Chief Complain Research Articles

Post Covid Acute Necrotizing Pancreatitis

The Coronavirus Pandemic began in China in December 2019. In a short time, this pandemic spread globally. World has been challenged by SARS COV-2, a new virus causing pneumonia and acute respiratory distress syndrome. There is lack of literature implicating COVID-19 in Pancreatitis, yet virus is generally understood to be a cause of pancreatitis in children. We present a case of previously well 12-year-old girl who presented to emergency department with a chief complain of abdominal pain, anorexia and bilious vomiting. She was diagnosed with acute pancreatitis with an abnormal lipase, ultrasound and computed tomography and was found to be COVID-19 positive by polymerase chain reaction. Our case suggest that in current pandemic, consideration for SARS COV2 testing in children with gastrointestinal symptoms and pancreatitis may be considered. Additionally, this case highlights the need for appropriate personal protective equipment for providers, even when COVID is not initially on the differential.

Postpartum Seizures: Cerebral Venous Sinus Thrombosis, Case Report

Cerebral venous sinus thrombosis is of rarity during pregnancy, and it is included in the differential diagnosis of a woman presenting with seizures during pregnancy and puerperium. Here we report a case of young lady who developed Cerebral Venous Sinus Thrombosis (CVST) 6 days after delivery, presented with a chief complain of loss of consciousness and high grade fever with recent past history of severe occipital headache and generalized convulsions, which progressed into left sided weakness. Magnetic Resonance Imaging (MRI) / Magnetic Resonance Venography (MRV) demonstrated filling defects at the right transverse and sigmoid sinuses. The patient was started on Enoxaparin and warfarin. The patient kept on improving gradually and was discharged after 24 days in a good condition.

Satisfied Result of Modified Knapp Procedure for A Rare Case of Isolated Superior Rectus Muscle Rupture

Purpose: To report a successful management of strabismus after isolated superior rectus muscle rupture with modified Knapp procedure. Case Description: A 23-year-old patient with chief complain of having double vision since 6 days. He had history of falling and his right eye hit the floor. After that, he had double vision and his right eye could not move normally to the right and up gaze. Ophthalmology examination of right eye, uncorrected visual acuity was 6/12 and not improved with pinhole. He had 15 PD esotropia and right hypotropia on Hirschberg test. Right eye movement was restricted to to lateral, superotemporal and superonasal (-3 on abduction and elevation). The superior rectus muscle was barely visible at superior part of orbit. However, Computed Tomography scan showed there was not any enlargement of the extra ocular muscles. He had exploration surgery and intraoperatively the superior rectus muscle could not be identified. Surgeon decided to do modified Knapp procedure. On the third week and second month of follow up, patient did not have any complain of diplopia and no vertical and horizontal deviation. Conclusion: Isolated superior rectus muscle rupture is a rare case. A thorough patient’s history, ophthalmology and imaging technique are needed to establish the etiology. Modified Knapp procedure gave a satisfied result in this case to treat the esotropia and hypotropia.

An unusual ocular presentation of histoid leprosy

Leprosy is a chronic granulomatous infection caused by mycobacterium leprae, mainly affecting the skin and peripheral nerve. Histoid type of leprosy, which is considered as an extremely rare variant of lepromatous leprosy. We report a case of a 50/year old male presented to our institute with chief complain of conjunctival swelling in both eyes, encroaching over cornea and involving limbus and sclera, associated with painless blurring of vision. An incisional biopsy of the right eye was performed under local anesthesia. Histopathology of right eye biopsy revealed spindle shaped cells having bland looking nuclei and variable amount of cytoplasm which was suggestive of histoid leprosy. A dermatology consultation was sought and patient was diagnosed to have leprosy. Consequent to which he was started on MBALD (multibacillary anti leprosy drug), and showed improvement in patient`s visual acuity as well as regression of right eye swelling and disappearance of left eye swelling.

