Manisha Bisht

Ototoxicity: The Hidden Menace

Otolaryngology, although considered a surgical specialty, also covers many diseases that are not cured by surgery. These are treated medically and thus the otolaryngologist should have a good knowledge of drug treatments. It also entails ability to recognize, when an ENT symptom may be caused by one of the patient’s medications, particularly as this is easily remedied by changing the drug. Although most of us know the common drugs that can cause otological side effects, there are many others that we may not be aware of. Here we have tried to consolidate a list of some commonly used drugs having otological side effects.

Human papilloma virus: A new risk factor in a subset of head and neck cancers

Head and neck cancer is the sixth most common malignancy worldwide. Tobacco smoking and alcohol consumption are two well known behavioral risk factors associated with head and neck cancer. Recently, evidence is mounting that infection with human papilloma virus, most commonly human papilloma virus-16 is responsible for a subset of head and neck squamous cell carcinoma especially tumors of tonsillar origin. The molecular pathway used by human papilloma virus to trigger malignant transformation of tissue is different from that of other well known risk factors, i.e. smoking and alcohol, associated with squamous cell carcinoma. Apparently, these subsets of patients with human papilloma virus positive tumor are more likely to have a better prognosis than human papilloma virus negative tumor. Considering this fact, the human papilloma virus infection should be determined in all oropharyngeal cancers since it can have a major impact on the decision making process of the treatment.

Effect of Educational Intervention on Adverse Drug Reporting by Physicians: A Cross-Sectional Study

In India, the pharmacovigilance program is still in its infancy. National Pharmacovigilance Program of India was started for facilitating the pharmacovigilance activities. The ADR reporting rate is still below satisfactory in India. This cross-sectional questionnaire based study was carried out in a tertiary care teaching hospital in Uttarakhand, which is a peripheral ADR monitoring centre to assess the level of knowledge, attitude, and the practices of pharmacovigilance among the doctors and to compare it with the group of doctors attending educational CME for improving awareness of pharmacovigilance. The most important revelation of this study was that although adequate knowledge and the right attitude about adverse drug reaction reporting were instigated in the doctors after the educational intervention, the practice was still neglectful in both groups, emphasizing the need to design the strategies to develop adverse drug reaction reporting culture.

Study of Histopathological Changes in Primary Atrophic Rhinitis

Primary atrophic rhinitis is a progressive chronic nasal disease and histopathologically characterized by squamous metaplasia and two characteristic types of vascular involvement (type I and type II). Despite its chronicity and squamous transformation, nothing is known about the occurrence of malignancy in atrophic rhinitis. The present work was undertaken to study the histopathological characteristics in primary atrophic rhinitis and identify whether it has any association with malignant transformation. Nasal biopsies obtained from 90 patients diagnosed as primary atrophic rhinitis were studied. Squamous metaplasia was noted in 89% of patients, and type I and type II vascular involvement were seen in 67% and 33% of patients, respectively. This preliminary report suggests that there is no association between atrophic rhinitis and precancerous lesions of nasal cavity despite squamous metaplasia and confirms the presence of two types of vascular changes in the disease which is helpful to decide the treatment modality.

Study of pain management in advanced cancer patients in a tertiary care hospital in India

This observational study was carried out to investigate the pain management of 100 advanced cancer patients in a multidisciplinary academic centre. Ninety-five percent of patients reported substantial pain, 66% of patients received inadequate analgesics and only 6.32% received strong opioids. This study revealed that pain management was insufficient at the investigated institute, which could be attributed to the restricted use of strong opioids.

Effect of Palliative Drug Therapy on Quality of life in Advanced Head and Neck Cancer Patients

Advanced cancer patients are managed by palliative care and its main aim is to provide best possible quality of life to the patients by symptom management. Pain is the most agonizing symptom experienced by advanced head and neck cancer patients. Control of pain hence requires more attention by the caregiver in order to improve their quality of life. Recently quality of life issues have emerged as a main focus of cancer treatment as compared to conventional increase in survival rate. This study mainly focuses on the effect of palliative drug therapy on quality of life.

Primary Atrophic Rhinitis: A Clinical Profile, Microbiological and Radiological Study

Background. The objective of this prospective study was to evaluate the clinical profile, microbiological flora and radiological features in primary atrophic rhinitis patients and to identify their association with the etiology of primary atrophic rhinitis. Study design. Prospective case study. Materials and methods. Patients with primary atrophic rhinitis over a two years period were included in the study. Complete blood count, total protein and microbiological analysis from nasal swab were done to evaluate iron deficiency anemia, nutritional status and identification of the pathogenic bacteria respectively. Radiological evaluation was done to study the radiological features of primary atrophic rhinitis. Observations. Ninety cases of primary atrophic rhinitis were studied. The most common symptom was nasal crusting. Nasal crust, odour and atrophy of mucosa were the most consistent finding. Nasal myiasis was found in 26.6% cases. The nasal mucociliary clearance time was markedly increased. On investigation there were low value of hemoglobin and total protein in 46.6% and 25.5% patients, respectively. Pseudomonas aeruginosa (37%) was the commonest organism isolated from culture. On radiological evaluation evidence of different grade of sinusitis was seen in 87.7% case. Conclusion. The present study suggested that certain bacterial infections, anemia, poor nutrition and hereditary factor may contribute significantly to the etiology of primary atrophic rhinitis.

Active Sintered Controlled Porosity Dispenser (CPD) Cathode

CPD cathode, made out of tungsten wire, using active sintering resulted in uniform and two-fold emission as compared to B-type cathode. Studies on wire diameter using MATLAB code suggests that 20 μm diameter provides optimum barium coverage. Detailed experimental results will be presented.

Isolated palate ulcer due to mucormycosis

Mucormycosis is a rare but serious fungal infection that rapidly attacks and kills its untreated victims, who are often immunocompromised. It is one of the most fulminant and often fatal mycotic infections known to human beings. Rhinocerebral mucormycosis is the commonest presentation and its extension to the orbit and brain is quite usual but the palatal involvement is a rare and late occurrence. Isolated location of mucormycosis on the palate in an immunocompetent host is an unusual clinical entity. Here we report a case of deep hard palate ulcer due to mucormycosis in a 56-year-old man without any predisposing factor. He was successfully treated with a combination of surgical debridement and systemic liposomal amphotericin B administration for six weeks. By presenting this case report we would like to emphasis that mucormycosis should be included in the differential diagnosis of the hard palate ulcers even in immunocompetent patient.

Rosai Dorfman syndrome — A rare clinical entity

Sinus histiocytosis with massive lymphadenopathy (also known as Rosai Dorfman syndrome) is a unique disease of unknown etiology with a childhood predilection. It is an uncommon benign condition, often confused with lymphoma. Patients usually present with massive, painless, bilateral cervical lymphadenopathy and clinical course is variable. This condition has been sporadically reported in Indian literature. Here we report a 26-year-old women presenting with a painless bilateral cervical lymphadenopathy. A FNAC from cervical lymph node was compatible with Rosai Dorfman syndrome and confirmed histopathologically.