Shraddha Jain

Does magnesium matter in patients of Medical Intensive Care Unit: A study in rural Central India

Introduction: Hypomagnesemia has been common, but mostly underdiagnosed electrolyte abnormality. Studies regarding this is lacking in India especially in rural setting. Here, we have correlated serum magnesium (Mg) level with outcome in patients of medicine Intensive Care Unit (ICU) with respect to length of ICU stay, need for mechanical ventilatory support and its duration and ultimate outcome (discharge/death). Materials and Methods: This is a prospective observational study carried out over a period of 1-year enrolling 601 patients of Medical ICU (MICU). The Chi-square test is applied to correlate hypomagnesemia with the outcome. Result and Observation: About 25% patients had admission hypomagnesemia. When compared with the normal Mg group, there was significant association of hypomagnesemia with outcome in terms of duration of MICU stay 5.46 (5.75) versus 3.93 (3.88), need for mechanical ventilation (56.86% vs. 24.33%), discharge/cured from ICU (61.43% vs. 85.26%), and death (38.56% vs. 14.73%). However, no significant difference was found in the duration of ventilation between the two groups. Conclusion: Hypomagnesemia is associated with a higher mortality rate in critically ill patients. The need for ventilatory support, but not its duration is significantly higher in hypomagnesemic patients. Hypomagnesemia is commonly associated with sepsis and diabetes mellitus. The duration of MICU stay is significantly higher in patients with low serum Mg.

Nasal Septal Deviation and External Nasal Deformity: A Correlative Study of 100 Cases

A prospective study of 100 consecutive patients of deviated nasal septum to analyze association of septal deviation with external nasal deformity was undertaken at Acharya Vinoba Bhave rural Hospital of Jawaharlal Nehru Medical College, Sawangi (Meghe) Wardha from January 2009 to September 2010. Nasal septal deviations were evaluated by clinical examination and diagnostic nasal endoscopy while external nasal deformities, after evaluating, were documented using high resolution photography Nasal septal deviations were classified in seven types from I to VII by using Mladina’s classification modified by Janardhan et al. Jang classification was employed to classify external nasal deformities. 66% of the patients with deviated nasal septum were symptomatic while 34 lacked symptoms. Nasal obstruction was the most frequent symptom in 64% followed by nasal discharge in 33% Type VII was the most common type of deviation in 29%. Study revealed that 67% of the patients with deviated nasal septum had external nasal deformity and of the 67 patients with external deformity, Type I deformity was most frequent (26%). Remarkable feature of our study was Type I, III, V septal deviations were not associated with external deviation Type II septal deviations were commonly associated with Type III external deformity (7%) and Type IV septal deviation were closely associated with Type I external deformity (12%).

Racemose cysticercosis presenting as cystic neck swelling

Cysticercosis is a parasitic infection caused by the larvae of the tapeworm Taenia solium which occurs in neural and extraneural forms. Latter commonly involves subcutaneous tissue, skeletal muscles, and eyes. Head and neck sites commonly involved are buccal mucosa, tongue, and lips. It presents as single or multiple submucosal/cutaneous firm nodules. We report a case of cysticercosis of the supraclavicular region of the neck where it presented as a large soft cystic swelling. The diagnosis was made by sonography and confirmed by gross and microscopic examination to be racemose cysticercosis. This is a very rare cause of a neck swelling not reported previously in the literature.

Role of dynamic slow motion video endoscopy in etiological correlation between eustachian dysfunction and chronic otitis media: A case-control study