What is the optimal outcome after endoscopic sinus surgery in the treatment of chronic rhinosinusitis? A consultation of Canadian experts

ObjectivesMany experts feel that in the absence of well-defined goals for success, they have an easier time identifying failure. As success ought to not be defined only by absence of failure, we aimed to define optimal outcomes for endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) by obtaining expert surgeon perspectives.MethodsA total of 12 surgeons participated in this targeted consultation. Face to face semi-structured interviews were performed with expert surgeons in the field of CRS and ESS. General impressions and personal definitions of acceptable operative success and optimal operative outcomes were compiled and summarized.ResultsAccording to an expert survey, patients’ main objectives are an improvement in their chief complain, a general improvement in quality of life (QoL), and a better overall symptomatic control. The most important aspects of endoscopy for defining a successful intervention were an adequate mucus circulation, a healthy mucosa, minimal edema, and patency of all explored cavities or ostia. In the assessment of surgical outcomes, it was determined that both objective and patient reported data must be carefully examined, with more attention given to subjective outcomes.ConclusionsAccording to data gathered from a Canadian expert consultation, a definition of success must be based on both subjective data and nasal endoscopy. We propose to define an acceptable outcome as either a subjective improvement of at least the minimal clinically improvement difference of a validated patient reported outcome questionnaire, along with a satisfactory endoscopic result (1) or a complete subjective resolution with a sub-optimal endoscopy (2).Graphical abstract

Sonographic sunray appearance of Ewing's sarcoma of skull.

A 3-year-old male child with his mother visited our hospital after being referred from primary health care centre with chief complains of rapidly growing swelling over left temporal region for 2 months. On physical examination, the swelling measured 3.1 x 3.3cm and firm in consistency, non-compressible, non-tender with no discoloration of overlying skin. The child was afebrile with no associated cervical lymphadenopathy. Systemic and neurological status was normal. An ultrasound of the local site showed well defined heterogeneously hypoechoic lesion with linear hyper-echogenicity. Increased vascularity was noted on color doppler, the findings consistent with typical sunray appearance. A diagnosis of Primary Ewing´s sarcoma was made. Ewing´s sarcoma is a common pediatric bone tumor. Sunray appearance is a typical feature which results from spiculated type of periosteal reaction seen on ultrasound, an important non-radiation diagnostic tool. Treatment is planned based on location and extent of tumor spread.

Aggressive squamous cell carcinoma of lip in a village woman

A 33-year-old female visited the outpatient department of Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi with chief complains of painful ulcer over lower lip. On taking proper history the patient said she was apparently alright 4 months back when she noticed a painful non healing ulcer over lower the front region of jaw which was initially small in size and gradually increased to the present size of 5.3 x 2.3cm approximately. Patient had history of pain which was gradual in onset, dull aching, intermittent and localized in nature. Pain aggravated on mastication and relieved after taking medications. Patient also had history of change in quantity and consistency of saliva from normal to thick and ropy with intermittent bleed and pus discharge since 3months. On clinical examination face was asymmetrical due to soft tissue defect present over lower lip with irregular everted margins. On incisional biopsy of lesion done under local anaesthesia on 15/09/20 revealed squamous cell carcinoma of lower lip.

Congenital arteriovenous malformation of upper trunk in a child.

A 2-year-old male child was brought by his mother to outpatient Department of Surgery with chief complains of a swelling in the upper back on left side since birth. Further history suggested, the swelling was small in size since birth with associated mild tenderness and it gradually started increasing in size. On clinical examination, the swelling was pulsatile in nature, soft in consistency with mild reddish discolouration and ulceration of the overlying skin; however, there was no local rise of temperature. The swelling was superficial to the muscle plane and measured approximately 5.5 x 4.7 cm in size. For further investigation, the child was referred to the Department of Radiodiagnosis for ultrasonography. On ultrasound, there were multiple anechoic cystic areas showing increased vascularity on colour doppler.

A Rare Case Report Along With Surgical Management of Bilateral Maxillary Buccal Exostosis in a Patient of Polydactyly and Distomolars

Buccal exostosis is bony prominence located on buccal side of alveolar ridge of maxilla or mandible. It is commonly seen in maxilla than mandible, whereas the etiology remains unclear. This article presents a rare case of bilateral maxillary buccal exostosis, distomolars and polydactyly along with surgical management of exostosis. A 39-year-old male patient came to the dental OPD with a chief complain of swelling in the right and left back region of upper jaw from 12 years, which was a cosmetic concern to the patient. Patient was medically healthy with no familial history of gingival overgrowth. On examination, patient had polydactyly and bilateral mandibular distomolars. These isolated findings couldn’t be related to any syndrome after thorough examination and medical consultation. Finally, the treatment plan consisted of, oral hygiene instructions, mechanical debridement and periodontal resective osseous surgery, so as to reduce gingival inflammation and improve esthetic by removing the exostosis. Nonsurgical periodontal therapy alone did not reduce the gingival enlargement because of the bony nature of enlargement, thus necessitating surgical intervention. Post-operative evaluation at 1, 3 and 12 months reveled an uneventful healing and no sign of recurrence at surgical sites.

