bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic management of foreign bodies in the upper gastrointestinal tract
Authors: Chaudhari Sandip Kumar S. , Chaudhary Sonalben M.
Published: June 2020

Background: Foreign body ingestion and food bolus impaction is a common clinical scenario and can present as an endoscopic emergency. Though majority of them pass spontaneously 10-20% require endoscopic intervention. Flexible endoscopy is recommended as therapeutic measure with minimal complications. The aim of our study is to present 5 years’ experience in dealing with foreign bodies in the upper gastrointestinal tract.Methods: Cases of foreign body ingestion admitted to department of general surgery from March 2015 to March 2020 were evaluated. The patients were reviewed with details on age, sex, type of FB, its location in gastrointestinal tract, treatment and outcome.Results: A total of 55 cases were studied. Age range was 1-85 years. Males were predominant 61.81%. Coins were found most commonly 63.6%. Esophagus was the commonest site of FB lodgement 70.9%. Upper esophagus being the most common 36.36%. Upper gastrointestinal flexible endoscopy was useful in retrieving FB in all the 55 cases. There were no complications throughout the study period.Conclusions: Flexible endoscopy should be used as definitive treatment and endoscopic treatment is safe and effective.
A prospective study of effectiveness of Mannheim peritonitis index scoring system in predicting the morbidity and mortality in peritonitis due to hollow viscous perforation
Authors: Yadav Sitaram , Suthar Ramesh , Meena Rajaram , Meena R. S.
Published: June 2020

Background: Peritonitis is defined as inflammation of the peritoneal cavity, caused by a number of etiologic agents including bacteria, fungi, viruses, chemical irritants, and foreign bodies. The Mannheim peritonitis index (MPI) is one of the simple scoring systems in use that allows the surgeon to easily determine outcome risk. Aims and objective: To estimate outcome of patients with perforation peritonitis. To evaluate effect of MPI score in identification of high risk cases.Methods: A prospective study was conducted in 100 patients with peritonitis due to hollow viscous perforation at surgical unit of tertiary care unit. The duration of study was 2 years. All the data was recorded. Written informed consent was obtained and data was analyzed using appropriate analysis strategy.Results: In this study, total 100 patients enrolled, out of which 54 % patients were in the age group <50 years and 46% patients were in the age group >50 years. Mortality was higher among patients with age group more than 50 years (21%) and in female patients (37.93%). 18 patients had organ failure. 87 patients had preoperative duration was >24 hours. 93% patients had non-colonic origin of sepsis. In 52 (52%) patients total MPI score was <21 while 25 (25%) patients total score was 21-29 and it was >29 in 23 (23%) patients. Mortality was higher among patients with MPI Score more than 29 (95.65%).Conclusions: MPI is accurate to be used with patients with peritonitis and should be considered reliable and simple reference for estimating their risk of death. This study differs in one adverse outcome variables, non-colonic origin of sepsis, we advocate need for further studies on Mannheim peritonitis index to include colonic origin of sepsis.
Comparative study of outcome and complications of surgical management of benign gastric outlet obstruction
Authors: Prasad Dinesh , Patel Yash
Published: June 2020

Background: Gastric outlet obstruction (GOO) implies complete or incomplete obstruction of the distal stomach, pylorus, or proximal duodenum. There are many causes of benign GOO like acid ingestion, pyloric stenosis, peptic ulcer etc. The main aims of this study were to compare the perioperative morbidity and short and long term complications of different procedures for benign gastric outlet obstruction.Methods: This non-randomised retrospective study was undertaken in the department of General Surgery, SMIMER Hospital, Surat, Gujarat, India from August 2016 to July 2019. Thirty patients had been operated during this period and included in the study. Records of all 30 patients were retrieved and analysed. All these patients underwent pre-operatively upper GI scopy with biopsy and CECT abdomen.Results: Nausea and Vomiting was most common symptoms at time of presentation in our study. Incidence of wound infection in open Gastrojejunostomy group was very high i.e. 25% and hospital stay was also very high in open Gastrojejunostomy group. Post-operative PPI dependence was more common in Gastro-jejunostomy group in all follow up and there was no any requirement of PPI in Heineke-Mikukicz and Finney’s pyloroplasty group.Conclusions: On comparison of different surgical modalities for management of benign GOO, all surgeries performed laparoscopically were safe and carried comparatively less morbidities (perioperative, short term and long term) in comparison to open methods. Among all three laparoscopic procedures, outcome of laparoscopic pyloroplasty, both H-M pyloroplasty and Finney’s pyloroplasty were better than laparoscopic gastro-jejunostomy.
Our experience of arteriovenous fistula creation as vascular access for hemodialysis
Authors: Sharma Pradeep K. , Nagori Rupesh , Baweja Shekhar , Aggarwal Vikas , Katti Pawan , Chabbra M. K.
Published: June 2020

Background: End stage renal disease (ESRD) patients depend on lifelong renal replacement therapy. The arteriovenous fistula (AVF) is the preferred hemodialysis access. Cimino fistulas are currently accepted as the best mode of vascular access for hemodialysis (HD). The present study was planned to study for presence of on table bruit and thrill and to know postoperative outcome and patency.Methods: This single center, prospective study was carried out in department of Urology at SNMC, Jodhpur from November 2018 to May 2019.  Dominance of hand was examined, and preference was given to non-dominant hand. Physical examination of the arterial system along with physical examination of the venous system was done.  Preoperative color Doppler of upper limb veins and arteries was done in selected patients. End to side anastomosis was done between cephalic vein and radial artery.Results: In this study of 70 cases of AVFs, there were 53 (75.71%) successful cases and 17 (24.2%) were failures.  End (vein) to side (artery) anastomosis was done in 70 (100%) cases.  On table bruit was present in 63 (90%) and thrill in 58 (82.8%) cases. All patients with failed post-operative fistula were not doing ball exercise.Conclusions: Presence of on table thrill and bruit are indicators of successful AVF. Post-operative ball exercise should be done for better results.
A study on clinical grading and bacteriological profile of diabetic foot ulcers in tertiary care centre
Authors: Hamza Mohammed , Thomas Thomas K.
Published: June 2020

