w procesie symbiozy
Authors: Zamłyńska Katarzyna
Published: March 2020

Lipopolisacharydy produkowane przez rizobia mają bardzo zróżnicowaną strukturę. Różnice obserwuje się zarówno w lipidzie A (uważanym za najbardziej konserwatywną część LPS), w obrębie regionu rdzeniowego oraz polisacharydu O-swoistego. Lipidy A różnią się między sobą szkieletem cukrowym oraz schematem acylacji. W skład regionu rdzeniowego rizobiów wchodzą głównie heksozy, kwasy uronowe, N-acetylochinowozamina i Kdo, a brakuje w nich typowych dla enterobakterii heptoz. Natomiast O-PSy mogą mieć odmienną strukturę nawet wśród szczepów tego samego gatunku. Zbudowane są z różnych monocukrów i często mają charakter hydrofobowy.

Odpowiednia struktura każdej z domen LPS jest wymagana do nawiązania efektywnej symbiozy na poziomie bakteria-roślinny gospodarz. Skutkiem zmian w strukturze LPS (najczęściej powodowanych mutacjami) było zmniejszenie wydajności, bądź brak wiązania azotu atmosferycznego. Kompletny LPS chroni bakterie symbiotyczne wnikające do wnętrza komórek roślinnych oraz decyduje o właściwej organizacji i dojrzewaniu symbiosomów.