5th Decade Research Articles

Squamous Cell Carcinoma in Upper Aerodigestive Tract: Comparative Study In between Smoking Tobacco and Smokeless Tobacco Products

Background: Squamous cell carcinoma in upper aerodigestive tract is most often caused by smoking. Smokers get laryngeal cancer, while chewers get mouth cancer. With the surge in smokeless tobacco use, it's important to determine if this differentiation influences clinical and pathological characteristics beyond site distribution. Objective: The purpose of the present study was to assess any relation between tobacco smoking, oral intake of tobacco with betel leaf or tobacco powder and squamous cell carcinoma in upper aero digestive tract. Methodology: This cross-sectional study was conducted in a single Diagnostic center at Dhaka, Bangladesh for a period of one year from July 2022 to June 2023 on patients presented with histopathologically established upper aerodigestive tract malignancies. Patients age, gender and involved site was taken from the patients report. Results: Male were predominant than female. Male to female ratio was 3.3:1. Mean age of the patients was 59.26 ± 12.55 years of the male and 56.11 ± 13.13 years of the female. Cancer was more in female at 5th and 6th decade whereas cancer was found more in male at 6th and 7th decade. Most common location of the lesions was sub-glottis (27.6%) and tongue (20.0%). The most common causes of Upper Aerodigestive Tract cancer were smoking (76.2%) and smokeless tobacco using (54.1%). There was no association between smoke and smokeless tobacco with severity of carcinoma. Maximum cases of carcinoma were grade II but there was no significant difference in grade of carcinoma between tobacco smoker and tobacco non-smoker. There was no significant difference in grade of malignancy between tobacco user and non-user. Conclusion: Smoke and/or smokeless tobacco user have increased risk of development squamous cell carcinoma in upper aerodigestive tract. However, there is no significant difference between incidence and grade of tumor among only smoker, smokeless tobacco user or both. Journal of National Institute of Neurosciences Bangladesh, January 2024;10(1):52-56

Prevalence and Mortality Trends of Hypertension Subtypes Among US Adults: An Analysis of the National Health and Nutrition Examination Survey (NHANES).

Hypertension (HTN) has been demonstrated as one of the leading risk factors for development of cardiovascular disease (CVD) and CVD mortality. This study examines the prevalence and distribution of HTN subtypes (isolated diastolic hypertension [IDH], isolated systolic hypertension [ISH], and systolic-diastolic hypertension [SDH]) across age, sex, and race/ethnicity per the nationally representative National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020 based on the updated 2017 ACC/AHA HTN definition. We further examined for associations of each subtype with CVD and all-cause mortality using Cox regression analysis. Among US adults, the overall prevalence of HTN is 47.4%. Across increasing age, the prevalence of IDH decreased, ISH increased, and SDH increased and peaked in the 6th decade of life after which SDH prevalence decreased. By age 80, over 80% of persons with HTN demonstrated ISH. A sub-cohort from NHANES 1999-2008 with follow-up until 2018 showed that ISH and SDH were most strongly associated with increased risk for CVD (HR 1.18, 95% CI 1.01-1.38; HR 1.31, 95% CI 1.07-1.60, respectively) and all-cause mortality (HR 1.17, 95% CI 1.06-1.28; HR 1.21, 95% CI 1.08-1.37, respectively). Our data demonstrate the continuing importance of HTN subtype transitions across age and their differences in predicting future CVD and total mortality.

Incidence of ANCA associated vasculitis and polyarteritis nodosa in Norfolk, UK, from 2011-2020.

