Higher Centre For Further Management Research Articles

OCULAR BLUNT TRAUMA IN BUNDELKHAND REGION: A RETROSPECTIVE STUDY IN BUNDELKHAND REGION

Background: Ocular injuries can be classified into mechanical and non-mechanical injuries. Ocular injuries are more common in young patients than in elderly or female people. About thirty percent of eye injuries are caused by blunt objects. The most common mode of ocular injury was road traffic accident followed by occupational hazard. Material and Methods: The study was retrospective study of 50 patients who had blunt ocular trauma from November 2022 to October 2023 . Patient data, mode and extent of injury, management and outcome was noted and analyzed which was conducted in patients with definite history of recent blunt ocular trauma of all age. Results: During our study period, 50 patients of blunt ocular trauma were evaluated. Majority of patients were above 25 years age, out of which majority of patients were male (70%) and the most common mode of injury was road traffic accident followed by occupational injury. Majority of patients were managed at our centre both medically as well as conservatively, few cases which requires further management (traumatic dislocation of lens, corneal tear with grade 4 hyphaema) were referred to higher centre for further management. Conclusion: Blunt ocular trauma was more seen with Road traffic accidents and were more in males than females. Early and prompt detection with appropriate management lead to prevention of further complications.

Non-healing wound suspicious of foreign body

A 55-year-old male, known case of type II diabetes mellitus, from Manthali – 1, Ramechhap presented with history of fall injury from tree one day back followed by pain and swelling over his right face. He presented with history of swelling over right cheek extending from right chin to right forehead. Despite of many counseling, patient refused to visit higher center for further management. He was under oral antibiotics, oral hypoglycemic agents. On subsequent follow up, we noticed pus drainage near from right medial canthus. After one month of incident, Incision and drainage was done and black chunk of wooden piece (5x2cm) were removed.

ACCEPTANCE AND OUTCOMES OF CERVICAL CANCER SCREENING AMONG WOMEN OF NORTH INDIA

Cervical cancer is one of the preventable cancer, still it is fourth leading cause of death of women worldwide and second leading cause of death of women in India. Screening for cervical cancer using high performance test and vaccination against HPV(Human papilloma virus) are recommended by WHO as global strategy to eliminate cervical cancer. The very rst indigenous vaccine CERVAVAC is also launched in India in year 2023,however data from nationally representative survey(NFHS-5) showed very low awareness and acceptance of cervical cancer screening among women. Present study is a descriptive cross sectional study done in camp based settings (25-30 women in each camps) from November 2021 to november 2022 at peripheral health centers of Lucknow district of state Uttar Pradesh of North India. Aim of the study was to assess the acceptance and outcomes of cervical cancer screening among ASHA(accredited social health activist) from health centers and women visiting peripheral health centers. Result showed that total 43% women accepted screening(41.4% ASHA, 31.4% women visiting health center). On bivariate analysis education level(p=0.003 ), employment status (p<0.001)and knowledge of cervical cancer(p=0.02) found to be predictors of cervical cancer screening. Liquid based cytology test was carried to screen those who were willing and it was found that as per Bethesda system of classication among those who opted for screening(N=110), 4(3.1%) were having ASCUS (Atypical squamous cells of undetermined signicance), 2(1.5%) had LSIL (low squamous intraepithelial lesions), 4(3.1%) reported to have HSIL (High squamous intraepithelial lesion), 9 (7.7%) had non neoplastic inammation, 93(84.6%) were negative for any neoplastic or non- neoplastic lesion. All Positive screened participants were referred to higher centre for further management.

Rhino-orbito-cerebral invasive fungal sinusitis associated with COVID-19 infection in a malnurished child

