Outpatient Department Procedure Research Articles

Cytological Analysis of Thyroid lesions According to the Bethesda System for Reporting Thyroid Cytology and their Correlation with Histopathology: A Prospective Study

Introduction: Fine-needle aspiration cytology (FNAC) has a crucial role in differentiating between nonneoplasticand neoplastic lesions of the thyroid. It is a quick outpatient department (OPD) procedure. It greatlyaffects the treatment decision. The current study was done to evaluate the role of FNAC as a diagnostic tool inthyroid lesions and establish a clinico-cytological and histological correlation.Aim: To study efficacy of Bethesda system for reporting (TBSRTC) FNAC of thyroid in view of offering guidancefor patient management, for review of distribution of diagnostic categories and correlation with histopathology.Materials and Methods: It is a prospective study of thyroid lesions carried out at the Department of Pathology, CAIMS,Karimnagar over a period of 3 years (January 2020 to January 2023) A total of 303 patients of neck swelling (thyroid),with satisfactory cases on 290 patients in cytology were undertaken for histopathology. Their clinico-cytological,biochemical, and histological correlation was done only in 133 patients only. Their statistical analysis was done.Results: Majority of cases were non neoplastic. The accuracy of cytodiagnosis was 89.3% and overall malignancyrate on histopathology was 16% (37 cases).Conclusion: FNAC of lesions in thyroid gland has a high accuracy in differentiating between malignant andbenign lesions. It is safe cost effective, minimally invasive, and OPD procedure. Using FNAC as the first line ofinvestigation which streamline the reporting terminologies and the number of surgeries on thyroid lesion hasreduced greatly.

The photoreal new-age innovative pedagogical & counseling tool for glaucoma with 3D augmented reality (Eye MG AR).

In this manuscript, we have reported an augmented reality (AR) application named, 'Eye MG AR' innovated by us, to show different anatomical/pathological parts of the eyeball pertaining to glaucoma, from multiple customized angles of the user's choice to simplify glaucoma learning and clinical counseling. It is available free of cost from the Google Play Store for Android users. Procedures ranging from a simple outpatient department procedure (yttrium aluminium garnet peripheral iridotomy) to a complex surgical technique (trabeculectomy/tube surgery) can be explained and counseled with this Android application. Also, complex structures such as the angle of the anterior chamber and optic nerve head, are constructed in advanced real-time three-dimensional (3D) high-resolution confocal images. These 3D models are useful for glaucoma neophytes' immersive learning and 3D patient counseling experiences. This AR tool aims to reinvent the approach to glaucoma counseling with 'Unreal Engine' software and is created in a patient-friendly approach. Incepting 3D pedagogy and counseling with AR in glaucoma with real-time and high-resolution TrueColor confocal images has never been reported in the literature according to our knowledge.

Changing trends in microbiological profile in patients with active chronic suppurative otitis media in rural based tertiary care hospital

Background: Chronic suppurative otitis media (CSOM) is a major health issue in developing countries causing persistant problem and may lead to life-threatening complications. This major health issue and its complications can be best avoided by early and effective treatment based on the knowledge of causative micro-organisms and their antimicrobial sensitivity which ensures prompt clinical recovery. Aims and Objectives: The aim is to study the recent microbiological pattern of patients with active CSOM and to determine the in vitro antibiotic sensitivity pattern in order to scientifically guide the patient management rather than trying emperical therapy alone. Materials and Methods: This prospective study was conducted in Otorhinolaryngology and Microbiology Department of a Burdwan Medical College and Hospital, Burdwan, a tertiary care hospital in Burdwan from January 2019 to December 2020 and 117 clinically diagnosed cases of COM were included in this study after through history taking and meticulous clinical examination. Two Aural swabs were collected from the affected ear by an ENT specialist as outpatient department procedure, under strict aseptic precautions using sterile swabs, after cleaning external auditory canal with a spirit swab. In cases with bilateral disease, ear swabs were taken separately from both the ears. Pus swabs collected were immediately sent to microbiology department for aerobic culture and sensitivity as well as mycological study as per standard procedure. Results: In the present study, the predominant organism which was isolated from the ear swabs of this region was Pseudomonas aeruginosa, followed by Staphylococcus aureus, Proteus mirabilis, Klebsiella pneumoniae, and Escherichia coli. P. aeruginosa showed maximum susceptibility to Colistin, Aztreonam, Piperacillin, and Tazobactum, Polymixin B in decreasing order and showed moderate sensitivity to Levofloxacin and Ceftazidime. Amikacin is found to be the most effective antibiotic against Proteus and Klebsiella spp. isolated from CSOM patients. Conclusion: Knowledge of the local microorganism pattern and their antibiotic sensitivity is essential to allow effective and cost saving treatment to patients who will lead to reduction in morbidity and mortality.