Background: Diabetes is one of the commonest diseases worldwide and diabetic foot ulcer and its complications are associated with significant morbidity and even amputation. Early detection of colonizing agent of these ulcers help in reduced morbidity and hospital stay. We targeted this subgroup of patients to study Wagner’s grade, identify the bacterial agent and its antibiotic sensitivity and ankle-brachial pressure index (ABPI) assessment to detect PAD, for the best treatment outcome of diabetic foot ulcers.Methods: The present study was conducted in the Department of Surgery of SGMCRF, Venjaramoodu on 210 patients with diabetic foot ulcers between November 2017 and May 2019. Wagner’s grading of ulcer, culture and antibiotic sensitivity of microbe were done as well as ABPI was measured. Outcome of ulcers was compared to ABPI and ABPI was compared to time of healing.Results: Out of 210 patients 122 were males and 88 females, 62.9% had neuropathy and 66.7% had vasculopathy. Most patients presented with Wagner’s grade-II ulcers.  Most common microbe isolated was pseudomonas aeruginosa which was most sensitive to piperacillin and tazobactam combination. Majority of lesions 62.9% had ABPI in range of 0.5-0.89.Conclusions: Wagner’s grading and presence of neuropathy are predictors of major amputation. Piperacillin and tazobactam should be empirical choice of antibiotic. ABPI was inversely related to time of healing and has got significant association with treatment outcome.
Diagnostic utility of serum procalcitonin as a biomarker of sepsis and infection in post-operative patients at tertiary care centre
Authors: Thakur Paritoshsingh B. , Ramachandrudu T. , Takalkar Anant A.
Published: June 2020

Background: Procalcitonin (PCT), the precursor peptide of calcitonin, a hormone involved in calcium homeostasis, is present in normal subjects in extremely low serum levels (0.1 to 0.5 ng/ml). In response to bacterial infectious stimulation serum procalcitonin rises substantially and its role in inflammatory response includes chemotactic function modulation of inducible nitric oxide synthase and induction of cytokines, among other. The objective of this study to assess serum procalcitonin as a biomarker of sepsis and infection in post op patients.Methods: The present descriptive observational study was conducted at Department of Surgery, Aarupadai Veedu Medical College and Hospital, Puducherry from September 2018 to June 2020. Total 48 patients who had undergone surgery and presented with post-surgical sepsis were included. Data entered in MS excel sheet and analysed by using SPSS 24.0 version IBM USA.Results: Out of 48 cases, majority of cases i.e. 18 (37.5%) were from 36-50 years age group followed by 11 (22.9%) from 51-60 years age group. Prevalence of sepsis was 20.8%, septic shock 25%, severe sepsis 33.3% and SIRS 14.6%. Procalcitonin (PCT) assay shows positive in 47 (97.9%) cases. E. coli were isolated from 5 (45.5%) cases with PCT 2-10 as compared to 6 (16.7%) cases with PCT >10.Conclusions: PCT shares remarkable promise as a marker of sepsis and can be used as a routine lab parameter. It was also found to be an accurate diagnostic parameter for differentiating various stages of sepsis and predicting the outcome.
Rhabdomyosarcoma of lip - issues of subtyping, morphology and immunohistochemistry versus molecular studies: a case report with review of literature
Authors: Alexander Leon , Ravindran Hiran Kattilaparambil , George Juliet
Published: June 2020

Rhabdomyosarcoma (RMS) is a malignant soft tissue tumour occurring most frequently in younger age groups. Study presented a rare case of spindle cell Rhabdomyosarcoma of the upper lip involving the commissure area. In this case report after successful surgical excision, the patient underwent extensive postoperative histopathological studies including special stains and immunohistochemistry. Genotype studies (reverse transcription polymerase chain reaction) were done to help in subtyping and prognostication, and it turned out to be a surprise as it showed positivity for PAX3-FOXO1 t (2;13) translocation which is almost exclusively seen with alveolar RMS. After that he successfully underwent chemotherapy and radiotherapy as it was an aggressive variant and has been disease free for the past 2 years. The author hopes that this case report will highlight the importance of high clinical suspicion in head and neck masses presenting in pediatric age group and to not rely solely on biopsy reports to confirm diagnosis, so that early detection will lead to successful therapy and outcome as exemplified in this case.
Contained rupture of a large right hepatic artery aneurysm: the ticking bomb within!
Authors: Kundil Byju , Mathews Mano Zac , Tony Tina , Kurian Robin
Published: June 2020