BackgroundCorona virus disease has been associated with a wide variety of fungal and bacterial co-infections. These secondary infections could be due to the irrational use of antibiotics, immunosuppressive therapy, pre-existing co morbidities, and immune modulator effects of the virus. But here, we report a very rare occurring of rhino-orbito-cerebral invasive fungal sinusitis in a malnourished child and no other co morbidities.Case presentationThis is a case of a 6-year-old boy with severe thinness and no other co-morbidities, with mild COVID-19 infection, during the course of illness developed rhino-orbito-cerebral invasive fungal sinusitis. The child’s mother had COVID-19 1 week prior to child’s illness. The child then developed fever followed by headache. The child reported to hospital on seventh day of illness and RTPCR for COVID-19, turned positive. The child’s vitals were stable and maintaining saturation. Child was being treated with supplements and symptomatic treatment for fever. On his second day of stay at hospital, he started to develop gradually progressive left-sided peri-orbital swelling. Due to the association of COVID-19 with fungal infection, child was started on AMPHOTERICIN-B and given for 4 days and referred to a higher center for further management. Radiological imaging was suggestive of rhino-sinusitis with orbital cellulitis with meningeal enhancement suggestive of fungal etiology. Debridement was done, child was adequately treated with anti-fungal, and the child showed significant improvement along with radiological clearing.ConclusionInvasive fungal infection can occur in association with COVID-19 among malnourished pediatric age groups with no other comorbidities.

Cytomorphological Spectrum of Thyroid Lesions Based on Bethesda Reporting System: Diagnostic Utility and Pitfalls

Introduction: Fine Needle Aspiration Cytology (FNAC) is the frontline diagnostic tool in assessing Thyroid enlargement. FNAC is simple, easy to perform, cost effective procedure with rapid diagnosis. Other diagnostic tests like Ultrasound, radionucleotide scanning, Thyroid profile are adjuvant to FNAC which is more reliable. Aim: To categorise the spectrum of Thyroid lesions on FNAC according to the Bethesda system for Reporting Thyroid Cytopathology (TBSRTC) and study its utility and pitfalls. Materials and Methods: This was a retrospective observational study carried out in the Department of Pathology at Government Medical College/Government General Hospital, Mahabubnagar, Telangana, India, from January 2019 to December 2021. The analysis of the data was done from January 2022 to June 2022. FNAC and fine needling was performed in cases of enlarged Thyroid gland, the smears were prepared and fixed in 95% ethyl alcohol, stained with Hematoxylin and Eosin and Papanicolaou stain. Cytohistopathological concordance was done wherever was possible. Sensitivity, Specificity, Positive Predictive value, Negative Predictive value were calculated. Results: Out of 155 cytology cases, 8 cases (5.16%) were unsatisfactory/nondiagnostic, 133 cases (85.80%) were Benign lesions, 8 cases (5.16%) were follicular neoplasm/ suspicious for follicular neoplasm, No cases were reported as Atypia of undetermined significance, 3 cases (1.93%) were suspicious for malignancy and 3 cases (1.93%) were malignant. Cytohistopathological concordance was studied in 19 cases. One of the case reported on cytology as Anaplastic carcinoma was referred to higher center for further management. Conclusions: FNAC plays a pivotal role in diagnosis of Thyroid Swellings. The Bethesda system for reporting Thyroid Cytopathology effectively categorises the Thyroid lesions into various sub groups which facilitates better communication between the pathologist and clinician resulting in proper management of the patient. In this study, the number of Benign cases predominated and occurred in females. Cases presenting with nodular lesions, suspicious for malignancy and malignant lesions are advised surgical resection for further evaluation. The Bethesda system was found useful in categorisation of lesions and in advising medical or surgical management, urgency of treatment and the extent of surgery.

Dyke-Davidoff-Masson Syndrome: A Case Report

Background: Dyke Davidoff Masson syndrome (DDMS) is a neurological syndrome characterized by the presence of convulsions, facial asymmetry due to 7th nerve palsy, contralateral hemiplegia, and reduced intellectual capacity. The Case: We report a case of DDMS in a 20-year-old male who is a previously known case of generalized epilepsy on medication presenting with status epilepticus and initially managed by anticonvulsants. On admission, the seizures manifested again which required the patient to be sedated with injectable anesthetics and intubated. Clinical examination showed no focal neurological deficits or neurocutaneous markers. Imaging studies showed characteristic features of DDMS which were hemiatrophy of the right cerebrum with calvarial thickening and sinuses showing hyperpneumatization on the same side as hemiatrophy. Previous history of such episodes had been recorded and the patient was kept on strict pharmacotherapy. Failure of adherence to these led to the current presentation. The diagnosis of DDMS was kept and the patient was treated conservatively with anticonvulsants and referred to a higher center for further management. Conclusion: DDMS being a rare but important cause of refractory epilepsy is easily missed on initial assessment and failure of adequate management leads to higher rates of morbidity and mortality associated with this syndrome. In cases like these with an atypical presentation, a good background in radio imaging, and knowledge of the physical manifestations are required to arrive at its diagnosis.

