Achal Gulati

Inhaled foreign bodies in children: A global perspective on their epidemiological, clinical, and preventive aspects†

While several articles describe clinical management of Foreign Bodies injuries in the upper air tract, little epidemiological evidence is available from injury databases.

A comparative evaluation of ear diseases in children of higher versus lower socioeconomic status

This study was conducted with an aim to assess the prevalence and profile of ear diseases in children from the higher and lower socioeconomic strata of society. Two groups of schools within Delhi were selected. Group A comprised of government schools located in slum areas with an average parental income of INR (Indian National Rupees) 1050 per month and group B of elite private schools with an average family income of TNR 35,000 per month. Three thousand children between the ages of 5-12 years were screened with the help of a written proforma and ear examination. Tympanometry and audiometry were done, where required. 19.6 per cent of children of group A were found to be suffering from ear diseases compared to 2.13 per cent of group B children. The two groups were also compared for number of family members, status of hygiene and parental education.

A survey on the management of acute rhinosinusitis among Asian physicians

BACKGROUND Based on the `European Position Paper on Rhinosinusitis and Nasal polyps (EP3OS 2007)`, this study aimed to investigate general practitioners (GPs) and other specialists` understanding when managing patients with acute rhinosinusitis (ARS) in Asia. METHODOLOGY Among a total of 2662 questionnaires completed, 2524 (94.8%) were valid for analysis. There were 1308 GPs (51.8%), 989 otolaryngologists (39.2%) and 227 paediatricians (9%) from Mainland China, Hong Kong, Indonesia, India, Malaysia, Pakistan, Philippines, Singapore, Thailand and Taiwan. RESULTS ARS is affecting an estimated 6 - 10% of patients seen in a daily out-patient practice. The EP3OS criteria are well supported by Asian physicians (94.1%). Most physicians (62.7%) agreed that radiological investigation is not needed to diagnose ARS. However, even for mild ARS (common cold), medical treatments were still recommended by 87% of GPs, 83.9% of otolaryngologists, and 70% of paediatricians. The top three first-line treatments prescribed were antihistamines (39.2%), nasal decongestants (33.6%), and antibiotics (29.5%). Antibiotics usage increased as the first line treatment of moderate (45.9%) and severe (60.3%) ARS. CONCLUSION ARS is commonly managed by GPs, otolaryngologists, and paediatricians in Asia. However, understanding of the management of ARS needs further improvement to minimize unnecessary use of radiological investigations, overuse of antibiotics, and under use of nasal corticosteroids.

Sinus histiocytosis with massive lymphadenopathy (Rosai‐Dorfman disease): Report of two cases with fine‐needle aspiration cytology

Sinus histiocytosis with massive lymphadenopathy (SHML) or Rosai‐Dorfman disease is a rare but well‐defined histiocytic proliferative disorder. There are only few reports or small series of cases on the fine‐needle aspiration (FNA) cytologic features of this entity. Our first case was a 14‐yr‐old girl who presented with low‐grade fever and neck swellings of 2 mo duration. FNA smears from the submandibular and cervical lymph nodes showed numerous histiocytes with evidence of lymphophagocytosis (emperipolesis) against a background of reactive lymphoid cells. The FNA cytodiagnosis was Rosai‐Dorfman disease. The patient was put on steroids, with improvement. The second patient was a 3½‐yr‐old girl who presented with fever and left cervical lymphadenopathy. The initial FNA smear from an outside laboratory was reported as reactive hyperplasia. A repeat FNA smear showed numerous histiocytes with evidence of emperipolesis, mild nuclear enlargement and multilobation/multinucleation in a few histiocytes, and reactive lymphoid cells. The cytodiagnosis was Rosai‐Dorfman disease. Review of the initial smear showed the Rosai‐Dorfman (RD) cells, but in smaller number. We conclude that FNA cytology is a useful tool in the diagnosis of SHML, but the diagnosis may be missed at initial stages when characteristic cytomorphologic features are not well‐developed. Diagn. Cytopathol. 2001;24:42–45.

Types of Food and Nutrient Intake in India: A Literature Review

Nowadays India is undergoing an impressive economic growth accompanied by a very slow decline, almost stagnation, in malnutrition levels. In developing countries, studies on dietary patterns and their relationship with nutritional status are scarce. Over the years some nutritional studies have been performed to explore different types of food consumed in various Indian regions, among different social samples. The aim of the present paper is to review and describe trends in food and nutrition intake patterns in the different states of India. The review was carried out in PubMed, using the advanced research criteria: [food* OR (“meal pattern*”) OR (“eating pattern*”)] AND (“nutrient intake”) AND India*. PubMed research gave back 84 results and out of these, 7 papers due to their focus on food intake and consumption levels in India have been included in this study. Food intake patterns showed that most of the Indians are vegetarians and that food items rich in micronutrients (pulses, other vegetables, fruits, nuts, oilseeds and animal foods) are generally consumed less frequently. Poor and monotonous cereals-based diet may promote inadequate nutrition intakes according to Recommended Daily Allowance (RDA) standards.