Hepatic artery aneurysms (HAAs) are rare and represents one fifth of visceral aneurysms. We report a case of a 75 year old female who presented to the outpatient department with complaints of abdominal pain and anorexia for 2 weeks. On examination the patient was stable, she had mild tenderness in the right hypochondrial region. Ultrasound abdomen showed an intrahepatic cystic area with both arterial and venous flow, suggesting the possibility of an intrahepatic arteriovenous malformation. Contrast-enhanced computed tomography abdomen showed a large right HAA with contained rupture and intra hepatic extension. She was posted for emergency laparotomy and was found to have a contained rupture a contained rupture of the right HAA of size 10×8 cm with intra hepatic extension. Right hepatectomy was done and the resected margin of liver showed a dilated cystic space with blood clot. Histopathological examination showed intrahepatic aneurysm with atherosclerosis and laminated luminal thrombus. Contained rupture of HAAs with intrahepatic extension are rare. Even though the prevalence of HAAs is low, the risk of rupture is reported to be as high as 20-80% and the mortality following spontaneous rupture is 40%. Hence an aggressive approach to the management of HAA is required whenever detected.
Presacral schwannoma: a bizarre presentation in the Pandora’s box of abdomen and pelvis
Authors: Poojary Harsha S. , Sherigar Vishwanath , Balaji Abhinav
Published: June 2020

Schwannomas are benign tumors arising from the Schwann cells of nerve fibers. They are extremely rare in the pelvis accounting for only 1-3% of all schwannomas. These tumors are nonaggressive, slow growing, solitary neoplasms with an extremely low possibility of malignant transformation or recurrence after excision. We present a case of a 19 years old male with complaints of radiating pain from lower back to the left thigh associated with altered bowel and bladder habits. Following a detailed work up he underwent laparotomy and mass excision. Histopathological report revealed presacral schwannoma. Post-surgery patient improved symptomatically and is on regular follow up. There are a smaller number of cases of presacral schwannoma reported in the literature. Due to its outlandish striking presentation, diagnosis is very challenging. Although presacral schwannoma is rare, it should be considered as a differential diagnosis in the back of the mind of a surgeon while dealing a case of pelvic mass. In symptomatic and asymptomatic cases, surgical excision is the mainstay of treatment of these tumors.
Does tranexamic acid have role in controlling intraoperative blood loss in tonsillectomy?
Authors: Dutta Heempali Das , Rayamajhi Pabina , Ibrahim Nazeef
Published: June 2020

Background: The study was done with the objective to assess the effect of tranexamic acid in controlling intraoperative bleeding in tonsillectomy.

Methods: Retrospective study was conducted in the Department of ENT and HNS, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from August 2016 to July 2017. Patients more than 15 years who underwent bilateral tonsillectomy were included in the study. Whereas patients who underwent unilateral tonsillectomy and patients who had hypersensitivity to tranexamic acid were excluded from the study. The patients who received tranexamic acid during surgery were taken as study group whereas the patients who didn’t receive tranexamic acid were taken as control. The amount of the intraoperative blood loss, i.e. mean and the frequency of early post-operative bleeding were evaluated.  

Results: A total of 48 patients who fulfilled the inclusion criteria were evaluated. Among whom, 24 patients who received tranexamic acid during tonsillectomy were taken as study group and other 24 patients who did not received tranexamic acid were taken as control. The mean blood loss in study and control group were 92.85 ml and 91.40 ml respectively and the difference was statistically not significant (p=0.785). There were no cases of early postoperative bleeding recorded in either group within the first 24 hours of surgery.

Conclusions: There is no significant role of tranexamic acid in controlling intraoperative bleeding in tonsillectomy. 
Reinforced temporalis fascia with conchal cartilage versus exclusive temporalis fascia grafting in type 1 tympanoplasty: a comparative study
Authors: Gosavi Rahul S. , Gosavi Shishir D. , Bandgar Digwijay A. , Gupta Akash D. , Naik Pradny S. , Narkhede Kshipra M.
Published: June 2020

Background: Various grafting materials have been used for the repair of a tympanic membrane perforation over the years, with temporalis fascia and conchal cartilage being the most widely used. Our study is an attempt to compare and analyse the use of exclusive temporalis fascia as grafting material against a reinforced graft consisting of temporalis fascia and conchal cartilage.

Methods: This is a prospective study of 100 patients having inactive mucosal chronic otitis media with a dry central perforation with moderate conductive hearing loss, undergoing type 1 tympanoplasty using underlay technique. 50% of the subjects were grafted with temporalis fascia alone while a reinforced temporalis fascia graft along with conchal cartilage was used in the remaining 50% of the cases. The results were evaluated at an interval of 24 weeks after surgery on the basis of graft uptake and hearing restoration (closure of air-bone gap <10 dB).  

Results: Graft uptake in exclusive temporalis fascia grafting was 86% while it was 94% when a reinforced graft was used; the hearing restoration rates in both the groups were 82% and 80% respectively.   

Conclusions: Reinforced temporalis fascia grafting along with conchal cartilage gives better results than grafting with temporalis fascia alone as regards to graft uptake, while the audiometric results are comparable in both the groups.   
Utility of high resolution computed tomography in pre-operative evaluation of cholesteatoma
Authors: Jacob Amith , Sreedhar Sandeep , Choolakkaparambu Aboobakker Anwar Sadath , Bashir Nalakath Kunjhimon
Published: June 2020

Background: Prior knowledge about temporal bone anatomy and extent of cholesteatoma may help the ENT surgeon to plan the surgery and avoid impending complications. This study aims to evaluate the role of pre-operative high resolution computed tomography (HRCT) in cholesteatoma and to compare HRCT findings with intra-operative findings.

Methods: A diagnostic evaluation study was performed among 30 atticoantral cholesteatoma cases presenting in the ENT outpatient department of MES Medical College in Malappuram, Kerala over a period of one and half years. The intraoperative findings were considered as the gold standard to which the radiological features were compared and the sensitivity, specificity and predictive value of HRCT were determined.  