Rhinoorbital mucormycosis in COVID-19 pandemic: presentation and course of disease: An observational study

During the second wave of Covid 19[SARS- Co V-] pandemic, there is a sudden increase in number of mucormycosis infection cases in India. The present study is an attempt to understand the presentation, course and outcome of rhinoorbital mucormycosis in a group of patients who reported to Ophtalmology and Otorhinolaryngology department of our Govt. District Hospital (secondary referral centre) for enhancing measures for prevention and management. Patients who reported to our Government district hospital with signs or symptoms suggestive of rhino orbital mucormycosis during May-June 2021 were included in the study with consent of ethical committee, patients and patient’s relatives. Total 17 cases were reported and followed. Clinical examination was done for all the patients. History of the presenting complaints and underlying illness with COVID -19 was elicited. Underlying comorbid status was recorded. Patients were followed as all of them were referred to higher centre for further management as per the guidelines issued by directorate medical and health services, rajasthan, Jaipur.13(76.4%) patients were from rural and 4 (23.5%) were from urban area. 11(64.7%) patients had RT-PCR +ve, 6 had RT-PCR _ve, 2 did not have RT-PCR report. 15(88.7%) patients had high blood sugar at presentation mean being 315.7mg%. 9 (52.9%) developed mucormycosis during their treatment for COVID in hospital. 8(47.05%) presented in OPD. 9 patients had treatment with inhalational Owhile 8 patients did not have treatment with O Death rate was high (70.5%) among our patients. Patients who survived (29.4%) had only initial symptoms and signs at presentation therefore could be managed earlier. None of our patient had vaccination for COVID. Our study was done at secondary referral centre, all the previous studies were done at tertiary referral centres; therefore it shows the course of disease mainly among rural population ; most of them presented very late and had poor outcomes. It shows the need of more awareness about COVID and mucormycosis among people especially in rural areas. High blood sugar either due to treatment with steroids or pre existing is a major risk factor for Rhino orbital mucormycosis. Being RT- PCR negative for COVID 19 does not rule out the associated possible complication of Rhino orbital mucormycosis. Early diagnosis and management remains the key factor for managing Rhino orbital mucormycosis.

Admission profile and treatment outcome of neonates admitted in special newborn care unit in Maharashtra: A 7-year study

Introduction: Facility-Based Newborn Care program is one of the key initiatives launched by the Government of India under the National Rural Health Mission and RMNCH + A strategic program to improve the status of newborn health in the country. Under the program, efforts are being made to provide different levels of newborn care at the health facilities. Special newborn care unit (SNCU) is a neonatal unit in the vicinity of labor room which is to provide special care (all care except assisted ventilation and major surgery) for sick newborns. Aims and Objectives: We aimed to study the admission profile and treatment outcome of neonates admitted in SNCU. Materials and Methods: The present descriptive observational study with longitudinal design was conducted in the government-supported SNCU of District Hospital of Jalgaon district of Maharashtra which included all the neonates admitted in SNCUs from January 2013 to December 2019. The SNCU monthly report which is in a predefined format from the Ministry of Health and Family Welfare, Government of India, which includes data on admission information, reasons of admission, course of admission, and mortality reasons (if any) with treatment outcomes was used for data collection. The outcomes were classified into four groups, namely expired (died during the management), discharged (discharged after successful treatment), Left against medical advice (LAMA), and referred (referred to higher center for further management). Results: In the present study period (i.e., from January 2013 to December 2019), total 16,489 neonates were admitted to the SNCU. Out of them, 9895 (60.01%) were inborn. Majority (93.22%) of the deliveries were institutional deliveries. Meconium aspiration syndrome (MAS) (16.50%) was the most common indication for admission, followed by prematurity (12.68%), other low birth weight (LBW) (1000–2499 g) (11.96%), respiratory distress syndrome (RDS) (11.29%), and birth asphyxia (10.21%), respectively. 78.63% were discharged after successful management while 10.45% died during treatment. 3.97% were referred to higher center for further specialized management and 6.94% left the hospital against medical advice. Prematurity (25.70%) and RDS (25.48%) were the common causes of mortality. Birth asphyxia (15.12%), sepsis (7.73%), MAS (7.67%), and extremely LBW (7.62%) were other important conditions leading to the death of newborns. Conclusion: Thus, we conclude that the admission rate for inborn was higher as compared to outborn. MAS was observed to be the most common indication for admission, followed by prematurity, other LBW (1000–2499 g), RDS, and birth asphyxia, respectively. The discharge rate was 78.63% after successful management while the mortality rate was 10.45%. Prematurity, RDS, and birth asphyxia were the common causes of mortality.

