Major Presenting Symptom Research Articles

Prevalence of cerumen impaction and associated factors among primary school children in Mwanza city, Tanzania

Background: Cerumen impaction is a worldwide problem constituting a significant proportion of health problems in many settings and its prevalence varies. There is a paucity of published data regarding this condition in Tanzania with none from Mwanza region. The aim of this study was to determine the prevalence of cerumen impaction and associated factors among primary school children in Mwanza City and to assess the effect of cerumen impaction and its removal on hearing ability
 Methods and Patients: This was a cross-sectional, community-based study of primary school children with cerumen impaction that was carried out in randomly selected primary schools in Mwanza City between December 2016 and May 2017. Multistage cluster sampling technique was employed to obtain a required number of the study population.
 Results: Out of the 406 participants, ninety-five (23.4%) had cerumen impacted in their ears. Of these, 56 (58.9%) were males and 39(41.1%) were females. The mean age at presentation was 11.24±8.86 years. Ear bud abuse (83.7%) was the most common predisposing factor for cerumen impaction. Cerumen impaction was found in the right ear of 9 (9.5%) patients and in the left ear in 31 (32.6%) patients and bilateral in 55 (57.9%) of patients. The major presenting symptoms were ear itching, otalgia, hearing loss and tinnitus. Ear syringing was used to remove cerumen impaction and caused significant improvement in hearing thresholds. There were no recorded complications.
 Conclusion: Cerumen impaction is a common otologic presentation in our sub-region. Ignorance with the profound abuse of cotton buds is the major predisposing factor. Health education is of the essence as treatment is simple and effective.

Hepatocellular carcinoma in Ghana: a retrospective analysis of a tertiary hospital data.

IntroductionHepatocellular carcinoma (HCC) is a cancer of global public health concern because of its high incidence and mortality. The impact is greatest in areas with high prevalence of its major risk factors including chronic hepatitis B virus (HBV). HBV is endemic in Ghana but a comprehensive data on HCC is lacking. The aim of this study was to describe the clinical, laboratory and radiological features of HCC at the Korle Bu Teaching Hospital in Ghana.MethodsThe medical records of 194 HCC cases attended to at the Gastrointestinal Clinic of the Korle Bu Teaching Hospital between January 2015 and December 2018 were retrospectively analyzed for demographic, clinical, laboratory and radiological data.ResultsThe male: female ratio was 2:1 and mean age was 45.2 years. Weight loss and abdominal pain were the major presenting symptoms. No patients were identified through surveillance. HBsAg was positive in 109/145 (75.2%) of cases tested. Sixty-five (59.6%) of 109 HBsAg positives were aware of their HBsAg status but only 3 were receiving medical follow ups prior to the diagnosis of HCC. Raised alpha-fetoprotein level >165.2 IU/ML was found in 53.9%. One hundred and forty-four patients were eligible for only analgesia.ConclusionHBV infection is the leading aetiologial risk factor associated with HCC. Majority of HBV carriers are aware of their status but do not receive care prior to HCC diagnosis. Majority present late and are eligible for only palliative treatment. Improvement in the health seeking behavior of HBV carriers can aid early detection of HCC.

Awake Craniotomy with Functional Mapping for Glioma Resection in a Limited-Resource-Setting: Preliminary Experience from a Lower-Middle Income Country

Awake craniotomy with brain mapping aims to maximize resection of gliomas located within eloquent regions while minimizing the risk of postoperative deficits. This technique is common practice in the developed world but has yet to be implemented in most low- and middle-income countries (LMICs). We assessed the feasibility, safety, and efficiency of functional-based glioma resection using minimal facilities in a limited-resource institution. This is a retrospective review of patients harboring gliomas within eloquent regions who underwent awake craniotomy and tumor resection guided by cortico-subcortical mapping at a tertiary hospital of an LMIC. Patient characteristics, surgical results, and functional outcomes were studied. Twenty consecutive patients with a mean age of 37 years were enrolled in the study. Seizure, present in 70% of patients, was the major presenting symptom. Eighteen patients had diffuse low-grade gliomas and 2patients had high-grade gliomas. Intraoperative events were dominated by seizures, occurring in 5 patients (25%). The average extent of tumor removal was 89.5% and the rate of total and subtotal removal was 85%. New postoperative deficits were observed in 5 patients (25%), and permanent deficits were found in 1 patient (5%). The main hurdles encountered were the difficulties in investigating patients and human resource availability. Awake craniotomy with brain mapping for functional-based resection of gliomas can be safely achieved in a limited-resource institution with good functional and oncologic results.