To report the annual and age-specific incidence of ANCA associated vasculitis and polyarteritis nodosa in the adult population of Norfolk County, UK. Individuals newly diagnosed with ANCA associated vasculitis or polyarteritis nodosa between 1st Jan 2011 and 31st December 2020, residing in the postal areas of NR1-NR30 were included. Patients were classified according to the European Medicines Agency algorithm. Population data were available from the Office of National Statistics, UK. 164 patients were diagnosed with ANCA associated vasculitis or polyarteritis nodosa over 4.7-million-person years. The annual incidence (95% CI) of ANCA associated vasculitis was 34.3 (29.2, 40)/million person years. The annual incidence for granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis was 18.9 (15.2, 23.3), 12.8 (9.7, 16.4), and 2.6 (1.3, 4.5)/million person years respectively. The annual incidence for polyarteritis nodosa was 0.6 (0.1, 1.9)/million person years. The age specific incidence of granulomatosis with polyangiitis and microscopic polyangiitis rose with each decade of life and was highest in the 8th decade for granulomatosis with polyangiitis (53.2 (95% CI 36.2, 75.6) per million) and in the 9th decade for microscopic polyangiitis (48.4 (95% CI 27.1, 79.8) per million). The incidence of ANCA associated vasculitis, specifically that of granulomatosis with polyangiitis and microscopic polyangiitis is slowly rising over time. It is most notable amongst the elderly population where incidence rates for granulomatosis with polyangiitis and microscopic polyangiitis peak. There may be a 4-year incidence cycle which needs confirmation in a longer study.

Unveiling the unseen: anterior nasal septal schwannoma

Schwannomas also known as neurilemmomas are slow-growing, encapsulated benign peripheral nerve sheath tumours that arise from Schwann cells. It has no gender or racial predilection and commonly occur between the 3rd to 6th decades. Approximately 45% of schwannomas arise from the head and neck region. Sinonasal and paranasal schwannomas however are relatively rare tumours and not commonly documented, accounting less than 4% of all head and neck schwannomas. Schwannomas arising from the nasal septum are rarely encountered, with only few cases reported. Here we report a case of a 50-year-old lady presented with unilateral nasal congestion and intermittent left sided epistaxis. Physical examination revealed a soft tissue mass occupying the left nasal cavity. A complete tumour excision via endoscopic approach was performed and the histopathologic examination identified the tumour as a schwannoma. A prompt resolution of the symptoms ensued following complete excision of the tumour.

Periorificial dermatitis in infants and preschoolers - a narrative review.

Periorifical dermatitis (POD) is a papular, chronic inflammatory skin disease commonly seen in women in their 2nd to 4th decade of life. The major differential diagnosis is persistent acne. In children, POD is less common than in adults. In infants and preschoolers POD is rare. We performed a narrative review for POD in children ≤6years of age. Diagnosis is clinical. The disease presents with monomorphic erythematous papules that usually leave a 1-2mm Grenz zone around the red lips unaffected. Perinasal skin, nostrils and eyelids can be involved, while extrafacial manifestations are rare. The granulomatous subtype of POD is more common in small children that in adults. The most important differential diagnoses in children include atopic and seborrheic dermatosis, pediatric rosacea, juvenile acne, and cutaneous sarcoidosis. While topical macrolides, azelaic acid, and calcineurin inhibitors are often used in mild cases of adult POD, oral tetracyclines are the treatment of choice in more advanced cases. In infants and preschoolers, tetracycline should be avoided since they can affect the calcification (hardening) of the bones and teeth and lead to permanent discoloration of teeth. There are no randomized controlled trials for POD in this age group available. Topical metronidazole or erythromycin and oral erythromycin are most used. New drugs like JAK inhibitors are on the horizon.

Dent disease: Clinical Practice Recommendations.

Dent disease is a rare X-linked tubulopathy that is characterized by low-molecular-weight (LMW) proteinuria associated with hypercalciuria, which may lead to nephrolithiasis, nephrocalcinosis, and kidney failure between the 3rd and the 5th decades of life in 30-80% of affected males. The disease is most often associated with various manifestations of proximal tubular dysfunction. Affected individuals may present nephrotic range proteinuria which may be misinterpreted and cause diagnostic delay. Due to its rarity, there is limited evidence to guide diagnosis and management. This clinical practice recommendations summarize the current knowledge on Dent disease and provide guidance for diagnosis and management. The recommendations are based on a systematic search of the literature and were endorsed by a Delphi procedure among stakeholders in the field as well as the respective ERA and ESPN working groups.

The epidemiologic trend of multiple sclerosis in Razavi Khorasan Province, Iran in fifteen-year period.