Primary tuberculous petrositis

Tuberculous osteomyelitis of the temporal bone is a rare and dangerous entity that should be included in the differential diagnosis of infectious processes of the base of the skull. We present the case of an 11-year-old child who presented with diplopia, ear discharge and hearing loss. The radiological and histopathological findings revealed tuberculous otitis with osteomyelitis and an abscess in the petrous apex. The child responded to anti-tuberculous chemotherapy. The diagnosis and management of tuberculous osteomyelitis are discussed and a brief review of the literature is presented.

Amyloid goiter: A case of primary thyroid amyloid disease

Amyloid goiter is an atypical presentation of an already rare disease, amyloidosis, which uncommonly comes across in previous review of literature. A patient presented with respiratory distress, which aroused a dilemma on diagnosis because the presentation mimicked that of malignancy. A high index of attentiveness should be kept whenever amyloid deposits are seen on fine needle aspiration cytology, as they are also established in medullary carcinoma. Amyloid deposits have been traced in goiter; however, it was astonishing to observe this condition causing a rapidly growing goiter, large enough to cause respiratory distress. The confirmative diagnosis rested on the histopathology of the specimen.

Public Health Implications of Obstructive Sleep Apnea Burden

ObjectiveTo assess the implications of obstructive sleep apnea (OSA) burden among Indian children.MethodsMonteCarlo simulations were performed in order to estimate the number of OSA related obesity cases among Indian children (1–14 y of age) and the number of cases of stroke, coronary heart disease (CHD) and type 2 diabetes, considered as main adverse outcomes of OSA related childhood obesity, according to untreated and treated [adenotonsillectomy (AT) alone and AT associated to continuous positive airway pressure (CPAP)] pediatric OSA. Data used to perform MonteCarlo simulations were derived from a review about current literature exploring OSA related obesity.ResultsThe analysis on the number of adverse outcomes according to treated and untreated obesity related to OSA showed that treatments reduce the number of obesity cases, resulting in a great reduction of the amount of stroke, CHD and type 2 diabetes cases. However, the cost for treating adverse outcome was higher in patients treated for obesity related to OSA compared to those not receiving any treatment.ConclusionsThe reduction in the number of adverse outcomes due to treatment of obesity related OSA implicates the urgent need for public health policies in providing screening for OSA among children population: an early detection and a consequently prompt reaction to pediatric OSA could improve the burden of OSA related obesity.

Signet ring carcinoma parotid gland: A case report

Signet ring adenocarcinoma is a recently characterized entity occurring in the minor salivary glands. All reported cases have occurred in minor salivary gland. Pure signet ring adenocarcinoma of a major salivary gland has not been reported in the literature.

Neonatal hearing screening OTOLARYNGOLOGIST’S PERSPECTIVE

1. Nelson HD, Bougatsos C, Nygren P. Universal newborn Hearing screening: systematic review to update the 2001 US Preventive Services Task Force Recommendation. Pediatrics. 2008;122:e266-76. 2. American Academy of Pediatrics, Joint Committee on Infant Hearing Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120:898-921. 3. Canale A, Favero E, Lacilla M, Recchia E, Schindler A, Roggero N, et al. Age at diagnosis of deaf babies: A retrospective analysis highlighting the advantage of newborn hearing screening. Int J Pediatr Otorhinolaryngol. 2006:70:1283-9. 4. Pimperton H, Kennedy CR. The impact of early identification of permanent childhood hearing impairment on speech and language outcome. Arch Dis Child. 2012;97:648-53. 5. Vohr BR, White KR, Maxon AB, Johnson MJ. Factors affecting the interpretation of transient evoked otoacoustic emission results in neonatal hearing screening. Semin Hearing. 1993;14:57-72. 6. Patel H, Feldman M. Universal newborn screening. Paediatr Child Health. 2001;16:301-5. 7. Augustine AM, Jana AK, Kuruvilla KA, Danda S, Lepcha A, Ebenezer J, et al. Neonatal hearing screening – Experience from a tertiary care hospital in Southern India. Indian Pediatr. 2014;51:179-83. 8. Mukhari SZ, Tan KY, Abdullah A. A pilot project on hospital-based universal newborn hearing screening: Lessons learned. Int J Pediatr Otorhinolaryngol. 2006;70:843-51.