Use of Punch in the Treatment of Plantar Warts: A Study of 250 Cases

Background: Plantar wart is a frustrating infection for both patients and clinicians that can significantly cause embarrassment, negative gauging by others, and vexation due to persistence and/or recurrence of warts, affecting a patient’s quality of life. Materials and Methods: A prospective observational study from April 2020 to March 2021 was conducted in an Indian tertiary care center on 250 patients aged between 15 and 40 years. Punch excision of solitary to multiple plantar warts was carried out with a 5-mm punch. Results: A total of 342 plantar warts were punch excised in 250 cases with 162 males and 88 females. 214 (85%) patients had a complete cure over 10 days of treatment. Eleven (5%) patients developed local secondary bacterial infections managed with oral and topical antibiotics. Complete healing was achieved in all over 2–4 weeks without any scarring. There was no recurrence among 225 cases over the follow-up period of 3 months, while 25 (10%) were lost to follow-up. Conclusion: Use of punch excision for plantar warts is a simple, affordable, and quick outpatient department procedure, requiring no suturing even with an excision size of 5 mm. It needs minimum postprocedural care and heals without scarring. This methodology of management of plantar wart highlights it as a preferable procedure in primary care centers or resource-poor settings that requires less expertise.

Clinical outcomes of titanium elastic nailing system for middle third clavicular fracture

Aim: Clinical outcome of displaced middle third clavicular fracture using intramedullary fixation by titanium elastic nail. Materials and Methods: 20 cases of displaced middle third clavicular fracture underwent closed reduction internal fixation with Intra medullary fixation by titanium elastic nail. The study was conducted from July 2020 to August 2022 admitted to Narayana Medical College and hospital, Nellore. We evaluated the Constant score to determine the outcomes.Results: All fractures got united in our study. Average time taken for full clinical and radiological union was 11.8 weeks (Range 10- 14 weeks).There were no major complications noted. Average Constant Score at final follow up was 95.16.Conclusion: Minimally invasive fixation with TENS is a safe method and can be performed with minimal complications. This method of fixation of displaced middle third clavicular fractures should result in less soft tissue injury, shorter operating time, satisfactory stabilization, a good cosmetic appearance, quick pain relief, early return to work and easy implant removal under local anaesthesia as an outpatient department procedure.

Nasopharyngolaryngoscopy in the Diagnosis of Various Pathologies of the Larynx in a Tertiary Care Hospital.

Introduction: Laryngeal disorders are frequently encountered in ENT practice. Nasopharyngolaryngoscopy is an outpatient department procedure that is used for the diagnosis and management of laryngeal disorders. The objective so the study was to study the prevalence of different laryngeal disorders by the use of Nasopharyngolaryngoscopy as an outpatient department procedure in ENT. Materials and Methods: A hospital-based prospective and analytical study was conducted in the department of ENT at Dhulikhel hospital, Kathmandu University Hospital during the period of 2 years. A total of 132 patients, who had various laryngeal symptoms and underwent NPL were included in this study. A careful and detailed history and clinical examination of the patients was done. Data were recorded and analyzed. Results A total of 132 patients with various laryngeal symptoms underwent Nasopharyngolaryngoscopy. Among them, 54.5% (72) were male and 45.5% (60) were female. The age range was from 18-84 years. The most common laryngeal disorder observed was Laryngopharyngeal reflux disease, followed by chronic laryngitis, true vocal cord nodule, and true vocal cord polyp. Conclusion Nasopharyngolaryngoscopy is a safe outpatient department procedure that is helpful for the diagnosis and management of various laryngeal disorders.