Multiple sclerosis (MS) is a major global health problem as a growing debilitating disease and according to the Global Burden of Diseases study in 2016 has had a 40 % prevalence increase in Iran during the 3 previous decades; far more from the Global prevalence which only increased about 10 %. Razavi Khorasan is the second most populous province in Iran with over 6.5 million people and its MS status is not clear; therefore, this study aims to define the current epidemiologic trend of MS in Razavi Khorasan METHODS AND MATERIALS: We performed this cross-sectional, analytical study in Khorasan Razavi Multiple sclerosis Center during 2021-2023. The data was extracted from the registry system for MS patients held in the center. The cases were all MS patients of the province numbered 4723. The sex- and age- standardized ratios were measured and the annual incidence and prevalence rates of MS were calculated using the province population information and so the epidemiologic trend of MS in the province was obtained. Of over 4700 MS patients in the province in 2021, 78 % were female. More than 40 % had academic education. In 2021 most patients lived in their 4th (about 40 %) and 5th (about 28 %) decades of life. Most of the patients were aged 20-29 years (37 %) and 30-39 years (34 %) at the time of diagnosis and the average duration of disease was 7 years among all patients until 2021. The annual incidence in Khorasan Razavi rose gradually from 1.57 to 6.40 person-years during 2006-2020; with a steeper slope in females compared with males. The prevalence of MS in 2021 was about 71.7 per 100,000 population (112.7 for females and 31.3 for males), approximately 80 % more than the prevalence in 2006 relative to population growth. There is an upward trend of multiple sclerosis in Razavi Khorasan; which is probably one of the fastest growth patterns in the region because it has been about two-fold as fast as in Tehran with the highest prevalence rates in Iran. Therefore, there should be extensive plans for managing the disease with secondary prevention in the coming years to decrease the complications and disabilities associated with disease progression.

The 7th decade manager: who are you and what do you do?

The 7th decade manager: who are you and what do you do?

Unilateral nasal mass beyond 4th decade: A comprehensive clinicopathological study

Unilateral nasal mass may be a common presentation in children and young adults, and the majority of them are inflammatory polyps. But as the age advances, unilateral nasal complaints should alert the physician to the possibility of an underlying neoplastic mass lesion. To study the etiopathology and clinical features of unilateral nasal mass in patients above 40 years of age. The study was conducted in the department of otorhinolaryngology, Tezpur Medical College & Hospital. A total of 27 patients with unilateral nasal mass who are above 40 years of age are included in the study. The clinical features, radiological findings, and histological findings of all the patients were evaluated. Among the 27 patients, 14 had non-neoplastic lesions compared to 13 neoplastic lesions. Inflammatory polyp was the most common non-neoplastic pathology, whereas inverted papilloma was the most common neoplastic lesion. Nasopharyngeal carcinoma was the commonest malignancy detected in the study. Though inflammatory polyp constitutes the majority of cases of unilateral nasal mass, there is a considerable number of neoplastic lesions, especially when considered age above 40 years. Therefore, one should not directly jump into the conclusion of inflammatory polyp when an elderly patient presents with unilateral nasal mass; rather, a thorough diagnostic protocol should be employed to rule out any neoplastic lesion. The diagnosis of inflammatory polyp should be a diagnosis by exclusion only after other possible causes are excluded.

Dysanapsis Genetic Risk Predicts Lung Function Across the Lifespan.

Rationale: Dysanapsis refers to a mismatch between airway tree caliber and lung size arising early in life. Dysanapsis assessed by computed tomography (CT) is evident by early adulthood and associated with chronic obstructive pulmonary disease (COPD) risk later in life. Objectives: By examining the genetic factors associated with CT-assessed dysanapsis, we aimed to elucidate its molecular underpinnings and physiological significance across the lifespan. Methods: We performed a genome-wide association study of CT-assessed dysanapsis in 11,951 adults, including individuals from two population-based and two COPD-enriched studies. We applied colocalization analysis to integrate genome-wide association study and gene expression data from whole blood and lung. Genetic variants associated with dysanapsis were combined into a genetic risk score that was applied to examine association with lung function in children from a population-based birth cohort (n = 1,278) and adults from the UKBiobank (n = 369,157). Measurements and Main Results: CT-assessed dysanapsis was associated with genetic variants from 21 independent signals in 19 gene regions, implicating HHIP (hedgehog interacting protein), DSP, and NPNT as potential molecular targets based on colocalization of their expression. A higher dysanapsis genetic risk score was associated with obstructive spirometry among 5-year-old children and among adults in the fifth, sixth, and seventh decades of life. Conclusions: CT-assessed dysanapsis is associated with variation in genes previously implicated in lung development, and dysanapsis genetic risk is associated with obstructive lung function from early life through older adulthood. Dysanapsis may represent an endophenotype link between the genetic variations associated with lung function and COPD.