Results: High sensitivity of HRCT was noted in detecting soft tissue in mesotympanum 94.4% and aditus ad antrum 94.1%. Low sensitivity 59% was noted in detecting stapes erosion when compared to malleus and incus erosions. Except in conditions of soft tissue in epitympanum, dural plate dehiscence and sclerotic mastoid, a high specificity of 100% was noted in all other findings.

Conclusions: This study reaffirms the usefulness of HRCT in pre-operative evaluation of cholesteatoma-atticoantral type. 
Chronic rhinosinusitis and its correlation with endoscopic anatomy of nose and paranasal sinuses: a cross-sectional study
Authors: Ghosh Nachiketa , Das Debabrata , Majumdar Sayantani , Dey Arijit , Haldar Debdutta
Published: June 2020

Background: Chronic rhinosinusitis (CRS) is a common condition characterized by inflammation of nose and paranasal sinuses and is associated with significant morbidity and healthcare expenditure. The study was undertaken to evaluate the endoscopic findings in different cases of CRS and correlating those findings with the clinical features and severity of symptoms.

Methods: A cross-sectional study was carried out at the outpatient Department of Otorhinolaryngology, R. G Kar Medical College and Hospital, Kolkata in a span of 18 months. A total of 56 patients who attended the outpatient department during the study period and met the inclusion criteria as well gave consent for participating in the study were taken as the sample size. The data was collected using history taking proforma.  

Results: Out of 56 patients, 51.8% were female, the most commonly affected age group was 31-40 years with 28.57% of patients. Majority of the patients 30.40% presented within one year of onset of symptoms, all the variables of clinical symptoms shows positive correlation statistically with the endoscopic findings, the most common anatomical variation was deviated nasal septum (DNS) present in 51.78% patients.

Conclusions: A more extensive and detailed study needs to be done to determine conclusively whether the severity of symptoms can be used to predict the severity of disease in patients diagnosed as having chronic rhinosinusitis
Oral submucous fibrosis: a study of qualitative and analytical treatment using intralesional injections: placental extract versus combination of steroid with hyaluronidase
Authors: Kale Meena Vishwanath , Gaikwad Ninad Subhash
Published: June 2020

Background: One of the premalignant conditions in oropharynx is oral submucous fibrosis (OSMF). It is a chronic debilitating condition of unknown etiology leading to fibrosis of mucosa affecting the oropharynx, esophagus and thus causes decreased mouth opening and dysphagia respectively. The disease is of multifactorial etiology with addictions, nutritional, micro elements and antioxidants deficiencies. In India males are more affected than females, due to their stress related excessive, irresponsible chewing habits. The available management is for symptomatic relief and at present there is no definitive treatment is available.

Methods: We have studied 60 cases diagnosed with OSMF with mild to moderate restricted mouth opening. Most of patients were between 17 to 55 years of age selected by randomized clinical trial. Its management was divided into 2 groups where group A was treated with a combined intralesional regimen of injection triamcinolone 40mg and hyaluronidase 1500 IU, while group B was treated with injection of 2ml placental extract. Each group has given a single dose intralesional injection per week for six weeks.  

Results: It was a comparative study of improvement in effectiveness on mouth opening and reduction in burning sensation of oral cavity seen in group A regimen than group B. Those having persistent trismus, needed surgery.

Conclusions: No effective treatment available but along with intralesional injection can give symptomatic relief. In addition, cessation of habits, antioxidants oral hygiene helps in improvement of OSMF.
The role of concha bullosa in chronic rhinosinusitis: our experience at a tertiary care hospital
Authors: Fathima Afshan , Arabhanvi Ramappa , Shamanna Karthik , Joy Lyra
Published: June 2020

Background: Chronic rhinosinusitis (CRS) is a common and persistent illness that otorhinolaryngologists encounter commonly. It is an important cause of morbidity and accounts for major loss of income. Anatomical variations of the lateral wall of the nose have been reported which can predispose to CRS. The aim of the present study was to determine the percentage of concha bullosa in patients with CRS and to ascertain its relationship with chronic rhinosinusitis.

Methods: 100 patients attending the ENT outpatient department, Bangalore Medical College and Research Institute between December 2018 and 2019 were included in the study. Patients clinically diagnosed as CRS underwent diagnostic nasal endoscopy (DNE) and computed tomography (CT) scan of nose and paranasal sinuses, following which the relationship between concha bullosa and CRS was determined. The results were tabulated in excel sheet. Chi square test was applied for qualitative data.  

Results: Of the 100 patients of CRS, 40 were males and 60 females. Of the 40 male patients, 16 showed presence of concha bullosa and of the 60 female patients, 28 showed concha bullosa. Headache (92%) was the most common presenting symptom in our study. A statistically significant correlation was noted between the presence of concha bullosa and chronic maxillary sinusitis (p value <0.05).