Cardiorenal Syndrome in Renal Transplant Recipients: Prevalence, Clinical Presentation, Treatment, and Outcome

Background: Data on the cardiorenal syndrome (CRS) in renal transplant recipients (RTR) are scarce. We investigated the prevalence, clinical presentation, treatment, and outcomes of patients with CRS in our renal transplant cohort. Methods: Charts and medical records of adult RTR were investigated to identify patients with renal allograft dysfunction and heart failure (HF) with reduced (HFrEF) or preserved (HFpEF) ejection fraction. Results: From December 2009 to December 2019, a total of 1,610 patients received a kidney allograft at our institution. CRS was diagnosed in 9 patients (0.56%) a median of 11 years after transplantation (4–20 years). Seven of the patients were male, and 2 were female. The median age when CRS was diagnosed was 71 years (64–80 years). The major presenting symptom was dyspnea. Five patients had HFrEF, and 4 had HFpEF. The patient’s median basal creatinine clearance was 37 mL/min (range 29–77 mL/min). At hospitalization, it was decreased to 24 mL/min (range 13–45 mL/min). The patients were treated with diuretics, but 5 of them required extracorporeal fluid removal. At the 16-month follow-up (median), all patients with HFpEF were alive and had returned to initial levels of creatinine clearance. Two of the 5 HFrEF had died, and 2 needed permanent extracorporeal water removal. Conclusion: CRS after renal transplantation was rare (<1.0%), but CRS in HFreF patients was associated with a poor outcome.

Diagnostic Performance of Novel Urine-Based mRNA Tests (Xpert and Urinary Metabolomics Markers Assay) for Bladder Cancer Detection in Patients with Hematuria

BACKGROUND: Hematuria is the most frequent presenting symptom in the vast majority of bladder cancer (BC) patients. The current recommended evaluation of hematuria includes cross sectional imaging and cystoscopy with possible high negative results, expensive costs and substantial patient burden. OBJECTIVES: To validate novel urine-based mRNA-dependant tests; Xpert test and urinary metabolomics assay (CRAT and SLC 25A20genes expression) for BC detection in patients with hematuria. METHODS: Patients presented with hematuria to our tertiary care hospital were evaluated by CT urogram and office white light cystoscopy with subsequent inpatient biopsy for positive findings. Voided precystoscopy urine samples were prospectively collected. Xpert test, assay of targeted urinary metabolomics and cytology, were performed. The tests characteristics presumably were calculated based on the ability to identify BC noninvasively. RESULTS: Between March 2018 and June 2019, 181 patients were included in the final analysis with mean (±SD) age 62 (±10) years with 168 (92.8%) males. Macroscopic hematuria was encountered in 153 (84.5%) patients with irritative bladder symptoms in 48 (26.5%) patients. BC was confirmed by cystoscopy/biopsy in 36 (19.9%) patients. The performance characteristics of Xpert alone (SN: 73%, SP: 83%, NPV: 92%, PPV: 52%) (AUC 0.84, 95% CI 0.75–0.93, p = 0.001), metabolomics assay alone (SN: 89%, SP: 93%, NPV: 97%, PPV: 78%) (AUC 0.91, 95% CI 0.85–0.98, p &lt; 0.001) and combination of both test results (SN: 66%, SP: 98%, NPV: 92%, PPV: 97%) (AUC 0.83, 95% CI 0.74–0.93, p = 0.001) were notably superior to urine cytology (SN: 30%, SP: 84%, NPV: 83%, PPV: 33%) (AUC 0.58, 95% CI 0.47–0.69, p = 0.154) for BC prediction. Cystoscopy-negative patients (CNP) were followed-up for a median (range) 12 (2–19) months. Re-cystoscopy was done for 35 patients with persistent symptoms. BC was diagnosed in 6 patients. Xpert and urinary metabolomics results were observably positive in those 6 patients. CONCLUSION: Xpert test and assay of urinary metabolomics (CRAT and SLC 25A20 genes expression) have the potential for BC detection in hematuria patients. These non invasive urine based tests can help prioritization of the use of invasive diagnostic tests in systems with long waiting times.