Anatomic total shoulder arthroplasty in the 7th decade of life demonstrates superior long-term maintenance than in older patients.

Anatomic total shoulder arthroplasty (aTSA) is often delayed due to concerns about a more rapid loss of postoperative improvements in younger, more active patients. This retrospective study investigated the effects of patient age on activity-specific functional outcomes at a minimum of 10 years following aTSA. A retrospective review of a shoulder arthroplasty database was performed. There were two cohorts: Patients who underwent aTSA at 60-70 years of age and patients 70+ years old with Minimum 10 years follow-up. Primary outcomes included range of motion (ROM) and patient reported outcomes (PROs) including American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), and Visual Analogue Scale (VAS) scores. Furthermore, individual survey responses to the ASES Score questionnaire were analyzed. 46 shoulders, 30 shoulders in the 60-70 age cohort and 16 in the 70+ cohort, were included with a mean age of 65.5±3.0 years and 74.2±3.2 years, respectively. Interval from surgery was 15.6±3.9 years in the 60-70 cohort, and 13.1±3.2 years in the 70+ cohort. Postoperatively, scores for the 60-70 cohort versus 70+ respectively included: 141.7° versus 153.1° forward elevation (p=0.12), 52.4° versus 51.3° external rotation (p=0.82), L1 versus T11 internal rotation (p=0.12), 2.1 versus 2.1 VAS (p=0.94), 75.7 versus 73.8 ASES (p=0.79), and 7.8 versus 8.8 SST (p=0.35). Postoperative scores were similar between cohorts. No difference was seen in preoperative responses for any activity listed in the ASES-score questionnaire. However, younger patients showed improvement across all survey responses, while patients above age 70 had long-term improvement in only 5 of 10 activities. Patients who receive surgery earlier may experience sustained improvement long-term, same as those who undergo aTSA at an older age. Patients undergoing aTSA earlier in life benefit from sustained long-term function and activity. 3.

Cerebrospinal Fluid Proteomics in Down Syndrome Identifies Common and Unique Pathological Changes Compared to Late‐Onset and Autosomal Dominant Alzheimer’s Disease

AbstractBackgroundNearly all people with Down Syndrome (DS) develop Alzheimer’s dementia (AD) by the 7th decade of life. However, whether the alterations in fluid biomarker levels associated with DS follow the same pattern to those observed in other forms of AD is not well understood.MethodWe used mass spectrometry‐based proteomics to measure 1116 proteins in cerebrospinal fluid (CSF) across euploid controls (n=130), sporadic late‐onset AD (LOAD, n=89), asymptomatic DS (n=117), prodromal DS (n=57), and dementia DS (n=80) cases, and compared the protein changes observed in DS to those in LOAD and to those recently described in autosomal dominant AD (ADAD).ResultWe observed both common and unique CSF proteomic alterations in DS compared to LOAD and ADAD. Common changes included increased levels of 14‐3‐3 proteins, glucose metabolism, immune activation, and decreased levels in neurosecretory and neuropentraxin synaptic markers. Common changes were strongly correlated to tau and Aβ pathology, and like ADAD, most CSF protein changes occurred prior to the onset of cognitive symptoms. Compared to LOAD, DS showed markedly early elevations in complement, immunoglobulins, extracellular matrix and plasma proteins, suggesting early dysfunction in immune‐related processes and blood‐brain barrier function. These DS‐related changes were observed to occur prior to the onset of Aβ or tau pathology. In contrast to the progression observed in ADAD, in DS neurofilament light was increased prior to total tau levels, which were in turn increased prior to pTau levels, suggesting relatively earlier white matter and axonal dysfunction in DS. Neuronal and neurosecretory proteins were also decreased earlier in DS than in ADAD, consistent with early neuronal dysfunction in DS. Compared to LOAD, DS demonstrated more significant elevations in endosome/lysosome markers in symptomatic phases of the disease.ConclusionEarly pathological alterations in immune function and the blood‐brain barrier associated with trisomy 21 may contribute to the onset of AD pathology in DS. While most pathological alterations are shared between DS, ADAD, and LOAD, the temporal ordering of these pathological changes in DS has unique features.