SURGICAL TREATMENT FOR A SEVERE SCOLIOSIS IN MARFAN SYNDROME BY POSTERIOR STABILIZATION

Scoliosis in Marfan syndrome is a common occurrence, constituting up to 63% prevalence. Correction is not always easy as the structural anatomy differs from the general population. We present a female 23 years old with chief complain of curved back since 10 years before admission. The patient had high stature and positive Marfan syndrome’s criteria. The patient also complained of shortness of breath. The curvature was progressive becoming more severe over time. In radiographs we found that the main thoracic curve Cobb’s angle of 920 and main lumbar curve Cobb’s angle 760. We performed scoliosis correction with pedicle screws and rod by posterior approach. Intra-operative blood loss was 1900 cc. Postoperatively, the patient had weakness at the lower limbs but resolved after several days and gained full motoric function after one week. Severe scoliosis is an indication for surgery to correct the spinal deformity that causes several complications such as pulmonary and cardiac complications. The result was satisfying proving that the procedure is safe and with proper peri-operative preparation, we may achieve a good functional outcome.

A case of gastric ulcers and intussusception due to Ascariasis in a 4-months old American Hampshire boar in Sabon Gari Local Government Area, Kaduna State, Nigeria

A Four months old American Hampshire boar weighing about 35kg from a back-yard piggery in Sabon Gari Local Government Area, Kaduna State was presented with the chief complains of restlessness, shivering and pasty perineum. There was no medical history. Physical examination revealed, pale ocular mucus membrane, restlessness, shivering and pasty perineum. The vital parameters were above normal ranges. Faecal sample from the rectum was taken to the helminthology laboratory of the Veterinary Teaching Hospital, Ahmadu Bello University, Zaria, for helminth egg detection and identification. Based on the tentative diagnosis of Ascariasis and enteritis, 35mg of a 17% piperazine adipate solution and 700mg of a 20% oxytetracyline long acting were administered orally and deep intramuscularly, respectively as single doses. The boar died 2 hours after therapy. Post-mortem examination revealed; distended ingesta-filled stomach, ulceration of the stomach mucosal wall with tarry (blackish) haemorrhages, Ascaris suum in the stomach and small intestine, intussusception of the small intestine and empty distal portion of the intussuscepted small intest ne. The helminthology laboratory result indicated eggs of Ascaris suum. Based on the helminthology laboratory result and the post mortem examination findings, it was concluded that the b ar died of gastric ulcer and small intestine intussusception due to Ascariasis. Routine deworming and deworming record keeping in order to know when the next deworming is due were advocated to the farmer.

A contemporary treatment approach for fissure in ano: A case report of 38 year old patient

Anal Fissure is one of the major causes for pain at anal region. We are presenting case report of 38 year old male patient came to Shalyatantra OPD with chief complains of pain during and after defecation, bleeding per rectum, itching since 30 days. Intervention-In this case report patient is treated by using chakramarda ghrita for the management of acute fissure in ano chakramarda ghrita was used for local application along with sitz bath. The effectiveness of Charamarda was assessed by pain bleeding itching and healing. The patient has found effective relief from pain, bleeding, itching at perianal region using chakramarda ghrita which has anti-inflammatory activity, antibacterial, antifungal scavenging activity, antiulcer, anti-proliferative activity, antioxidant activity. The outcome of this management is that Chakramarda is effective in the management of Fissure in ano. Patients who take all follow-up after treatment will have less chance of symptom reoccurrence.

Clinicoradiographical Features of Jaw Bone Lesions in a Group of Patients Attended Two Maxillofacial Centers in Sulaimani City

Objective: This study aims to determine the distribution, clinical and radiographic features of different jaw lesions. 
 Methods: A descriptive study included 110 cases of jaw bone lesions collected along seven years from two major maxillofacial centers in Sulaimani governorate-Iraq.
 Results: The sample predominated by males (59.1%), male to female ratio of 1.4:1., the most affected age group 21-40 years (40.9%), the most common presenting sign was swelling (74.5%) besides, the swelling was the most common chief complain (with pain 30%; or without pain 59.1%). Systemic symptoms like fever and weight loss were present in only four patients (3.6%). One-third of cases (33.6%) presented for the 2-12months duration. The mandible was affected in 56.4% of cases. Regarding the radiographic features, 80% of lesions were ≤5cm in maximum dimension, 69.1% of the lesions were radiolucent. Ill or well-defined borders were equally presented (47.3%). 39.9% of lesions related to the teeth (root apices, impactions, displacement, and resorption). Concerning the diagnosis, 48.2% of the lesions were diagnosed as a cyst, followed by tumors 29.1%. 
 Conclusions: Jaw lesions of different origins can share the same clinical and radiographic features; dental professionals should have information about the most common lesions to guide them toward proper investigations and management.

