Avani Jain

Diphtheria: It is still prevalent!!!

BACKGROUND Diphtheria is a respiratory infectious disease of childhood. It is a fatal disease and may cause complications if not recognized early and treated properly. Despite availability of effective vaccination it continues to be reported from many parts of the world particularly developing countries. OBJECTIVE To assess the demographic and clinical characteristics of diphtheria patients, and the predictors of outcomes of respiratory diphtheria. METHODS A prospective analysis of 180 patients with a clinical diagnosis of respiratory diphtheria admitted from 2011 to 2014 at a tertiary referral hospital. They were evaluated with respect to demographic details, immunization status, clinical features, complications and outcomes. RESULTS Most common age group affected was children less than 5 years of age (87 cases, 48.33%). The peak incidence of diphtheria was seen in the months of September and October (111 cases, 62%). Majority of the patients were unimmunized (54%), followed by partially immunized (21%). The most common complication was respiratory in 80 cases (44%), followed by cardiac complications in 54 cases (30%), and renal (16%) and neurological complications (10%). Cardiac complications were associated with the highest mortality rate (63%). The presence of bull neck and pseudomembrane score >2 was associated with a high mortality. CONCLUSION Diphtheria is still a preventable public health problem in many developing countries. Improved vaccination coverage, including booster dosage, coupled with early detection and effective treatment, may all reduce incidence and mortality.

A prospective study on the role of octreotide in management of chyle fistula neck.

To study the effectiveness of octreotide in managing chyle fistula neck and its effect on duration of hospitalization.

A rare case of subglottic embryonal rhabdomyosarcoma: managed with the aim of organ preservation.

BACKGROUND Rhabdomyosarcoma is a malignant mesenchymal neoplasm rarely diagnosed in the larynx. Traditionally, it has been treated by radical surgery (i.e. total laryngectomy), followed by radiation and/or chemotherapy. Recent advances suggest that it may be treated with combination therapy comprising high-dose radiation and pulse chemotherapy, with a high success rate. CASE REPORT We report the first documented case of subglottic embryonal rhabdomyosarcoma in an adolescent female treated with chemoradiation alone, and review the literature reflecting a move towards organ preservation. CONCLUSION While surgery has been successfully used to treat this neoplasm, combination therapy, as described in our study, also seems effective and has the added advantage of preserving laryngeal function.

Deep neck space abscesses in children below 5 years of age and their complications

OBJECTIVES To study the outcomes and complications of deep neck space abscesses in children less than 5 years of age over a period of 15 years. METHODS A retrospective analysis of children less than 5 years of age with deep neck space abscesses over a 15-year period was conducted at a tertiary care centre in India. Patients were evaluated with respect to the clinical, radiological and laboratory findings. All patients underwent surgical incision and drainage of the abscess and pus cultures were obtained. The incidence of complications was recorded. The collected data was tabulated and statistical analysis was done. RESULTS A total of 510 children less than 5 years of age were identified who were admitted for deep neck space abscess over a 15-year period. The mean age was 23.6 months. The most common organism isolated in the pus was Staphylococcus aureus (21%). The incidence of methicillin resistant S. aureus (MRSA) was 9%. Complications were reported in 10% patients. CONCLUSION Paediatric deep neck abscesses can be managed with prompt surgical management and intravenous antibiotics. Children less than 2 years of age, and those with multiple abscesses or retropharyngeal abscess were more prone to complications.

Successful cochlear implantation in Langerhans cell histiocytosis: A rare case

An 8-year-old girl presented with a 1-year history of bilateral progressive hearing loss and vertigo for 6 months. High-resolution computed tomography of the temporal bones demonstrated multiple lytic lesions. Histopathology examination confirmed a diagnosis of Langerhans cell histiocytosis (LCH). She underwent chemotherapy for 12 months. Following treatment, she was in remission. However, the bilateral profound sensorineural hearing loss persisted. She underwent right cochlear implantation with very good functional audiological outcomes. This is the first known reported case of successful auditory rehabilitation through cochlear implantation in a patient with bilateral profound hearing loss due to isolated bilateral temporal bone LCH.

Island cartilage vs temporalis fascia in type 1 tympanoplasty: A prospective study

OBJECTIVE (1) To compare the results of graft take-up and audiological outcome of temporalis fascia versus island cartilage graft in type 1 tympanoplasty. (2) To compare the rate of postoperative retraction of neotympanum in both. METHODS A prospective study was conducted on 70 patients of ages ranging from 11 to 50 years with dry subtotal perforation. 35 underwent island cartilage tympanoplasty and 35 underwent type 1 tympanoplasty using temporalis fascia graft. Graft acceptance rates and post-operative audiograms were compared. RESULTS At one year follow up, the graft take-up rate for temporalis fascia and island cartilage graft were found to be 82.9% and 97.1% respectively, which was found to be statistically significant (p<0.05). In the temporalis fascia group, two out of 35 patients (5.7%) had retraction of the neo tympanum. There was no incidence of retraction using island cartilage graft. There was no significant difference in the postoperative air-bone gap gain between temporalis fascia graft and island cartilage graft. CONCLUSION Island cartilage tympanoplasty shows a high degree of reliability in high risk cases. It has a higher graft take-up rate with no incidence of retraction of neotympanum. Moreover, it provided significant hearing improvement in our patients.

Removal of an Unusual Neglected Foreign Body in Infratemporal Region Using Navigation.

A 19-year-old male presented with complaint of a bluish mass in the hard palate since 3 months. The patient had a history of trauma 8 years back in the left zygomatic area with a pen. It was lodged in the wound and removed at that time. Computed tomography scan was revealed a linear heterogenous dense structure extending from left infratemporal fossa to oral cavity, traversing through left maxillary sinus, with bone defect seen in lateral and medial wall of maxilla, and in the hard palate, most likely a neglected foreign body. The foreign body was removed by navigation-assisted endoscopic surgery and the palatal perforation repaired using local rotation flap. There were no intraoperative or postoperative complications. Navigation-guided removal of foreign body in proximity to vital structures, in the infratemporal region, is a valuable option with minimal morbidity.A 19-year-old male presented with complaint of a bluish mass in the hard palate since 3 months. The patient had a history of trauma 8 years back in the left zygomatic area with a pen. It was lodged in the wound and removed at that time. Computed tomography scan was revealed a linear heterogenous dense structure extending from left infratemporal fossa to oral cavity, traversing through left maxillary sinus, with bone defect seen in lateral and medial wall of maxilla, and in the hard palate, most likely a neglected foreign body. The foreign body was removed by navigation-assisted endoscopic surgery and the palatal perforation repaired using local rotation flap. There were no intraoperative or postoperative complications. Navigation-guided removal of foreign body in proximity to vital structures, in the infratemporal region, is a valuable option with minimal morbidity.

Adenoid Hypertrophy in Adults: An Underdiagnosed Entity?

Adenoid enlargement is uncommon in adults. We studied the varied presentation of adenoid hypertrophy in two adults. A 45 year old male who presented with nasal obstruction and snoring, and a 35 year old male who presented with non resolving chronic otitis media.