Conclusions: Concha bullosa is one of the most common anatomical variations of the lateral wall of the nose. The presence of concha bullosa plays a significant role in the development of chronic rhinosinusitis particularly in chronic maxillary sinusitis.
Large lymphangiomatous polyp present in palatine tonsil: a case report
Authors: Rajan G. Soundara , Kannan D. Senthamarai , Narendrakmar Veerasigamani , Baby Arya N.
Published: June 2020

Lymphangiomatous polyps are rare tumours present in head and neck. Squamous papilloma accounts for majority of benign lesions, whereas vascular tumours are rarely reported. Tonsillar lymphangiomatous polyp is an uncommon hamartomatous lesion that generally arise from tonsillar surface. We present a case of young adolescent female with right tonsillar mass, tonsillectomy performed and post operatively found to be lymphangiomatous polyp, which has been rarely reported.
Laryngeal amyloidosis: a case report
Authors: Alswaiheb Jameel N. , Motiwala Mohammed A. , Alkhodair Abdulmalik , Aljadoa Abdulrahman , Alhindi Ghada , Cletus Jose
Published: June 2020

Amyloidosis is a rare, benign, slowly progressive disease characterized by extracellular accumulation of amyloid in different tissues of the body. It accounts for 0.2-1.2% of benign laryngeal tumors and usually presents as an isolated localized laryngeal amyloidosis, but can also be part of systemic amyloidosis. A 26 years old female with history of gradually developing, persistent hoarseness, and progressive dyspnea since 1 year, worsened over the past three days. Outpatient Department based endoscopy showed bilateral mobile, thickened vocal cords with subglottic edematous thickness. Computed tomography scan showed symmetrical thickening of bilateral vocal cord, causing glottic narrowing about 70% on the AP view and about 50% on the lateral view and no cartilage invasion or lymphadenopathy. Microlaryngoscopy and biopsy of the specimen were performed and histopathology confirmed the diagnosis of amyloidosis with Congo red stain. Patient was managed by surgical excision of the mass and long term follow-up. To rule out systemic amyloidosis patient is referred to rheumatology clinic and hematology clinic for further evaluation and management. Histopathological examination of the involved tissue confirms the diagnosis, and long term follow up is mandatory in the management of amyloidosis.
Ectopic primary olfactory neuroesthesioblastoma originating from the anterior nasal septum
Authors: Lim Sin Wee , Mohamad Wan Emelda Wan
Published: June 2020

Olfactory neuroestesioblastoma (ONB) is a rare malignant neoplasm of the paranasal sinus. Ectopic growth of ONB outside the region of neuroepithelial cells are exceedingly rare and so far, it has only been reported to arise from the maxillary sinus, sphenoid sinus, posterior septum and the turbinates. None has been reported to originate from the anterior cartilaginous part of the septum. A 31-year-old lady, who was premorbidly well, presented with 2 episodes of spontaneous epistaxis from the left nostril in 1 year. The epistaxis worsened over the one week prior to her visit. Nasoendoscopy showed a vascularised round mass at the anterior part of the left septum. Initial biopsy was reported as possible ectopic squamous cell carcinoma of the salivary gland. A repeat biopsy then confirmed the diagnosis of ONB. Computed tomography scan of the paranasal sinus showed an isolated mass (18×18 mm) arising from the anterior part of the septum. Endoscopic resection of the tumour was done and histopathology report revealed as ONB. Post-operative radiotherapy was given with a total dose of 66. The rarity of ONB poses a challenge during diagnosis. The histological identification is difficult as these tumours may show little or no differentiation. A simple biopsy from the mass is often insufficient and may produce inaccurate results. Isolated growth without involvement of the upper nasal vault is extremely rare. A possible explanation would be the presence of ectopic neuroepithelial cells at the cartilaginous anterior septal area that has failed to degenerate during fetal development.
A rare case of inflammatory myofibroblastic tumour in the maxillary sinus: masquerading a malignancy
Authors: Kumar E. Siva , Swapna C. A. , Karanam Lavanya , Radhika S.
Published: June 2020

Aim establishing the diagnosis of inflammatory myofibroblastic tumour is very challenging due to its varied clinical and radiological manifestations. We report a rare presentation of a 5 years old female child with inflammatory myofibroblastic tumour, which was endoscopically resected with postop steroid therapy. Case report, a 5 years old female child presented to ENT OPD with complaints of right nasal obstruction since, 4 months along with recurrent minor episodes of spontaneous bleeds from the right nasal cavity. On examination a huge fleshy reddish polypoidal and pulsatile mass was seen filling the entire right nasal cavity associated with right eye proptosis. MRI with contrast showed expansion of right maxillary sinus bony walls with internal soft tissue leision measuring 41 mm (TRANS) × 36 mm (AP)×31 mm (CC) seen enhancing with contrast. Vascular supply is from maxillary artery. Under anaesthesia right external carotid artery ligation was done followed by removal of mass from right nasal cavity. Histopathological examination was consistent with inflammatory myofibroblastic tumour. On immunohistochemistry spindle cells showed cytoplasmic positivity for SMA. Inflammatory myofibroblastic tumour though a very unusual tumour, should be considered in the differential diagnoses of tumours in the nasal cavity. A vigilant clinical evaluation and extensive imaging along with histopathological examination can guide us to an early diagnosis and proper treatment resulting in better patient satisfaction.
Post-auricular dermoid cyst- uncommon lesion at an uncommon site
Authors: Kathuria Bhushan , Dhingra Himani , Arora Madhuri , Rana Deepshikha
Published: June 2020

Dermoid cyst in the post auricular region is a rare occurrence, with only a handful of cases described in the literature. It is an uncommon benign midline cyst which arises in the sub-cutaneous plane, but deeper extension into bone to intra-cranial and intra-calvarial has been reported. The usual presentation is asymptomatic, but it can present as a swelling gradually progressing in size, pain following secondary infection or rupture of the cyst. Malignant transformation of the cyst is exceedingly rare but has been reported. Here we discuss a case of a middle aged female with left dermoid cyst in the mastoid region which was excised surgically and showed no recurrence in the 6 month post-operative period. It is imperative to mention that the removal of the cyst with its wall in entirety is required to prevent recurrence. The final diagnosis is made based on the histo-pathological examination of the excised specimen. 
Adenoid cystic carcinoma of arytenoid: a rare tumor at a rare site
Authors: Krishnappa B. D. , Akshay B. K.
Published: June 2020