Alterations in corneal sensitivity according to age and gender in healthy population in Turkey

ABSTRACT Clinical relevance Knowing the changes in corneal sensitivity according to age and gender is important for the correct evaluation of pathologies. Background The aim of this work was to analyse variability of corneal sensitivity according to age and gender in the healthy population in Turkey. Methods Healthy volunteers between the ages of 20 and 84, who applied to outpatient clinic due to routine examination, were included. Exclusion criteria were any ocular diseases other than refractive error, any systemic disease, contact lens use, chronic ocular and systemic drug use, and previous ocular surgery. Central and 4 quadrants (superior, inferior, nasal, temporal) corneal sensitivity measurements were performed with a Cochet-Bonnet esthesiometer (Luneau Ophthalmology, France). The patients were divided into 5 groups according to their ages (Group 1:20-29, Group 2:30-39, Group 3:40-49, Group 4:50-59, Group 5 ≥ 60). The data were evaluated in terms of groups and gender. Results The right eyes of 324 volunteers were included. The mean age was 44.31 ± 15.65 (20–84) and the female/male ratio was 165/159. The mean central, superior, inferior, nasal, and temporal sensitivities were 50.15 ± 9.7,48.62 ± 10.3,48.59 ± 10.3,47.73 ± 10.2,47.71 ± 10.3 mm, respectively. Sensitivities in all quadrants decreased significantly depending on age (p = 0.001 for all, central, superior, inferior, nasal and temporal correlation coefficients,r = −0.783, −0.791, −0.789, −0.760, −0.775, respectively). The decrease accelerated in Group 4 and 5. Gender-related changes were detected as significant in central and temporal quadrants (p = 0.038, p = 0.019). When sensitivity according to gender was evaluated within each decade, significant difference was detected in Group 2 and 4 (p < 0.05). Conclusion Corneal sensitivity decreases with age, most significantly in 5th and 6th decades. Sensitivity differs between genders in central and temporal quadrants. Geographic location, gender, and ethnicity may affect sensitivity values. The present study defines normal values in aTurkish population and may guide the evaluation of pathologies that impair corneal sensitivity.

Surgical treatment of thymic epithelial tumor and myasthenia gravis.

Thymic epithelial tumors originate from the epithelial cells of the thymus and are typically diagnosed during the 5th and 6th decades of life. The incidence is consistent between men and women, averaging 1.7 cases per year. Thymomas, neuroendocrine tumors, and thymic carcinomas are subtypes of thymic epithelial tumors, with thymomas being the most prevalent (75%-80%) and thymic carcinomas following at 15%-20%. Thymoma and thymic carcinoma exhibit distinct disease courses; thymomas grow slowly and are confined to the thymus, while thymic carcinomas demonstrate rapid growth and metastasis. Overall survival rates vary, with a 78% 5-year survival rate for thymoma and a 30% rate for thymic carcinoma. Thymic epithelial tumors may be linked to paraneoplastic autoimmune diseases, including myasthenia gravis, hypogammaglobulinemia, pure red cell aplasia, Cushing's syndrome, systemic lupus erythematosus, and polymyositis. Staging of thymic epithelial tumors can be done according to Masaoka-Koga and/or TNM 8th staging systems. The treatment algorithm is primarily determined by resectability, with surgery (Extended Thymectomy) serving as the foundational treatment for early-stage patients (TNM stage I-IIIA, Masaoka-Koga stage I-III). Adjuvant radiotherapy or chemotherapy may be considered following surgery. In advanced or metastatic cases, chemotherapy is the first-line treatment, followed by surgery and radiotherapy for local control. Myasthenia gravis, an autoimmune disease presents with progressive muscle fatigue and diplopia. Positive antibodies (Anti-AChR, Anti-MuSK, LRP4) and electromyography aid in diagnosis, and approximately 10% of myasthenia gravis patients can also have thymoma. Treatment includes cholinesterase inhibitors and immunotherapy agents, with extended thymectomy serving as an effective surgical option for drug-resistant cases. Minimally invasive approaches (video-assisted thoracoscopic surgery or robot-assisted thoracoscopic surgery) have demonstrated comparable oncological outcomes to sternotomy, highlighting their effectiveness and reliability.