Outcome of hypoxic COVID-19 patients treated with dexamethasone-based treatment protocol in a designated COVID center

Background: Managing severe COVID-19 is a difficult situation in resource limited settings. With the inclusion of steroid based treatment guidelines, this can be made feasible in such settings.Methods: This was a hospital record based retrospective cohort study done at a designated COVID hospital. Data of all patients who were 18 years and above, hypoxic and required initiation of dexamethasone-based protocol were analysed. Hypoxia was defined as a finger pulse oximeter value less than 95%. The primary outcome was the percentage of patients who required a referral to the higher centre or died in hospital.Results: 109 patients with hypoxia with a mean age of 55.2±13.5 years and a median symptom duration of 4 days were analyzed. Seventy-eight (71%) patients were male and 81 (74.3%) had other comorbid illnesses. Of the 109 patients, 5 (4.6%) patients died in hospital, 22 (20.2%) patients were referred to higher center for further management and 82 (75.2%) patients could be treated and discharged. Those who were referred or died had lower SpO2, reduced time to initiation of protocol, more severe pneumonia, lower absolute lymphocyte count and lower platelet count. New onset diabetes was detected in 20 (18.3%) patients.Conclusions: Detection of hypoxia early and initiation of dexamethasone-based treatment protocol with timely referral of worsening patients can help to improve outcome in COVID-19 patients. This model can be effectively constructed in limited resource settings and can be of much help to the struggling health infrastructure.

Upper Limb Ischemia in Preterm Infant Leading to Autoamputation of Hand – a Case Report

Acute limb ischemia(ALI) in a paediatric patient is a rare condition but may result in limb loss and life long complications. We present here a case of a 34 weeks premature infant, with birth weight 1530 grams, who was having respiratory distress at time of birth. Infant was referred to advanced pediatric center for further management, where he was kept in neonatal ICU. He was put on C-PAP and oxygen support and an infant feeding tube for feeding. On 21st day infant developed ischemia of the right upper limb. Color Doppler flow study was done which revealed thrombosed right radial and ulnar artery and biphasic flow in brachial artery. He was put on low molecular weight heparin and was advised referral to higher center for further management. Patient developed dry gangrene of right hand and wrist resulting in the autoamputation of the hand and wrist after a period of 15 day from development of gangrene. In order to prevent such complications there should well trained staff to detect early ischemic changes in the limb so that timely treatment can be started and the long term chronic complications can be prevented.

How can Head & Neck disorders be a liability to Indian population: Hindrance & Nuisance or Hesitance & Negligence???

Introduction: Head & Neck disorders still remains a “global burden” in the world map till date. With the increasing trend of cancer in the present day scenario and raising parameters of aetiology with varied clinical occurrence, there has been a major plunge at the way things are perceived by a common man in day to day life. Aims & Objectives: To find out the various causes for Head & Neck disorder at our set up. Also to put together and touch upon aspects like risk factors, symptomatology associated with nature of the disease process in this belt of Malnad region. Methodology: 352 patients with Head & Neck disorders were considered for the study over a period of 1 year who were evaluated clinically and radiologically. After initial evaluation, most of them were referred to higher centre for further management. Results: Nearly 75% of patients presented with malignancy with 5 times predominance in males and around 97% patients belonging to the region from oral cavity up to larynx as they have a common epithelial origin. Conclusion: Head & Neck disorders are never to be neglected as it the “runway” to the crux of the body system. Any sort of limitation or hesitation can cost life and well-being.

How can Head & Neck disorders be a liability to Indian population: Hindrance & Nuisance or Hesitance & Negligence???