Pedunculated primary adenoid cystic carcinoma of larynx is an uncommon form of malignant neoplasm. This case is an extremely rare entity and hence reported. Until today this type of carcinoma is not reported in medical literature. A 55 year old female patient came with 6 months history of dyspnoea and foreign body sensation in throat and occasional change of voice. Micro laryngeal surgical excision of the pedunculated polyp was done under general anaesthesia using diathermy cautery and specimen was sent for histopathological examination, perineural spread of the tumour is highlighted. The pedunculated polyp from the arytenoid looked like a benign lesion and histopathological examination showed the lesion to be adenoid cystic carcinoma. 
Acute necrotizing otitis media in infant: a rare and challenging case
Authors: Hajare Priti S. , Soni Samanvaya , Patil V. D. , Havaldar Rajesh R. , Mudhol Ramesh S.
Published: June 2020

Acute necrotizing otitis media (ANOM) is a highly virulent middle ear infection that results in necrosis of the tympanic cavity. Here a rare case report is presented of a 4 month infant who presented with bilateral ANOM and right facial nerve palsy which was aggressively managed with debridement and intravenous antibiotics obviating the need of surgery. The child was followed up for a period of 6 months where both the ears remained disease free accompanied with hearing gain and grade of facial palsy improvement from grade V to grade II. ANOM is still a possibility in the modern era of higher antibiotics and a high index of suspicion is required. Timely and aggressive management has to be done in order to prevent the dreaded complications and sequelae like facial nerve palsy and hearing loss which are likely to be permanent.
Pseudo-Duane’s retraction syndrome: a rare clinical entity
Authors: Chandran Sobhana
Published: June 2020

Studies of sequelae of isolated medial orbital wall fractures show that the majority of patients with this condition are often asymptomatic, which makes the diagnosis based only on clinical grounds difficult. One of the rare complications of this entity is Pseudo-Duane’s retraction syndrome, which is characterised by horizontal diplopia, restricted abduction with or without limited adduction, accompanied by narrowing of the palpebral fissure, globe retraction and pseudo ptosis on abduction. This is a case report of a 46-year-old female who developed Pseudo-Duane’s retraction syndrome following trauma to her left orbit. She presented with left eye pain, diplopia, horizontal gaze restrictions, left eye ecchymosis and enophthalmos. Careful history taking and thorough ophthalmic examination including forced duction test along with radiological imaging helped clinch this diagnosis. Timely intervention by an endoscopic approach to release the medial rectus muscle entrapped within the fracture resolved the patient’s symptoms.
Cryptococcus neoformans infection in a post-operative mastoid cavity of an immunocompetent individual: a rare case report
Authors: Gosavi Rahul S. , Gupta Akash D. , Gosavi Shishir D. , Phatak Jayanti U.
Published: June 2020

This is a case report of isolated cryptococcosis in the operated mastoid cavity of an immunocompetent individual. A 24 year old immunocompetent male who underwent modified radical mastoidectomy presented to the OPD with complaints of otalgia and recurrent otorrhoea, not responding to regular medical line of treatment and aural toileting. Microscopy and culture of the ear dischrage revealed Cryptococcus neoformans. The patient was treated with oral and topical fluconazole and recovered completely. Although rare, cryptococcal mastoiditis should be considered even in an immunocompetent patient, as any delay in diagnosis and treatment can lead to fatal complications.
La visión de la inmigración a México en los viajeros extranjeros (1821-1850)
Authors: Ramírez  Rodríguez Rodolfo
Published: June 2020

Este texto es una aproximación al proceso de colonización e inmigración a México visto por un grupo de viajeros e inmigrantes extranjeros de la primera mitad del siglo XIX. El objetivo es mostrar un análisis cualitativo de la percepción del paisaje, los aspectos sociales de la vida cotidiana y el material cultural de la población mexicana a través de las obras de algunos viajeros europeos. A partir de ellas se muestran las compatibilidades y discrepancias del proceso de integración mediante la adopción o rechazo de ciertos modelos occidentales, relacionados con las expectativas de los segmentos sociales mexicanos. Algunos obstáculos económicos, sociales y políticos serán recurrentes durante los primeros años independientes; no obstante, se logra evidenciar el origen de una inicial construcción de la identidad nacional.
Brumana: una maestra argentina que escribió para sus alumnos a partir de 1900
Authors: Guadalupe  Mosso Agustina
Published: June 2020

El presente artículo estudia a una mujer argentina y su labor docente e intelectual en un período crucial para la historia mundial. Este ejemplo dará lugar a analizar escuetamente la situación de la mujer en las postrimerías del siglo XIX junto a los cambios impulsados por la Rusia revolucionaria, acompañados estos por la aparición de luchas emprendidas por dichas féminas. Pretendemos entonces comprender algunas de las discusiones que resonaban a nivel mundial y centrarnos en una mujer en particular, quien con sus accionares profirió de manera escrita muchas de sus expresiones, poco permitidas en aquel entonces. Será Herminia Brumana la figura estudiada. Utilizando una de sus primeras obras, destinada para los alumnos junto a epístolas referentes, intentaremos encuadrar el pensamiento de una maestra que traspasó su labor educativa no solo con el objetivo de reflexionar sobre la misma, sino también para luchar por los derechos de los menos favorecidos
Marginados, pero no marginales. Negros, mulatos y sus disputas por la autonomía en Chocó, Colombia (1903-1947)
Authors: Rhenals Doria Ana Milena , Flórez Bolívar Francisco Javier
Published: June 2020