National Trends in Lumbar Puncture from 2010 to 2018: A Shift Reversal from the Emergency Department to the Hospital Setting for Radiologists and Advanced Practice Providers.

Prior research has shown substantial shifts in procedure shares between specialty groups providing lumbar punctures. Our aim was to analyze national trends in lumbar punctures among the Medicare population from 2010 to 2018. Medicare Part B Physician/Supplier Procedure Summary Master Files from 2010 to 2018 were analyzed for all Current Procedural Terminology, Version 4 codes related to lumbar punctures (62270 and 62272). Lumbar puncture procedure volume and utilization rates were assessed and stratified by place of service and specialty background of the providers. From 2010 to 2018, the overall number of lumbar puncture procedures essentially has not changed (92,579 versus 92,533). Radiologists hold the largest and an increasing procedure share of diagnostic and overall lumbar punctures (overall share, 45.7% in 2010 [n = 42,296] versus 52.3% in 2018 [n = 48,414]). Advanced practice providers have increased their procedure share (3.7% in 2010 [n = 3388] versus 8.4% in 2018 [n = 7785], + 129.8% procedure volume). Emergency medicine physicians and neurologists have a decreasing procedure share (21.8% versus 15.3% and 12.5% versus 8.8%, respectively). The inpatient hospital setting remains the largest place of service for lumbar punctures, recording a 5.3% increase in procedure share. The emergency department lumbar puncture volume has declined, with a 7.4% decrease in the overall procedure share. Similarly, the hospital outpatient department procedure volume has increased (+4%), while the private office volume has decreased (-1.7%). During the past decade, lumbar puncture procedures among the Medicare population have remained stable, with a shift in procedure volume from the emergency department and private offices to the hospital setting, which has mainly affected radiologists and advanced practice providers.

Hoarseness of voice-prospective study: etiology, evaluation and treatment

<p class="abstract"><strong>Background:</strong> Despite advances in medical technologies and improvement in diagnostic armamentarium in laryngology about 20% of cases remain undiagnosed until suspension laryngoscopy. The study was undertaken to identify etiological factors, type of lesions, age and sex distribution, sites of involvement, efficacy of different diagnostic and treatment modalities.</p><p class="abstract"><strong>Methods:</strong> A prospective study of 45 cases of benign vocal cords lesions was carried out. Patients with hoarseness of voice for >3 weeks were investigated and treated with conservative management and surgery. </p><p class="abstract"><strong>Results:</strong> Hoarseness of voice presented within 6 months after onset of symptom. The common age of presentation was between 21 to 40 years, with male:female ratio of 1.25:1. Vocal abuse, laryngopharyngeal reflux disease (LPRD) and smoking, were the most common etiological factors. Housewives were most common group. Wide angled 70<sup>0</sup> telelaryngoscopy showed 80% accuracy rate. Suspension laryngoscopy showed 100% accuracy rate. Involvements of both the vocal cords were more common, vocal cord nodule being the commonest. 70% responded very well to conservative management.</p><p class="abstract"><strong>Conclusions:</strong> Dysphonia is the most common presenting symptom having vocal cord lesion, non-professional voice user young females are most common sufferers with delay of 6 months in presenting to a laryngologist. Vocal abuse and LPRD are most common aetiologies. Telelaryngoscopy can diagnose up to 80% of them which is cost effective Outpatient Department procedure. 70% of them respond well to medical therapy and voice training. Identification of causative factor and management of them is mandatory for treatment and prevention of recurrence.</p>

Treatment of Temporomandibular Joint Arthritis with Triamcinolone Acetonide and Hyaluronic Acid Injection: An Observational Study.