Medium-term survival of patients with mechanical and biological aortic prosthesis at the 6th decade of life.

The best aortic prosthesis type in 60-70 year old patients is not established. Our aim was to evaluate the survival in a National cohort of patients between 60-70 years old who required surgical aortic valve replacement for aortic stenosis (SAVR) with either a mechanical (MP) or bioprosthesis (BP) valve. This is a retrospective study using national data from the Ministry of Health. We included all patients between 60 to 70 years old who underwent SAVR for aortic stenosis in Uruguay from 2011 to 2021. The primary outcome was overall survival according to type of prosthesis used stratified by effect modifiers. The independent effects of gender and use of statins were evaluated. We included 1196 patients (66±3.0 years old; 39.1% female). Mortality was higher for BP (296, 29.9%%) than MP (36, 17.1%; p<0.001). Median follow-up time was 4.5 years (Interquartile range [IQR] 3.4-6.5). The unadjusted incidence rate ratio was higher for BP (Incidence rate ratio [IRR] = 1.43;95%CI: 0.99, 2.14, p = 0.045). The effect of BP on mortality rate was greater in males (IRR = 1.82;95%CI:1.14,2.92. p interaction = 0.08) and patients who were not taking statins (IRR = 1.97;95%CI:1.14,3.41. p interaction = 0.06). The use of BP was an independent predictor of overall survival in male patients (Hazard ratio [HR] = 1.32;95%CI: 1.68, 1.04. p = 0.021) and in patients who were not taking statins (HR = 2.07;95%CI: 1.17, 3.67. p = 0.013). The use of BP was associated with worse survival in male patients and patients not taking statins. Gender and statins use should contribute to type of prosthesis decision in the 60-69 age group.

Middle fossa approach for a petrous apex bony spur causing trigeminal neuralgia: illustrative case.

Trigeminal neuralgia (TN) can arise from trigeminal nerve compression at the root entry zone due to neurovascular conflict, which most often presents in the 6th decade of life. The authors report the case of a young patient with TN with a petrous apex bony spur near the entrance of Meckel's cave, causing compression of the proximal trigeminal nerve. A 21-year-old woman presented with a 5-year history of progressive right-sided TN. Axial T2 sampling perfection with application optimized contrast using different flip angle evolution magnetic resonance imaging (MRI) did not reveal vascular compression of the trigeminal nerve. However, sagittal reformats demonstrated a prominent bony ridge along the petrous apex, causing compression of the right trigeminal nerve at the porus trigeminus. Removal of the bony spur via a middle fossa approach completely resolved the patient's symptoms. Although TN is most frequently caused by neurovascular compression, it is vital to examine the entire course of the trigeminal nerve on MRI to identify alternative causes of nerve compression in the absence of neurovascular conflict. Bony compression is a rare cause of TN that should be considered, particularly in younger patients. The presence of prominent osseous structures along the course of the trigeminal nerve can be evaluated reliably on sagittal MRI. https://thejns.org/doi/10.3171/CASE24321.

Frequency of Different Etiologies in Patients of Upper GI Bleed

Objectives: To find out the frequency of different etiologies of upper GI bleed, based on endoscopic findings. Methodology: It was a retrospective study done over a period of 6 months in gastroenterology department of Federal Government polyclinic (FGPC), hospital from 1st January 2023 to 30th June 2023. Results:A total of 229 patients presented with Upper gastrointestinal bleed.Chronic liver disease manifesting as variceal bleed or portal hypertensive gastropathy was found in significant number of patients as compared to peptic ulcer disease.The predominant age group for most of causes of bleed was 5th decade of life with a significant female predominance. Conclusion:Viral hepatitis along with other causes of portal hypertension seem to be the major predisposing factor as a cause of upper GI bleed. There is an increased need for future awareness campaigns about viral hepatitis in order to reduce the risk of upper GI bleed. It is further suggested to study the impact of such awareness programson incidence of upper GI bleed through future studies.