Chocó se caracterizó por ser un territorio con bajos niveles de autonomía política, económica y administrativa. Al ser intendencia y no departamento, electoralmente dependía de Antioquia, jurídicamente del Cauca y administrativamente de Bogotá. En este artículo analizamos los roles de líderes afrodescendientes en la consecución de mayores niveles de autonomía para el Chocó en la primera mitad del siglo XX. Sugerimos que el estatus de intendencia no solo se le asignó por lo que significó la separación de Panamá de Colombia, sino además por las representaciones raciales despectivas que pesaban sobre este territorio y sus habitantes. Funcionarios nacionales, viajeros y miembros de la élite política e intelectual de Colombia insistían en que Chocó era un territorio habitado por salvajes que necesitaba de una suerte de tutelaje de parte del gobierno nacional. Concluimos que sus habitantes negros, lejos de sentirse marginales, adelantaron acciones que fueron definitivos en la consecución del estatus de departamento para este territorio.
De las violencias campesinas al sectarismo político en el Cauca 1938-1953
Authors: Burbano  Vega Robinson  Alejandro
Published: June 2020

La Violencia en el Cauca es un fenómeno desconocido para la historiografía colombiana y, a diferencia de otras regiones, este tuvo sus determinantes, exclusivamente, en aspectos políticos. Y lo anterior se verificó empleando técnicas de estadística descriptiva orientadas desde un enfoque de historia social y regional. Para ello se analizaron dos fuentes documentales principalmente: i) “El Liberal” (un diario local) entre 1938 y 1959; y ii) 17 expedientes judiciales del Cauca entre 1940 y 1953. De ellos se extrajeron los siguientes datos: número de hechos violentos, proporción de las motivaciones de los hechos violentos y proporción de los actores de la violencia principalmente. Como resultado, se evidencia un incremento de la violencia a partir de situaciones políticas entre campesinos. Así pues, se puede concluir que en los cincuenta hubo un aumento de la violencia propiciada a partir del sectarismo político, distanciando este proceso del de otros departamentos.
Aproximación jurídica internacional al ejercicio de la jurisdicción civil universal frente a violaciones graves de derechos humanos
Authors: Bonet Pérez Jordi
Published: June 2020

No es reconocible ni en el Derecho internacional general ni en el convencional una obligación jurídica internacional que exija el ejercicio de la jurisdicción civil universal frente a violaciones graves de derechos humanos. Considerando que su implementación no está prohibida (principio permisivo), parece necesario conciliar el alcance de las jurisdicciones estatales con el derecho a la justicia de las víctimas, lo que comporta un compromiso solidario erga omnes de evitar la denegación de justicia a toda víctima. El Derecho internacional privado puede ofrecer cauces para garantizar ese acceso y, en ese sentido, el foro de necesidad como institución subsidiaria (residual) es uno de ellos. Sin embargo, visto el asunto Naït-Liman c. Suiza ante el Tribunal Europeo de Derechos Humanos, los requisitos para encauzar una reclamación mediante el foro de necesidad pueden llegar a ser un impedimento excesivo desde el prisma del derecho a la justicia. .Recibido: 30 enero 2020Aceptado: 20 mayo 2020Publicación en línea:26 junio 2020
Diabetes mellitus and COVID-19. How are they connected? Current strategy of fight
Authors: Babenko A. Yu. , Laevskaya M. Yu.
Published: June 2020

Infectious epidemic of COVID-19 caused by the new coronavirus is characterized by severe course in patients with diabetes mellitus, which presents another noninfectious pandemic accelerating for last decades. Today, according to the International Diabetic Federation data, there are 463 million patients with diabetes mellitus in the world. The burden of the COVID-19 epidemic is largely explained by a frequent combination of these two pathologies. From the previous flu epidemics and already available data of the current epidemic, diabetes mellitus and obesity are considered to be the predictors of more severe course of COVID-19 and mortality. On the other hand, SARS-CoV-2 can aggravate diabetes mellitus, via direct damage of pancreatic beta cells and the liver injury, resulting in higher insulin resistance. We discuss the mechanisms underlying the relation between coronavirus infection and diabetes mellitus and consequences of their mutual influence. Also the article reviews potential strategies of personalized therapy in COVID-19. Timely control and maintenance of individualized target glycemic level is the cornerstone of successful prevention of COVID-19 complications. Disease severity defines strategy of treatment and the choice of antihyperglycemic therapy.
The EU VAT system – the importance of the “Quick fixes”, simplifications in force as from 1 January 2020
Authors: Wdowczyk-Szpytma Ewa
Published: June 2020

The Article explains in detail how to understand four simplification measures to the current EU VAT system, referred to as “Quick fixes”. They were adopted by the Council on 4 December 2018 and are included in the Council Directive (EU) 2018/1910, the Council Implementing Regulation (EU) 2018/1912 and the Council Regulation (EU) 2018/1909.The adopted solutions cover:1) the clarification of the material status of the VAT number of the customer in the context of an exempt intra-Community supply;2) the proof of transport in the context of an exempt intra-Community supply;3) the chain transactions;4) the call-off stock arrangements.The Article also provides a short introduction on the way that led to the adoption of these four measures.
Podatek od nieruchomości komercyjnych – podatek dochodowy czy majątkowy?
Authors: Jankowski Jakub , Klimiuk Wiktor
Published: June 2020