Introduction: Head & Neck disorders still remains a “global burden” in the world map till date. With the increasing trend of cancer in the present day scenario and raising parameters of aetiology with varied clinical occurrence, there has been a major plunge at the way things are perceived by a common man in day to day life. Aims & Objectives: To find out the various causes for Head & Neck disorder at our set up. Also to put together and touch upon aspects like risk factors, symptomatology associated with nature of the disease process in this belt of Malnad region. Methodology: 352 patients with Head & Neck disorders were considered for the study over a period of 1 year who were evaluated clinically and radiologically. After initial evaluation, most of them were referred to higher centre for further management. Results: Nearly 75% of patients presented with malignancy with 5 times predominance in males and around 97% patients belonging to the region from oral cavity up to larynx as they have a common epithelial origin. Conclusion: Head & Neck disorders are never to be neglected as it the “runway” to the crux of the body system. Any sort of limitation or hesitation can cost life and well-being.

Role of peritoneal drainage in moribund patients of perforation peritonitis

Background: Objective of the present study was to evaluate applicability of primary peritoneal drainage under local anesthesia in moribund patients as pre-laparotomy support when laparotomy under general anesthesia could not be done. Also to assess outcome in terms of survival, patients needing definitive surgery and complications associated with the procedure on immediate and follow up basis.Methods: We conducted this study in Teerthanker Mahaveer Medical College, Moradabad, UP, India from October 18 to October 2019. 71 patients were admitted as cases of perforation peritonitis in moribund condition, demographic data of all patients was noted, peritoneal drainage under local anesthesia in flanks was done and variable amount of fluid was drained in different patients, simple parameters were taken in to consideration in pre and post drainage phase. We also noted the complications after the definitive surgery.Results: Out of 71 patients, admitted in late and in very critical state, 61 patients improved after drainage and resuscitative procedures, although in ASA grade 3 and 4 they underwent surgical treatment and we were able to save their lives. 13 patients expired after definitive surgery inspite of best efforts.Conclusions: Peritoneal drainage under local anesthesia in late reporting and critical patients, not only improves general condition but makes patients better to undergo further surgery, and can prove to be life saver. It being a simple procedure can easily be done at even PHC level, before patient is referred or shifted to higher centre for further management.

Changing Clinical Pattern of Sheri-Amaranthji Yatra Patients Attending a Tertiary Care Centre in North-India