Primary Nasosinus Melanoma: A Case Report

Naso-sinusal mucosal melanoma is a highly aggressive but uncommon tumor. It is often diagnosed late, making treatment complex (surgery and/or radiotherapy---), with a generally poor prognosis. The absence of an established etiological factor and a specific clinical appearance make diagnosis difficult at an early stage. This tumor frequently affects women, with a predilection for the 6th decade of life. In this articl, we report a new case of nasosinus melanoma.

Post COVID rhino-cerebral mucormycosis at a tertiary hospital in Central India: a retrospective cohort study

BackgroundUsually non-pathogenic in immunocompetent individuals, mucormycosis is an aggressive, angio-invasive fungus. It is a rare, opportunistic infection belonging to the zygomycete family. The second wave of COVID-19 saw the emergence of a more dangerous and a potentially deadly invasive fungal sinusitis evolving in rhino-cerebral mucormycosis thus compounding and complicating the pandemic. Alarming and exponential rise in the number of cases of rhino-cerebral mucormycosis in India versus the rest of the world when the treatment protocols essentially remained the same needs to be probed scientifically along with its prompt management. Here an attempt has been made to explore this in the study of 50 cases of rhino-cerebral mucormycosis. This study aims to explore the cause and extension of the disease along with its treatment and outcome in 50 cases of post COVID rhino-cerebral mucormycosis.ResultsThis is a retrospective cohort study conducted on 50 patients with post COVID-19 invasive mucormycosis of the paranasal sinuses with extension to surrounding structure visiting Otorhinolaryngology department at Acharya Vinoba Bhave Rural Hospital, Wardha. Among 50 patients, 86% males in 4th to 7th decade with mean age of 51.08 years. Large majority had mild–moderate severity on high-resolution computed tomography thorax with 84% having uncontrolled diabetes and 18% newly diagnosed diabetic cases. Seventy-two percent had history of steroid intake for COVID-19 management. Maxillary sinus was most commonly involved sinus in 94% cases while 32% had commonest extra nasal spread hard palate. Seventy-eight percent of the post operated mucormycosis cases are alive with no recurrence, 8% are alive and had recurrence of the disease while 14% resulted in death.ConclusionEffective management and control of the infection can be achieved with the use of strong antibiotics, oral or systemic antifungal drugs, extensive surgical excision of diseased tissue, and addressing underlying risk factors can effectively manage and control the infection. This approach results in positive outcomes and reduced morbidity compared to the time prior to the COVID-19 pandemic including cases with extensive disease.

Incidence of head and neck cancer among Baquba Teaching Hospital Patients

Background: Squamous cells lining the tissues of the head and neck region, such as the nasal cavity, paranasal sinuses, oral cavity, lip, salivary glands, and hypopharynx, give growth to a group of malignancies together recognized as squamous cell carcinoma of the head and neck, which is the seventh utmost communal cancer diagnosis around the world. Objective: Determine the prevalence of head and neck cancer in Diyala province during 2022-2023 and their distribution according to age and gender of patients. In addition, this study aimed to identify the numbers of each type of head and neck cancer. Patients and Methods: A retrospective study achieved on the prevalence of head and neck cancer in the region accomplished in oncology center of Baquba teaching hospital in Diyala province, Iraq. Head and neck cancer patients recorded from 2022 to 2023. During this dated, a total of 172 patients were recorded. A search was accomplished on numerous databases, moreover, the information evaluated by age, gender and cancer type. Results: Regarding patients during 2022 (first group) which is contained of (94) patients with different head and neck cancer, 38(40.4%) were males and 56(59.6%) were females with statistically significant relationship. The patients during 2023 (second group) comprises of (78) patients with different head and neck cancer, 43(50.1%) were men and 35(44.9%) were women with statistically no significant correlation. Conclusion: Oral and pharyngeal cancer is more common in men than in women. The most common age group is 4th and 5th decade for head and neck cancer.