Podatek od nieruchomości komercyjnych został wprowadzony do polskiego systemu podatkowego z dniem 1 stycznia 2018 r. w ramach przepisów ustawy o podatku dochodowym od osób prawnych. W odniesieniu do przedmiotowej konstrukcji prowadzona jest dyskusja co do tego, czy odpowiada ona klasycznemu podatkowi dochodowemu od osób prawnych. W opracowaniu zostają przeanalizowane najważniejsze cechy konstrukcyjne tego podatku. Udziela się również odpowiedzi na temat możliwości funkcjonowania tego typu konstrukcji w polskim systemie podatkowym z perspektywy prawa konstytucyjnego oraz unijnego.
„Uszczelnianie systemu VAT” – próba oceny skuteczności podjętego wysiłku legislacyjnego i organizacyjnego
Authors: Bełdzikowski Marek
Published: June 2020

Artykuł koncentruje się na przebiegu działań legislacyjnych i organizacyjnych mających na celu zwiększenie wydajności fiskalnej podatku od towarów i usług, podejmowanych w szczególności po 2015 roku. Główne pytanie badawcze dotyczy realizacji celów postawionych przez inicjatorów procesu „uszczelniania podatku VAT” oraz kosztów tego procesu. Jako koszty procesu zostały wskazane koszty pozafiskalne ponoszone przez podatników, w postaci obciążeń administracyjnych. Celem opracowania jest próba odpowiedzi na pytanie badawcze poprzez przedstawienie genezy, obecnego stanu oraz próby oceny w kategorii koszt/efekt wprowadzonych zmian legislacyjnych i organizacyjnych.
NEGATIVE PRESSURE IN THE TREATMENT OF WOUND INFECTIOUS COMPLICATIONS IN THE TREATMENT OF STERNO-MEDIASTINITIS AFTER CARDIAC SURGERY IN CHILDREN UNDER 1 YEAR
Authors: Ivantsov S. M. , Soinov I. A. , Kulyabin Yu. Yu. , Nichay N. R. , Voitov A. V. , Gorbatykh A. V. , Zubritsky A. V. , Gorbatykh Yu. N.
Published: June 2020

Aim of the study. To evaluate the results of treatment of sterno- mediastinitis using vacuum therapy in patients of the first year of life. Material and methods. The study included 25 children under the age of 1 year who had undergone cardiac surgery from median sternotomy in the period from August 2013 to August 2016 on the basis of the E.N. Meshalkin National Medical Research Center, , complicated by infection of the wound. Results. Vacuum therapy in the treatment of sterno-mediastinitis was used in 25 infants, aged 103 (average) (9 ÷ 167) days. Superficial infection developed in 10 (40%) patients, deep infection - in 15 (60%) children. The average duration of vacuum therapy was 6.9 (3 ÷ 8) days. The average time of artificial lung ventilation was 147 (12 ÷ 176) hours, the duration of treatment in the intensive care unit was 7.6 (3.2 ÷ 8.6) days. Complications were present in 7 (28%) patients and included multiple organ failure (8%), isolated renal dysfunction (12%), bleeding (4%), relapse of infection (4%). 2 (8%) patients died due to symptoms of severe multiorgan failure. The average length of the hospital stay was of 30 (23 ÷ 38) days. Conclusions. Vacuum therapy can be successfully used for the treatment of sterno-mediastinitis in children of the first year of life as also an excellent alternative to the traditional treatment method.
El buen diseño para lograr autonomía en el entorno de playa para la población con movilidad reducida
Authors: Rivera-Picado Ada Luz
Published: June 2020

El artículo consiste en el desarrollo de un buen diseño de producto, cuyo objetivo permita el desplazamiento autónomo en el entorno de playa, con el fin de contribuir al disfrute de la población con movilidad reducida.

El buen diseño se describe mediante tres variables: usabilidad (accesible y seguro), experiencia de usuario (a través de satisfacción y versatilidad del producto) y diseño emocional (estética universal). Dichas variables se evaluaron a través de: trabajo etnográfico, basado en la observación de campo; entrevistas, encuestas y testeos con usuarios.

De esta manera, se busca abarcar el buen diseño, gracias a la autonomía del usuario en el entorno de playa y la satisfacción de realizar actividades para su bienestar social y personal. Por último, otro fin es promover la cultura inclusiva y la movilidad sostenible.
Desarrollo de un sistema de objetos inteligentes para mejorar la experiencia de acampar
Authors: Ulloa-Ovares Eduardo , Barrantes-Gamboa Pilar , Linares-Ramírez Maricruz , Berman-Fernández Lior
Published: June 2020

El proyecto consistió en el desarrollo de un sistema de objetos inteligentes que contribuyan a mejorar la experiencia de acampado. Muchas personas anhelan disfrutar de la naturaleza, pero no se atreven a realizar esta actividad por las incomodidades que pueden presentarse. Según el estudio realizado, las principales necesidades están relacionadas con la ambientación del entorno y las labores de cocinado. Con base en esta información, se definió el concepto de diseño “comodidad asistida” como guía y a partir de él se desarrollaron múltiples propuestas hasta llegar a una solución.

Se planteó un sistema inteligente compuesto por una linterna y fogata portátiles: la linterna busca satisfacer las necesidades de entorno como la iluminación y entretenimiento, mientras que la fogata resuelve las tareas de cocina. Las propuestas fueron depuradas mediante una evaluación para verificar el grado de cumplimiento de los requerimientos iniciales. El diseño seleccionado fue desarrollado en un prototipo de alta fidelidad y validado utilizando métodos iterativos por parte de usuarios afines para la mejora del sistema.