INTRODUCTION: The sacred cave of Amaranth, located deep in the Himalayas, is one of the holiest pilgrimage sites of Hindu religion in general and among Shiva followers in particular. Because of high altitude, rough terrain and harsh weather, pilgrims are prone to sicknesses which sometimes may prove fatal.
 OBJECTIVES: To study the profile and outcome among Shri-Amarnathji Yatra patients attending a Tertiary Care Centre in North-India, and to examine whether there is any change in the clinical pattern of yatra patients over time
 METHODS: This was a prospective, observational study carried out during the yatra period of 2017. Ninety-seven Yatra patients who were on a pilgrimage to Shri-Amarnathji cave and referred to SKIMS between July and August 2017 for various illnesses were studied. All the necessary clinical details were recorded in a pre-designed and pre-tested Proforma prepared for the study; admitted patients were followed from admission till discharge. The profile and outcome of illness of these 2017 Yatra patients were compared with the results of the study conducted in the year 2011.
 RESULTS: Out of 97 Yatra patients ( referred to our Centre, 54 (55.7%) patients were managed in the outpatient department (OPD) of the hospital; the majority of these patients (33, 61%) were male and were having minor ailments. Out of these 54 patients managed in OPD, 18 (33%) had respiratory tract infection, while 11 (20%) had Hypertension. Patients who were sick (n=43) were admitted and managed in the Accident & Emergency (A&E) Department of the institute. Majority of the admitted patients were males (74%); trauma, particularly road traffic accidents constituted 32.5%, followed by acute myocardial infarction (16.3%). Out of admitted 43 Yatra patients, 36 (84%) patients improved, five patients (12%) expired, one was discharged on request, and one referred to a higher centre for further management.
 CONCLUSION: As compared to previous studies, more male patients were admitted this time, most of whom were in the age-group of 21-40 years. The proportion of patients due to injury and road traffic accident has increased, forming a significant proportion of the referred cases.
 INTRODUCTION: The sacred cave of Amaranth, located deep in the Himalayas, is one of the holiest pilgrimage sites of Hindu religion in general and among Shiva followers in particular. Because of high altitude, rough terrain and harsh weather, pilgrims are prone to sicknesses which sometimes may prove fatal.
 OBJECTIVES: To study the profile and outcome among Shri-Amarnathji Yatra patients attending a Tertiary Care Centre in North-India, and to examine whether there is any change in the clinical pattern of yatra patients over time
 METHODS: This was a prospective, observational study carried out during the yatra period of 2017. Ninety-seven Yatra patients who were on a pilgrimage to Shri-Amarnathji cave and referred to SKIMS between July and August 2017 for various illnesses were studied. All the necessary clinical details were recorded in a pre-designed and pre-tested Proforma prepared for the study; admitted patients were followed from admission till discharge. The profile and outcome of illness of these 2017 Yatra patients were compared with the results of the study conducted in the year 2011.
 RESULTS: Out of 97 Yatra patients ( referred to our Centre, 54 (55.7%) patients were managed in the outpatient department (OPD) of the hospital; the majority of these patients (33, 61%) were male and were having minor ailments. Out of these 54 patients managed in OPD, 18 (33%) had respiratory tract infection, while 11 (20%) had Hypertension. Patients who were sick (n=43) were admitted and managed in the Accident & Emergency (A&E) Department of the institute. Majority of the admitted patients were males (74%); trauma, particularly road traffic accidents constituted 32.5%, followed by acute myocardial infarction (16.3%). Out of admitted 43 Yatra patients, 36 (84%) patients improved, five patients (12%) expired, one was discharged on request, and one referred to a higher centre for further management.
 CONCLUSION: As compared to previous studies, more male patients were admitted this time, most of whom were in the age-group of 21-40 years. The proportion of patients due to injury and road traffic accident has increased, forming a significant proportion of the referred cases.

Severe Pulmonary Hypertension Due to Adult-Onset Still's Disease.

A 29-year-old female with adult-onset Still’s disease (AOSD) presented with progressive shortness of breath both on rest and on exertion, increased abdominal girth, and swelling in both legs. She was on oral prednisone and was recently started on canakinumab (interleukin-1 antagonist) for joint pain and rash of AOSD. Echocardiogram showed severely dilated right ventricle, dilated pulmonary artery, moderately reduced right ventricular systolic function, but with normal left ventricular systolic function. Computed tomography with contrast ruled out pulmonary embolism. Blood tests ruled out other rheumatologic diseases. The patient was diagnosed with right-sided heart failure likely secondary to AOSD. Right heart catheterization was needed but could not be performed because of severely dilated pulmonary artery. The patient was transferred to a higher center for further management and possible cardiopulmonary transplant.

Management of pathological femoral fracture secondary to Ewing sarcoma in pregnancy: A case report

Ewing's sarcoma is an ultra-orphan disease (2/1,000,000/year) which requires a multimodal therapy approach in high-volume centers. Treatment consists of pre-operative therapy followed by surgery and post-operative combination of chemo-radiotherapy. Experience with diagnosis and therapy of Ewing's sarcoma in pregnancy is very limited. We herein report the case of an atypical Ewing's sarcoma detected in the second trimester of gestation. The present study reports a case of a 24-week primigravida presenting with presented with chief complains of sudden onset of pain in left proximal thigh and inability to stand from bed on 28 feb.2017 in early mornig. Consult local doctor where x ray advice & some analgesic given. X-ray done at periphery which shows pathological subtrochantric fracture. From there she refer to higher centre for further management. An internal fixator was placed in the left femur for definitive treatment of the fracture. Normal delivery was performed at 32 gestational weeks. Following delivery, staging of cancer was conducted. Subsequently, adjuvant treatment started. The rare nature of this condition underlines once more the need for a multidisciplinary team to improve the quality of care for this highly special patient collective.