A preliminary clinico-epidemiological portrayal of COVID-19 pandemic at a premier medical institution of North India

CONTEXT:The outbreak and spread of severe acute respiratory syndrome coronavirus 2 has led to a global exigency of colossal and monstrous proportions in terms of public health and economic crisis. Till date, no pharmaceutical agent is known to manage in terms of prevention and treatment of coronavirus disease 2019 (COVID-19), the disease caused by a novel virus.AIMS:The aim of the present work was to understand the underlying disease profile and dynamics that could provide relevant inputs and insight into pathophysiology and prevent further spread and evolve management strategies of COVID-19 patients from data-driven techniques.SETTINGS AND DESIGN:A retrospective observational descriptive study was conducted on 29 COVID-19 patients admitted at a premier medical institution of North India in the months of February and March 2020.METHODS:The patients were diagnosed with reverse transcription-polymerase chain reaction test. Demographic, clinical, and laboratory data were collected.RESULTS:The mean age of population was 38.8 years with male preponderance, of which two patients were residents of Italy, and others hailed from semi-arid and Western sandy arid regions of Rajasthan (urban population). The major presenting symptom complex of said COVID-19 sample population included fever (48%), cough (31%), and shortness of breath (17%). Most of the patients (83%) had no comorbidity. No clinical correlation (r) could be appreciated between the duration of test positivity and age of afflicted COVID-19 patients (r = −0.0976).CONCLUSIONS:The present evaluation of various facets of the ongoing global pandemic of COVID-19 is an attempt to portray early clinical and epidemiological parameters of the menace of COVID-19 patients admitted at SMS Medical College and Attached Hospitals, Jaipur.

2023 A Unique Presentation of GI Bleeding as First Presentation of AML

INTRODUCTION: Acute Myelogenous Leukemia (AML) is a heterogenous group of cancers of blood cells associated with many dysfunctions due to monoclonal expansion of blood marrow. AML typically presents with symptoms of pancytopenia, including general fatigue, weakness, infections, ecchymoses, epistaxis, or menorrhagia. Overt GI bleeding is not a common initial presentation for AML. CASE DESCRIPTION/METHODS: Our patient was an 85-year-old female with a past medical history of gastrointestinal bleed while taking DOAC for pulmonary embolism, gastroesophageal reflux disease, hypertension, and uterine adenoma with subsequent hysterectomy and bilateral oophorectomy. She presented with complaint of “jet black” stools for 12 hours and accompanying weakness. She had no other alarm symptoms including pallor, bruising, neurological complaints, weight loss, hematochezia, or night sweats. She was known to have a hiatal hernia on previous EGDs and a bleeding distal rectal mucosal lesion concerning for a Dieulafoy lesion, both of which were two years prior to admission. Her initial labs were significant for hemoglobin 8.4, platelets 24, INR 1.0, and white blood cell count 5.1 with normal differential. Upper GI bleed was suspected, despite her previous lower GI bleeding, and the first upper endoscopy was performed; this revealed a possible Dieulafoy lesion that was hemoclipped. Her anemia and melena continued to worsen and Hematology performed a bone marrow biopsy. In the intervening time, two more upper endoscopies were performed yielding no further evidence of bleeding. Given her continued symptoms, colonoscopy was performed showing blood in the terminal ileum and right colon with no obvious lesion; there was, however, discrete mucosal bleeding sites in the rectum with no lesions noted after extensive cleaning. Multiple hemoclips were placed in the rectum but,ultimately, none of the endoscopic interventions proved durative. Shortly after colonoscopy, bone marrow biopsy revealed AML. DISCUSSION: Our case highlights a unique presentation of AML, where gastrointestinal bleeding is the first major presenting symptom. Bruising, epistaxis, and vaginal bleeding are the most typical types of bleeding in AML, none were found in this patient. AML is due to dysfunctions due to monoclonal expansion blood marrow that can lead to preferentially nonfunctional blood lines. This patient had significant thrombocytopenia with cells that were dysfunctional, leading to diffuse gastrointestinal hemorrhage without the presence of bleeding lesions.