Temporomandibular joint (TMJ) arthritis is a common cause of orofacial pain with distressing symptoms. The patients most commonly females are often anxious and worried due to the typical gritty sound produced during chewing moments. In other cases there is pain followed by decreased mouth opening. Currently the treatment is not standardised though the clinicians are treating these disorders either by oral medications; splintage or by injections. Though local injection of Triamcinolone acetonide and Hyaluronic acid is an innovative therapy yet it is elusive of much research. The main aim of the present study is to evaluate the efficacy of with Triamcinolone acetonide and Hyaluronic acid in treating temporomandibular joint arthritis. The present study is a prospective non randomized clinical trial of 100 patients in a tertiary referral centre. The patients diagnosed with temporomandibular joint arthritis were treated with local infiltration of 40mg triamcinolone acetonide along with 20mg of hyaluronic acid; one injection every week for 4weeks. The pre-treatment and post-treatment data was compared using student paired t test and Mann-Whitney U test. Majority of the patients showed relief in symptoms like pain (87/96) and clicking sounds (81/88) and the difference was statistically significant (p < 0.05). Though other symptoms like restrictive mouth opening; discomfort on lateral and medial movement were also relieved in 9/15 patients and 21/23 patients respectively however the difference was not statistically significant. We highly recommend the use of Triamcinolone acetonide and hyaluronic acid injection in TMJ arthritis as it helps in relieving pain and clicking of sound in majority of the patients. The treatment is an out-patient department procedure with almost no side effects in most of the patients. The cost effectiveness of the treatment is another benefit.

Flexible Nasopharyngolaryngoscopy for the Assessment of Upper Airway Disorders

Introduction: Upper airway problems are frequently encountered in ENT practice. It is difficult to diagnose upper airway pathology by conventional methods. So use of fibreoptic flexible nasopharyngoscopy (NPL) is very helpful in both diagnosis and treatment of upper airway disorders. The aim of this study is to observe the usefulness of flexible NPL in patients with upper airway problems as an outpatient procedure. Materials and Methods: A cross sectional descriptive study was conducted in the department of ENT at KIST medical college teaching hospital during the period of 2years. A total of 138 patients who had persistent upper airway symptoms and underwent NPL were included in the study Detail history, clinical examination and required investigations were done. Data were recorded and analysed.Results: Total 138 patients suffering from upper airway disorders underwent NPL. Among them 65(47.1%) were males and 73(52.9%) were females. Age range was from 16 to 82 years. Most common problem observed was laryngopharyngeal reflux disease accounting for 41 percent of cases followed by vocal cord nodule and polyp.Conclusions: Flexible fiberoptic nasopharyngolaryngoscopy (NPL) is safe and noninvasive outpatient department procedure for the assessment of upper airway disorders.