Asymptomatic bilateral chemodectomas: a masquerader of simple neck masses

Patients presenting with asymptomatic neck masses to surgical OPD can have many differentials, ranging from the simplest reactive lymph nodes to aggressive malignant masses. Bilateral neck masses in a patient can be due to infective lymph nodes, salivary gland pathology, solid - cystic lesions of the neck and malignancies. Based on the anatomical site of the lesion, clinical examination still remains the first step in characterising the lesion into solid, cystic, pulsatile, non pulsatile, response to cough impulse and so on. Imaging is always a mandatory next step for the confirmation of diagnosis and to know about the morphology of the lesion with finer details. USG, CT and MRI are indispensable tools in assessing neck masses with equivocal findings on clinical examination and particularly in asymptomatic individuals where there is lack of history and thus diagnosis becomes a challenging task. One such entity is bilateral Chemodectomas where imaging plays a pivotal role in the diagnosis. We report a case of bilateral neck masses in an asymptomatic female patient which on imaging was diagnosed as a case of bilateral carotid body tumours and referred to higher centre for further management.

Appraising the Role of Fine Needle Aspiration Cytology in Non-Thyroidal Head and Neck Masses: A Single Referral Institute Experience.

Background: Fine needle aspiration biopsy (FNAB) is a widely recognized and sensitive technique, in which a fine needle is introduced into a mass, cellular material is aspirated and a cytological diagnosis is made. It provides initial diagnosis for masses in the head and neck region, enables appropriate management plans for individual patients to be made and separates masses that are reactive or inflammatory in origin and do not require surgical intervention, from masses of neoplastic origin. Furthermore, FNAB can differentiate benign from malignant neoplasms. Objective: To study the value of fine needle aspiration biopsy (FNAB) in the diagnosis of palpable non-thyroidal neck masses in Dammam Medical Complex. Study design: Patients with palpable non-thyroidal neck masses, who had their FNAB during the three-year study period, were reviewed. The FNAB results were analyzed into two groups according to the tissue of origin, into lymph node and salivary gland in origins. The study groups were also classified based on the histopathology findings into; inflammatory, congenital and neoplastic. FNAB diagnoses were retrospectively correlated from patient’s file, with available histological findings or with the outcome of treatment. Accuracy, sensitivity and specificity of FNA were analyzed. Results: A total of 258 patients had FNAB during the study Period. All patients who lost follow-up, those who were referred from other hospitals so the full medical records could not be retrieved and those with inadequate FNAB specimens to make the diagnosis were excluded from our study. Out of the 178 FNABs included in our study, 159 FNAB were done in adult patients and only 19 FNAB were carried out in pediatric age group. For the masses from palpable lymph node, the most common diagnoses were reactive/nonspecific lymphadenitis in pediatric (73.7%) and in adult were reactive/nonspecific lymphadenitis and tuberculosis lymphadenitis (50.8% and 32.5%, respectively). The next most common masses were neoplasm (16.7%), of these 45% of the cases were metastatic in origin, while diagnosis of lymphoma made in 55% of the cases. FNA from major salivary glands were 12.6% of the cases, mainly parotid and submandibular gland (65% and 35%, respectively). In our experience, the overall FNA sensitivity was 96.77%, with specificity of 92.1% and accuracy of 95.68%. Conclusion: FNAB of head and neck masses is a simple and cost effective tool in reaching an initial diagnosis and road map the clinician’s management approach. It aids in separating inflammatory non-thyroidal neck masses from neoplastic lesions, enhances surgical planning for malignant diseases and allows rapid referral of lymphomas and cancer cases for a higher center for further management. FNAB carries a high sensitivity and specificity rate with high overall accuracy in both adult and pediatric patients if done by experienced physician and interpreted by experienced histopathologist. The complications of FNAB are negligible and the associated pain and discomfort is short lived and well tolerated by most patients. This advantage encourages the clinician to consider FNAB as first step in approaching non-resolving, non-vascular, non-thyroidal head and neck masses in both adult and pediatric population.