An Uncommon Silent Strategic Left Middle Cerebral Artery Infarction

Impairment of memory retrieval is not the major presenting symptoms of vascular cognitive impairment (VCI), which can result from silent strokes occurring in uncommon vascular territories, and can be detected only on neuroimaging or neuropathology. The neuroanatomical substrate for VCI remains unclear. This report presents an uncommon location of silent strategic infarction resulting in an insidious onset and gradual progression of the cognitive decline without overt sensorimotor deficits. J Med Cases. 2019;10(7):203-205 doi: https://doi.org/10.14740/jmc3328

A descriptive study to quantify severity in patients with severe scrub typhus in hilly city of Northern India

Background: Himachal Pradesh is an endemic area for scrub typhus. If not treated early, it can lead to life threatening complications. Therefore, more emphasis needs to be laid on the diagnosis and prompt treatment, so that mortality due to severe scrub typhus can be prevented. So, this study was done with an objective to study the clinical profile of patients diagnosed with severe scrub typhus and assess their severity using APACHE II score in IGMC, Shimla.Methods: Authors conducted a descriptive cross-sectional study in Indira Gandhi Medical College, Shimla over one year (June 2016-May 2017). Out of 538 confirmed scrub typhus cases, 58 severe cases were reported, and their severity was assessed with predefined criteria of sepsis and APACHE II score.Results: Mean age of males (50.18±18.6 yrs) was found to be more than that of females (45.52±14.5 yrs), the difference being statistically insignificant t(56)= -1.01, (P=0.32). Fever (100%), headache (84.5%), vomiting (79.3%) were the major presenting symptoms and tachycardia (96.5%), hypotension (87.9%), tachypnoea (94.8%) were the main clinical signs. The mean APACHE II score on admission was 16.25±5.0 with a predicted mortality of 23.5%, that was found to be less than actual reported hospital mortality (25.8%).Conclusions: APACHE II score was found reliable tool for risk stratification. Case fatality in diagnosed cases of severe scrub typhus was found high. Early diagnosis and prompt treatment according to guidelines would help in decreasing the mortality, financial burden on patient, society and health system.

Urinary Tract Infection in Febrile Children Attending OPD at Seti Zonal Hospital

Background: Urinary tract infection is a common problem in febrile children. It is dangerous because it may lead to a life-threatening episode or may lead to renal scarring. Recurrence of UTI is common in children. Though it is a serious problem, it is treatable if diagnosed early.&#x0D; Methods: A total of 340 urine samples from pediatric patients attending pediatric OPD were sent for culture after medical history taking, physical examination and counselling parents/guardians/children. Besides fever other presenting complains were noted.&#x0D; Results: In total there were 340 samples, 127 (37.35%) samples were culture positive showing isolated bacterial growth and 53 (15.6%) showed mixed bacterial growth in the culture. Out of 127 culture positive urine samples, 51.2% showed growth of E. Coli, followed by Proteus spp. and Streptococcus fecalis. Other less common bacteria were Klebsiella, Staphylococcus and Enterobacter spp. More than half 75(59.05%) of the children were male and only 52(40.95%) were female. Similarly, male children (59.06%) were affected more than female children (40.94%). Apart from fever, 72 (56.7%) of the children were presented with the symptoms of feeding problems, 68 (53.5%) were presented with pain abdomen, and 65 (51.2%) were presented with vomiting. Less typical presenting symptoms of the children with UTI were screaming attacks/irritability (37.8%), dysuria (30.0%) and frequency of urination (24.4%). Similarly, non-specific symptoms like diarrhea, failure to thrive, and convulsion were present in few children and none of the children had enuresis and loin pain. Of all the urine culture positive cases the bacterial isolate was Escherichia coli &#x0D; Conclusion: Prevalence of UTI was more in male than in female children and E. coli was found to be the most common bacteria causing it. Besides fever, feeding problems, pain abdomen, and vomiting were the major presenting symptoms of morbidity in children with UTI. Although UTI is rarely a difficult problem, for the accurate diagnosis of UTI in children attention should be paid during the history taking and collection of the urine sample.