New Approach in the Management of Adult Epiglottic Abscess—A Case Report

Background: Epiglottic abscess in an otherwise healthy adult is seen as a rare sequelae of acute epiglottitis. It is a life threatening condition which requires emergency management, which if not done early, may result in fatality. Respiratory infections, exposure to environmental chemical or trauma which may lead to inflammation and infection of the structures around the throat which may lead on to epiglottitis, and an epiglottis abscess very rarely. In our case, patient was immediately managed by doing an emergency tracheostomy followed by incision and drainage in the OPD (outpatient department). This emphasizes on need for emergency airway management by doing a tracheostomy there by facilitating incision and drainage in a case of epiglottic abscess as a daycare procedure. Aim: The primary aim of this clinical record is to emphasize the need for immediate airway management in epiglottic abscess there by facilitating incision and drainage as an OPD (out-patient department) Procedure. Case Presentation: A 45-year-old man presented to the OPD (outpatient department) with complaints of dysphagia, odynophagia, muffled voice, noisy breathing for the previous 7 hours. On clinical examination pt was in stridor & respiratory distress. Since the pt was in stridor, it was immediately shifted to the OT (operation theatre), and an emergency tracheostomy was done and the airway was secured, following which a video laryngoscopic examination was done in the OPD, which revealed oedematous enlarged epiglottis with pus pointing obscuring the laryngeal inlet. Abscess was incised and drained, and pus was sent for culture & sensitivity. Pt was treated with I. V (intravenous) antibiotics as per culture reports and subsequent video laryngoscopic examination revealed near normal epiglottis with an adequate laryngeal inlet. Conclusion: Patients with epiglottic abscess are at increased risk of airway compromise, hence in such patients airway should be immediately secured by doing an emergency tracheostomy. This case shows the benefits of an emergency tracheostomy for doing incision and drainage for epiglottic abscess as an OPD procedure.

Utility of Fine Needle Aspiration Cytology in Diagnosing Bone Tumors

Aim: Fine needle aspiration cytology (FNAC) for cytodiagnosis of various lesions is routinely used in many centers. In bone, however, FNAC has not been widely applied because of concerns about its diagnostic accuracy. The present study aims to determine the value of FNAC in the diagnosis of bone tumors. Methods: It was a progressive observational study conducted over a period of one year, undertaken on suspected bone tumor cases in Acharya Vinoba Bhave Rural Hospital, Wardha, India. The material obtained was smeared on glass slides and stained with Giemsa stain. Results: A total of 36 cases were studied, of which diagnostic material was adequately obtained in 32 cases (88.88%). The sensitivity (92.85%) and specificity (94.44%) of FNAC were high, with an accuracy of 93.75%, which is similar to findings in other studies. Conclusion: FNAC plays a vital role in diagnosing bone tumors. It is a rapid, easy, cheap, and minimum invasive outpatient department procedure. However histopathology is still important in diagnosing bone tumors that are unclear or undiagnosed on FNAC since histopathology gives a complete architectural pattern of tissue.

Pitfalls in diagnosing specific subtypes of carcinoma breast on fine needle aspiration cytology: A report of two cases with review of literature

Fine needle aspiration cytology (FNAC) is a useful procedure that can be conveniently performed in the outpatient department (OPD) and can be used in the subtyping of breast carcinomas. However, some specific subtypes can cause a hindrance to that. We present two such cases, one of tubulolobular carcinoma breast and the other of squamous cell carcinoma breast that were missed on FNAC, and subsequently diagnosed on histopathology and by immunohistochemistry. A thorough knowledge of the cytological features of the subtypes and the use of immunocytochemistry can appropriately make FNAC a standard, accurate, and simple OPD procedure, thus helping us in arriving at specific diagnosis.

Fine needle aspiration cytology of epididymal nodules

Background:The incidence of non neoplastic lesions are much more common in epididymis. Clinically, epididymal nodules are easily accessible to fine needle aspiration cytology (FNAC) procedure. There are very few literature reports documenting the role of cytology in evaluation of epididymal nodules. Thus, we studied patients presenting with palpable epididymis nodules in the out patient department (OPD) from a tertiary care general hospital.Aim:This study is aimed to put forth the diagnostic utility of FNAC in palpable lesions of epididymis.Materials and Methods:A total of 40 palpable epididymal nodules were aspirated as a routine OPD procedure as part of this study. Smears were fixed in isopropyl alcohol and air dried. In all the cases, wet fixed papanicoloau stained and air dried giemsa stained smears were studied. Zeihl Neelsen stain was performed in cases which yielded caseous aspirate.Results:Except for two cases of adenomatoid tumor of epididymis all other lesions were nonneoplastic and included 14 cases (35%) of tuberculous granulomatous inflammation, 10 (25%) cystic nodules (9 spermatoceles and 1 encysted hydrocele), 5 (12.5%) of nonspecific inflammations, 3 (7.5%) filarial infection, 3 (7.5%) sperm granulomas and 3 (7.5%) adenomatous hyperplasia of rete testes. Except for the two tumors, one adenomatous hyperplasia and one tuberculous lesion, no other lesion was excised. Follow up and response to therapy was available in 78% patients and resolution indicated appropriateness of the diagnosisConclusions:Thus, as most of the lesions in epididymis are non neoplastic responding to medical line of treatment and FNAC served to aid diagnosis of non specific inflammation and avoid surgical excision in most cases.