Brown Tumor Posing a Quandary: An Anecdote

Brown tumors are seldom encountered in oral and maxillofacial practice. It is not a neoplasm but can cause considerable bone resorption and occasionally pathological fracture. The treatment is to deal with the diseased parathyroid gland which interferes with the normal calcium metabolism. In this article, we are presenting a case report of a 16-year-old female patient who came with a chief complain of swellings in the maxillary region who turned out to be a case of primary hyperparathyroidism and the primary treatment was done by focus parathyroidectomy.

Pap smear: A cost effective method of screening of cervical cancer in a tertiary care centre

Cervical cancer is one of the commonest cancer cause of death among women worldwide. >80% of all the cervical cancer cases are found in developing and low-resource countries, because of a lack of awareness and difficulty in running cytology-based screening programs. Conventional Pap smear testing has been the mainstay of most of the screening programs. Cervical cytology screening by Pap smear has been proven to decrease the incidence and mortality of cervical cancer. Material and Methods: This study was conducted in the department of Gynecological Oncology, State Cancer Institute at Indira Gandhi Institute of Medical Sciences, Patna, Bihar. 876 women above 20 years of age were enrolled in this study and they were screened for cervical cancer by taking Pap smear. The smears were studied in detail and were interpreted as per the new Bethesda System for Reporting Cervical Cytology 2014. Results: In this study, most of the women belonged to 41 to 50 years of age group. White discharge per vagina is the chief complain. 69.59% women were negative for intraepithelial lesions or malignancy. Inflammatory smear were found in 10.76% women. Epithelial cell abnormalities reported on cervical cytology were ASCUS in 1.86%, LSIL in 0.13%, HSIL in 2.52%, ASC-H in 0.13%, Squamous cell carcinoma in 6.51% and Adenocarcinoma in 0.53%. Conclusion: Pap smear based cervical cytology is a simple, safe, and cost-benefit test to detect premalignant and malignant cervical lesions at an early stage. Pap smear should be encouraged as a screening method in developing countries like INDIA due to its low cost and effectiveness in detecting cervical lesions, especially high-grade.

Abdominal Ectopic Pregnancy with Retrocervical Localization

Study Objective To present an abdominal ectopic pregnancy with a retrocervical localization and laparoscopic management performed. Design N/A Setting Private health facility. Patients or Participants 36 years old female patient with obstetric history of 4 previous miscarriages and 2 cesarean sections presented at our clinic with a chief complain of abdominal pain and 7 weeks amenorrhea. Blood hCG level was 3500 mUI/ml. Endovaginal ultrasound reveled an abnormal implantation of a gestational sac, behind the uterus, at the recto-vaginal space. The endometrial cavity was normal. Interventions Emergency laparoscopy was performed. Initial assessment of the pelvic cavity reveled blood at cul the sac and normal adnexa from both sides. Careful assessment of structures led to identify an active bleeding spot at the insertion site of the right uterosacral ligament. Trough suction organized tissue was obtained from a peritoneal defect at the bleeding site, making us suspect the gestational sac was implanted at this level. The pararectal space was developed, identifying and lateralizing the hypogastric nerve. The uterosacral ligament was detached from it´s proximal end, managing to expand the peritoneal window with the certainty that important anatomical structures were not involved. This gave access the implantation site of the gestational sac that was removed and hemostasis with bipolar energy was performed. Measurements and Main Results N/A Conclusion Knowledge of the pelvic anatomy is fundamental in the management of any pathology, especially when we encounter surprises such as an abnormal and unusual implantation site of a gestational sac, as observed in the case presented.