Clinical Profile of Thalassemia Syndrome in Children of Northern Bangladesh

Background: Thalassemia is a common hematological disorder in our country having wide spectrum of clinical presentation. The frequency and severity of the several types of thalassemia depend on the racial background of the population. Hb-E Beta thalassemia is prevalent in our country.&#x0D; Objective: To see the clinical features of different types of Thalassemia in northern area of Bangladesh. Methods: Hundred cases were selected from Thalassemia patient admitted in department of pediatrics, on May 2012 to October 2012. A prescribed questionnaire was used to record the information. The methods were explained to the patients and consent was taken. Necessary physical examination was performed and investigations were done. The data was analyzed by standard procedure.&#x0D; Results: Out of hundred (100) cases, most (61%) were Hb-E beta Thalassemia, less common (1%) was Hb-E disease, and 1 % case was Hb-E trait. Majority (64%) manifested clinically under one year of age. 54% were male and 46% were female. The major presenting symptom was progressive pallor in 70% cases. Others presenting complaints were low grade fever (40%). Hemoglobin concentration at the time of diagnosis was below 5 gm/dl in 53.33% patients. In hemoglobin electrophoresis it was Hb-E ranged from 54.64 ± 13.02%, Hb-F 34.84±13.73%, Hb-A 23.32± 18.15% and Hb-A2 3.5± 70%. Radiological findings revealed gross bony changes occur in long standing cases. Enlarged cardiac shadow was found in those cases having severe anemia with heart failure.&#x0D; Conclusion: In countries with a high incidence of thalassemia, it is vitally important to offer prospective genetic counseling and to warn carriers about the risks of intramarriage. Nutritional and folic acid supplementation with regular blood transfusion along with iron chelation therapy is essential to improve the prognosis.&#x0D; TAJ 2018; 31(2): 6-11

Left Atrial Function Assessment in Patients with Rheumatic Mitral Valve Diseases

AbstractBackground: The assessment of Left Atrial (LA) function is used in various cardiovascular diseases. LA plays a com-plementary role in cardiac performance by modulating Left Ventricular (LV) function. Transthoracic two-dimensional (2D) phasic volumes and Doppler echocardiography can measure LA function non-invasively. However, evaluation of LA deformation derived from 2D Speckle Tracking Echocar-diography (STE) is a new feasible and promising approach for assessment of LA mechanics. These parameters are able to detect subclinical LA dysfunction in different pathological condition.Aim of Study: To assess left atrial function by conventional echo Doppler study and tissue Doppler based strain imaging as well as global longitudinal strain in patients with rheumatic mitral valve disease.Patients and Methods: A total of 50 rheumatic mitral valve disease patients appearing consecutively for echocardi-ogram (ECHO) test at the Cardiology Department in a tertiary care hospital were recruited into the study as per the pre-set inclusion and exclusion criteria. The data were pooled using Microsoft Excel and analysed using SPSS software by appli-cation of appropriate statistical tests.Results: Of the 50 subjects, 22 had Mitral Stenosis (MS), 14 had Mitral Regurgitation (MR), and 14 of them were found to have both MS and MR. The major presenting symptom as observed in 23 patients was dyspnea. LA functions were significantly reduced in double mitral lesion group which was observed in LA indices such as LA emptying fraction, LA passive emptying fraction, atrial fraction, and LA expansion index among groups.Conclusion: LA reservoir, conduit and contractile function were significantly affected in rheumatic mitral valve disease due to increased hemodynamic load. Global longitudinal strain was significantly reduced in patients with MS and MR.

Spinal Kyphoscoliosis Associated with Chiari Formation and Syringomyelia ‘Recovery’ Following Atlantoaxial Fixation: A Preliminary Report and Early Results Based on Experience with 11 Surgically Treated Cases