Prevalence of hypertension and diabetes mellitus at selected urban slums in Bangalore, India: a cross sectional study

Background: Non communicable diseases are increasingly affecting urban slum people. This study was carried out by our institute at the behest of MOHFW, GOI, as a combined initiative with the Director of Health & Family Welfare Services, Karnataka State and Bruhat Bengaluru Mahanagara Palike. The objective of the study was to estimate the prevalence of Hypertension and Diabetes Mellitus among the residents of selected slums of Bangalore. To correlate the association of these morbidities with variables such as overweight/obesity. Methods: Cross-sectional study from October 2010-February 2011. Slums in and around the urban field practice area of Bangalore Medical College and Research Institute (BMCRI), Bangalore, India. One thousand three hundred and six (1306). Sampling method: All slums under BMCRI urban field practice area and few adjacent urban slums chosen at random. People aged more than 30years were pooled in by the local link health workers to the camps. A pre-tested, semi-structured questionnaire was used. Blood pressure (Using sphygmomanometer) and random blood sugar (Glucometer) were measured. Hypertension was classified as per JNC VII criteria and Diabetes as per the ADA guidelines. Results: 1306 subjects participated at the survey. 255 were males and 1051 were females. Average age being 51.88+20 years. 209 (16%) subjects were using tobacco in any forms. 88 (6.7%) subjects had family H/O Diabetes and 46 (3.5%) had Hypertension in the family. 417 (31.92%) were found to be having Diabetes and 247 (18.9%) were diagnosed as hypertensives. 147 (11.2%) subjects were having both Diabetes and hypertension. Conclusions: The reason for high prevalence of the morbidities seemed to be lack of awareness regarding health care seeking and lack of compliance to treatment. Subjects with diagnosed morbidities were given health education and referred to higher center for further management.

Winking-owl Sign - An Uncommon Presentation of Spine Metastasis

Introduction: Spinal metastasis is the commonest form of secondary osseous involvement by variety of cancers usually presenting clinically in the form of backache. They may be osteolytic, osteoblastic or mixed types. Spinal radiograph is usually the first investigation used to define the future course of action. Case Presentation: A 50-year old female from a nearby village came to outpatient department of our hospital with an acute history of severe backache since few days. Clinical examination revealed focal tenderness in mid-lumbar region. Laboratory investigations were however, unremarkable. She was advised radiograph of dorsolumbar spine region in anteroposterior and lateral projections. Careful evaluation of radiographs revealed nonvisualisation of left-sided pedicle of L3 vertebra representing winking-owl sign, conspicuously noted on anteroposterior projection associated with surrounding vertebral lucency (Figures 1A and 1B). There was associated early lumbar spondylotic changes and diffuse osteopenia as well. Based on radiological findings, the diagnosis of solitary vertebral metastasis was kept as the first differential diagnosis and further work-up was advised to search for the primary tumour. A thorough clinical history and examination revealed invasive breast carcinoma with history of occasional blood stains on clothes and metastases to lungs on chest radiograph. Histopathological examination confirmed the primary malignancy and metastases. Patient was referred to higher center for further management. Discussion: All types of spinal metastases are usually multiple at the time of presentation, but occasionally they may be solitary at first presentation. Detecting solitary metastasis is important in a patient with known primary malignancy as it predicts progression of disease, poorer prognosis and requires further intervention in the form of chemotherapy or radiotherapy depending on the sensitivity of the primary tumour. At time, solitary metastasis may be the first presentation of cancer thus making aggressive search for primary tumour very imperative for deciding future course of action as seen in our index case. Pedicle destruction of a vertebra is an important radiographically detectable signs of osteolytic metastasis especially carcinoma. Though any part of the neural arch of vertebra may be involved by metastases yet the vertebral pedicle is the commonest site. Involvement of pedicle with adjacent part of posterior vertebral body results in loss of cortical margins that can be detected radiographically as nonvisualisation of vertebral pedicle on anteroposterior radiograph [1]. This is described as one-eyed pedicle or winkingowl sign. It is most commonly noted in the lower dorsal and lumbar vertebrae with solitary involvement being commoner than the multifocal involvement. Rarely both the pedicles may be involved by the above process leading to nonvisualisation of both vertebral pedicles on anteroposterior radiograph resulting in blind-vertebra [1,2]. Differential diagnosis includes congenital absence of pedicle which is usually associated with hypoplastic /agenetic ipsilateral and hyperplastic contralateral pedicles. There may be some degree of abnormal spinal curvature as well. Congenital disease usually presents in early childhood/adolescence. To summarise, it is important to recognise solitary spinal metastasis in form of winking-owl sign on spine radiograph as it affects the prognosis of the patient suffering from the cancers.