Management of Calcified Root Canal: A Case Report

Background: Calcification of root (calcific metamorphosis) is usually seen as defensive reaction of pulp totrauma. Intensity of trauma/hit, time span since trauma, pulp response to trauma are multiple factor decidingdegree of calcification. Calcification may be seen partially or entirely in root canal. Usually calcifiedtooth remain asymptomatic, but when tooth becomes symptomatic endodontic treatment need to be done.Treatment of calcified canal is challenge to dentist.Case report: A female patient reported to the department of conservative dentistry and endodontics at sharadpawar dental college with chief complain of pain in upper front region of jaw. On radiographic examinationcalcified root canal was associated with upper anterior teeth. Root canal treatment was planned for calcifiedtooth. Access opening was carried out using BR45. To achieve patency within canal file#8, 10 were used, butinitally patency could not be achieved due to calcified canal. With help of chelating agents 17% EDTA liquidand gel and small size K file #8,10 canal negotiation was carried out to achieve patency. Working lengh wasthen determined and canal was instrumented. Naocl, EDTA was used as intermittent irrigant. Final rinse wasdone using 2%CHX. Canal was obturated using cold lateral condensation technique followed by permanentrestoration. Entire procedure was carried out under magnification.Conclusion: Calcified canal treatment is bit tedious then routine endodontic procedure. But it can bemanaged if procedure is carried out under proper illumination, magnification, CBCT, understanding rootcanal anatomy, use of dye, modified access bur, files, chelating agent, irrigants and irrigation activationsystem.

Foreign body impaction in the maxillofacial region: A case report

This article describes the presence of foreign bodies which are asymptomatic in nature in the orofacial soft tissue spaces. The patient had reported to the Department of Conservative Dentistry and Endodontics with sensitivity as the chief complain in the lower right back tooth region. Clinical Examination were suggestive of generalised attrition in relation to #46. Radiographic findings revealed a well defined radio-opacity in relation to distal root of #46. This radiolucency was seen to have moved to the mesial root when another radiograph of the same tooth was taken. An orthopantomograph and CBCT was then taken to study the case better which apparently showed around 12 such radio-opacities lodged in the oral cavity with the patient being absolutely asymptomatic of it. The provisional diagnosis of foreign bodies embedded in the soft tissue was considered.

Unusual presentation of metastatic malignant melanoma: a case report

Introduction: The presentation of metastatic lesion of malignant melanoma (MM) may be unusual, as this case, in which the lesions were multicystic swelling over right arm and necrotized swelling at right chest wall. Identifying the unusual variants of MM is important to allow application of the most appropriate treatment strategies before something wrong happens. Methods: This case report has been prepared following the SCARE guideline 2018, a surgical case report guidelines. Presentation of the case: A 60-year-old man presented with a 14-month history of swelling on right arm and anterior chest wall with the chief complain of blackish discharge from the latter. Six months ago, he amputated his right thumb for melanoma after a histopathology evaluation. It was an unusual presentation of a metastatic lesion of MM. On the basis of the histopathology report, the final diagnosis of our patient was subcuticular metastatic MM which has a very poor prognosis. According to TNM classification, the final diagnosis of the case was T4bN0M1a. Although he has been under regular follow-up, the lesions are still present and his health condition is deteriorating. Discussion: Metastatic melanomas are often rare; their misdiagnosis potentially jeopardizes patients’ health and survival, and have medico-legal implications. Melanoma often has a protracted disease course, in which patients have a disease-free period following surgical excision of the primary tumor, only to discover visceral metastases—months, years, or even decades later. Melanoma metastasis is an ominous sign as it generally predicts a poor prognosis. This case is an unusual presentation of metastatic melanoma where, with the elaboration of history and proper examination of lesion, the diagnosis of metastatic melanoma was made. Conclusion: Metastatic MM has a very poor prognosis and an early diagnosis with clinical presentation is very essential in a country where health facilities are not well developed. Knowing the unusual variants of MM is important to allow application of the most appropriate treatment strategies before something wrong happens.

One-Step Urethroplasty in Recurrent Chordee on Scrotal Hipospadia

Hypospadia is genitalia externa congenital anomaly in male. Recurrent chordee is one of most complication often happen in hypospadias correction. One-step urethroplasty in recurrent chordee is very challenging due to formed massive fibrosis. Correction surgery goals is to release chordee and moving meatus urethra externa to glans tip, and could be done by one-step or two-step. We report patient, 13 years old boy came with chief complain urinate from scrotal region. Patient was diagnose with scrotal hypospadia. Patient done chordee excision previously, but penis still not straight. Then, we perform one-step urethroplasty rechordee excision with local flap. Patient was follow-up one week postoperative, wound in good condition, and dehiscent wasn’t found. Urinary catheter released after three weeks. Evaluation also done in one month postoperative, and found no fistel. One-step urethroplasty rechordee excision was perform in scrotal hypospadi with local urethroplasty flap technique. Evaluation from beginning until two months postoperative found no fistel and urinate in straight line.