Fine needle aspiration cytology(fnac) versus hlstopathology in cervical lymphadenopathy.

The present series includes 104 cases (36 males and 68 female) of lymph node swellings in the head and neck region in the mean age group of 30.6 years. The aspiration cytology was carried out as an outpatient department procedure and concomittant biopsy was performed in all the cases of this series. The overall diagnoitic accuracy rale of FNAC in the present histopathologically proved cases was found to be 92.3 percent. In 8 out of 104 cases (7.7 percent), the smears were unsatisfactory and therefore diagnosis could not be made by mere cytological examination.

The importance of gastroscopy in surgical diagnosis

G ASTROSCOPY is now a we11 recognized diagnostic procedure. It is safe, easy to perform, and gives information not obtainabIe by any other method. This discussion is based on a series of 456 gastroscopies performed at the Massachusetts Genera1 HospitaI, where the Wolf-Schindler AexibIe gastroscope1’2 has been in use since earIy in 1933. In this series there has been one minor compIication, but no major compIication. PreIiminary x-ray examination of the esophagus is aIways carried out before gastroscopy in order to ruIe out esophagea1 disease that wouId contraindicate the bIind passage of the gastroscope. PreIiminary esophagoscopy is unnecessary, however, for the A exibIe gastroscope aIways passes readiIy through an esophagus that appears normal to x-ray examination. Gastroscopy is conducted as an offIce or out-patient department procedure. As the patient must be fasting, earIy morning is the best time. PreIiminary gastric Iavage is usuaIIy unnecessary and inadvisabIe as it may iriitate the mucosa, but preIiminary drainage by lowering the patient’s head with a Iarge stomach tube in pIace wiI1 frequentIy yield from I to 2 ounces of retained secretions and resuIt in a more compIete and satisfactory view of the mucosa. For anesthesia of the throat a 2 per cent soIution of pantocaine, used as a gargIe, has been found suflicient. Codeine, I$ gr., may be used for sedation. During the examination the patient Iies on the left side with the head extended on piIIows or heId in the hands of a trained assistant. OnIy a very few minutes are necessary for complete gastroscopic study, and the patient may go home immediateIy afterwards. He may eat within an hour of the examination, or as soon as the IocaI anesthesia wears off. Except for sIight sore throat, there wiI1 be no unpIeasant aftermath. Gastroscopy permits a minute study of aImost a11 the gastric mucosa, but certain bIind areas shouId be mentioned. The duodenum cannot be seen. The pylorus is usuaIIy we11 visuaIized, but an uIcer Iying within the pyIoric cana wiI1 probabIy not be visibIe. In a J-shaped stomach it may be impossibIe to see the Iesser curvature of the antrum near the pyIorus. This gastroscopic bIind spot is due to anguIation and is not aIways present; during the passage of a peristaItic wave the whoIe lesser curvature may become visibIe even in a diff%uIt case. Owing to the fact that the objective Iens Iooks at right angIes to the axis of the instrument there is a bIind spot on the greater curvature where the tfp of the g&troscope impinges on the muscosa. Bv manipulation of the instrument this &ea beiomes very smaI1. The portion of the fundus above the cardiac orifice and adjacent to the esophagus is aIso invisibIe, but is a reIativeIy unimportant area. Except for these smaI1 areas, which are of varying visibiIity and importance in