Immediate postoperative and early clinical outcome of treatment of spinal kyphoscoliosis (SKS) associated with Chiari formation (CF) and syringomyelia (SM) and treated by atlantoaxial fixation is described. During the period April 2016 to March 2018, 11 patients with SKS as a major presenting symptom in association with CF and SM were surgically treated and are analyzed retrospectively. The patients were 6 boys and 5 girls, and their ages ranged from 11-17 years (average 14 years). Six patients (54.5%) had associated neurologic symptoms and 9 patients had neck pain. All patients were treated by atlantoaxial fixation. No manipulation of foramen magnum bone or dura was performed. No surgery was performed on the subaxial cervical or dorsal spine. Patient Satisfaction Score was based on a specially designed questionnaire. Other outcome measures included clinical and radiologic assessment data, clinical photographs and video observation, and a Scoliosis Research Society Questionnaire. Apart from improvement in neurologic condition, more particularly in breathing capability and voice volume restoration, all patients and their relatives noticed recovery in SKS in the immediate postoperative phase. During the average follow-up of 14 months, all patients continued to have progressive symptomatic recovery and recovery from SKS. Patient Satisfaction Score suggested that all patients were 'highly' satisfied with the surgical outcome. Atlantoaxial fixation in patients with CF and SM associated with SKS results in reversal of several musculoskeletal and neural abnormalities that includes recovery from spinal deformity.

A clinical study of gastric outlet obstruction

Background: Gastric outlet obstruction (GOO) is a diagnostic and therapeutic challenge in developing countries to a Surgeon. Gastric outlet obstruction, a clinical condition impeding emptying of stomach mechanically, can be due to varied etiology. This study was taken up to know the etiological factors and management.Methods: This was a descriptive prospective study done at Madurai Medical College for a period of 2 years from September 2009 to August 2011. A set of inclusion and exclusion criteria were defined and followed. Upper gastro-intestinal endoscopy (OGD) was done in all cases while Barium meal study was done in few cases to make the diagnosis. Relevant operative procedure was done, and patients were managed post operatively.Results: Cicatrised Duodenal ulcer (DU) was the commonest cause followed by Carcinoma Pyloric antrum (Ca PA). Majority of the patients were males (67.5%) with male to female ratio of 2.07:1. Vomiting was one of the major presenting symptoms in all the patients.Conclusions: Cicatrised DU was the commonest cause for GOO in present study. Present study highlights the increasing incidence of Ca PA. This could be due to better management of DU at an early stage.

Approach to the vomiting child

Abstract Vomiting is one of the commonest symptoms in children and accompanies most acute childhood illnesses. However, when vomiting is the major presenting symptom, particularly when episodes are repeated, it is an altogether different test of the clinician's skills in diagnosis and management. A simple coherent approach should be based on an understanding of essential basic physiology and a focussed history, leading to a logical choice of tests and rational management. This review presents some of the common and challenging situations that clinicians currently face in primary and secondary care and offers recommendation for investigation and management.

Voice Quality Affection as a Symptom of Chiari Formation

Voice alteration as a presenting symptom in cases with Chiari formation is analyzed, as well as outcome after atlantoaxial fixation. During the period January 2016 to June 2017, 25 cases of Chiari formation presented with associated or a major presenting symptom of voice or speech quality alteration related to inadequate breathing efforts. All patients underwent atlantoaxial fixation. No foramen magnum decompression was done. In all patients, the voice quality and volume and breathing disturbances improved in the immediate postoperative period after recovering from anesthesia. During the period of follow-up that ranged from 12 to 25 months, all patients continued to improve in their speech function. Such critical symptoms of voice disturbance and inadequate breathing and the possibility of rapid postoperative recovery have not been recorded earlier in the literature.

Nausea and Vomiting as Major Presenting Symptoms of Thyrotoxicosis

Thyrotoxicosis has a variety of presentations which depend on its severity and duration, as well as the age of the patient. Nausea and vomiting as major presenting symptoms of thyrotoxicosis are rarely reported. We report three patients with nausea and vomiting as major presenting symptoms of thyrotoxicosis, where two of the patients were extensively investigated, and thyrotoxicosis was not suspected until late in the disease. In reporting these patients we aim at drawing attention to these forgotten symptoms of thyrotoxicosis, and particularly to emphasize that, at times nausea and vomiting may be the only presenting features of thyrotoxicosis, leading to considerable difficulty in diagnosis. Moreover, these case reports give further support to the contention that thyroid studies should be carried out in border indications than conventionally accepted. J Endocrinol Metab. 2018;8(4):79-81 doi: https://doi.org/10.14740/jem511w

High rates of Mycobacterium fortuitum isolation in respiratory samples from Iranian patients with suspected tuberculosis: is it clinically important?

Although Mycobacterium fortuitum (M. fortuitum) is not an organism rarely isolated from respiratory samples, its clinical importance is still not fully understood, which therefore prompted our current study. We evaluated respiratory samples from 6800 patients with suspected tuberculosis from May 2014 to May 2016, for the detection of M. fortuitum using phenotypic and genotyping methods.Results/Key findings. Of the 40 patients with M. fortuitum lung disease, 35 had two or more positive culture results. The mean age of these 35 patients was 50.7±18.4 years, and 20 (57.1 %) were men. Sputum (68.6 %), haemoptysis (51.4 %), cough (45.7 %) and gastroesophageal disease (22.9 %) were the major presenting symptoms. Cystic fibrosis, other bacterial lung diseases and lung cancer were the main underlying pulmonary diseases. Five patients (12.5 %) were human immunodeficiency virus (HIV) positive. The most common chest X-ray findings were reticulonodular opacities (53.3 %). Multivariate logistic regression analysis revealed that cigarette smoking history (OR 0.334, 95 % CI 0.125-0.843, P=0.048) and underlying lung disease (OR 0.393, 95 % CI 0.216-0.588, P=0.023) were significant predictors for positive M. fortuitum infection. These results demonstrated the high frequency of M. fortuitum in respiratory samples and that this bacterium causes transient infection or colonization in patients with underlying pulmonary conditions, such as cystic fibrosis and cigarette smoking-induced. Additionally, it appears that infection with M. fortuitum is particularly common and may be important in patients with HIV.

Evaluating the Effect of Endoscopic Sinus Surgery on Laryngeal Mucosa Stroboscopic Features.

The major presenting symptom of nasal polyps is nasal obstruction. The role of nasal obstruction in the genesis of laryngeal disorders is still unknown. The aim of this study was to evaluate laryngeal videostroboscopic changes after functional endoscopic sinus surgery (FESS) in patients with nasal polyposis. A longitudinal study was carried out from March 2012 to June 2013. Thirty patients with bilateral nasal polyposis who did not respond to maximum medical treatment and were candidates for FESS were recruited. Laryngeal videostroboscopy was performed before and 3 months after FESS. Glottic gap, true vocal cord (TVC) borders and pliability, false vocal cord (FVC) movement, laryngeal erythema and mucosal edema were documented. Laryngeal erythema and TVC edema were significantly decreased after FESS. Laryngeal erythema was documented in 18 patients after a 3-month follow-up. Four patients (13.3%) showed mild-to-moderate TVC edema and 26 patients (86.7%) had normal TVC mucosa. The results of this study show that FESS has a significant impact on laryngeal videostroboscopic features including laryngeal erythema and TVC edema.

Minimally Invasive Resection of Deep-seated High-grade Gliomas Using Tubular Retractors and Exoscopic Visualization.

Deep-seated high-grade gliomas (HGGs) represent a unique surgical challenge because they reside deep to critical cortical and subcortical structures and infiltrate functional areas of the brain. Therefore, accessing and resecting these tumors can often be challenging and associated with significant morbidity. We describe the use of minimally invasive approaches to access deep-seated HGGs to achieve extensive resections while minimizing surgical morbidity. All patients who underwent resection of a deep-seated intraparenchymal HGG with the use of a tubular retractor with exoscopic visualization from January 2016 to May 2017 were identified prospectively at a single institution. Variables evaluated included tumor location, pre- and postoperative neurologic function, extent of resection, and length of hospital stay. Overall, 14 patients underwent resection of an HGG (11 glioblastomas, 3 anaplastic astrocytomas) with a tubular retractor under exoscopic visualization. Seven tumors (50%) involved the thalamus, three (21%) the motor corticospinal tract, two (14%) the inferior frontal occipital fasciculus, one (7%) each the basal ganglia and optic pathway. The median preoperative Karnofsky Performance Score (KPS) was 70 (interquartile range: 55-80), where the major presenting symptom was motor weakness in seven (50%). The average plus or minus the standard error of the mean percentage resection was 97.0 ± 1.2%. The median hospital stay was 4 days (range: 2-7). At 1 month postoperatively, median postoperative KPS (within 30 days) was 87 (range: 77-90), where eight (57%) were improved, five (36%) were stable, and one (7%) was worse postoperatively. Deep-seated HGGs can be accessed, visualized, and resected using tubular retractors and exoscopic visualization with minimal morbidity.