Objective: To assess the role of dynamic slow motion video endoscopy (DSVE) for diagnosing eustachian tube (ET) dysfunction in the cases of middle ear disorders and to classify eustachian dysfunction into mechanical and functional for the purpose of systematic management of middle ear disorders. Materials and Methods: A prospective, case-control study was carried out on total 84 patients (168 ears) of whom 64 patients with ear complaints (total 95 ears) having middle ear disease was taken as cases. Remaining 20 patients without any ear and nasal complaints (40 ears) and the normal ears among the case group (33 ears) were taken as controls (total 73 ears). DSVE was performed in cases and controls to compare the incidence of eustachian dysfunction in the two groups. Tubal movements were classified into four grades depending on: (1) Appearance of tubal mucosa, (2) movements of medial and lateral cartilaginous lamina, (3) lateral excursion and dilatory waves of the lateral pharyngeal wall, (4) whether tubal lumen opened well or not and (5) presence of patulous tubes (concavity in the superior third of tube). Results: On correlating the DSVE findings of ET in both case and control group, 4 times higher incidence of abnormal ET dysfunction was obtained in cases of middle ear disorders as compared to controls (P = 0.001, odds ratio of 4.0852). We found that 29 tubes had mechanical type of dysfunction (Grades 2A and 3A), whereas 30 tubes had functional type of dysfunction (Grades 2B and 3B and patulous). Conclusion: There is a positive etiological correlation between eustachian dysfunction and chronic otitis media by DSVE. It provides valuable information regarding the structural and functional status of the pharyngeal end of the ET and in classifying the type of eustachian dysfunction into mechanical or functional, which has management implications.

Applied anatomy of round window and adjacent structures of tympanum related to cochlear implantation

INTRODUCTION Various aspects of the round window anatomy and anatomy of posterior tympanum have relevant implications for designing cochlear implant electrodes and visualizing the round window through facial recess. Preoperative information about possible anatomical variations of the round window and its relationships to the adjacent neurovascular structures can help reduce complications in cochlear implant surgery. OBJECTIVE The present study was undertaken to assess the common variations in round window anatomy and the relationships to structures of the tympanum that may be relevant for cochlear implant surgery. METHODS Thirty-five normal wet human cadaveric temporal bones were studied by dissection for anatomy of round window and its relation to facial nerve, carotid canal, jugular fossa and other structures of posterior tympanum. The dissected bones were photographed by a digital camera of 18 megapixels, which were then imported to a computer to determine various parameters using ScopyDoc 8.0.0.22 version software, after proper calibration and at 1× magnification. RESULTS When the round window niche is placed posteriorly and inferiorly, the distance between round window and vertical facial nerve decreases, whereas that with horizontal facial nerve increases. In such cases, the distance between oval window and round window also increases. Maximum height of the round window in our study ranged from 0.51-1.27mm (mean of 0.69±0.25mm). Maximum width of round window ranged from 0.51 to 2.04mm (mean of 1.16±0.47mm). Average minimum distance between round window and carotid canal was 3.71±0.88mm (range of 2.79-5.34mm) and that between round window and jugular fossa was 2.47±0.9mm (range of 1.24-4.3mm). CONCLUSION The distances from the round window to the oval window and facial nerve are important parameters in identifying a difficult round window niche. Modification of the electrode may be a better option than drilling off the round window margins for insertion of cochlear implant electrodes.

Comminuted laryngeal fracture following blunt trauma: A need for strict legislation on roads!

Laryngeal fracture is a rare condition with potential life-long implications related to airway patency, voice quality, and swallowing. Rarity of the condition leads to lack of consensus on the most suitable way to manage this injury. The mode of injury can be prevented by strict legislation on the roads. We report a case of a 28-year-old Indian male who sustained a comminuted displaced fracture of the thyroid cartilage with disruption of anterior commissure due to blunt trauma caused by the metallic side rod of a ladder projecting from the rear of a vehicle in front of the bike on which he was riding. He presented with breathing difficulty, change in voice, surgical emphysema, and pneumomediastinum, but without any skin changes over the neck. His airway could be restored due to early tracheostomy and open reduction with internal fixation with sutures along with laryngeal stenting. He has no significant swallowing or breathing problem and reasonably good voice 6 months after surgery. This case highlights the need for strict legislation on roads in India and the importance of high level of suspicion for laryngeal fracture in acute trauma patient. Early identification and timely internal fixation not only restore the airway but also improve long-term voice and airway outcomes.

Arytenoid sclerosis in diffuse idiopathic skeletal hyperostosis presenting with acute stridor in elderly: Chance or association?

Forestiers disease or diffuse idiopathic skeletal hyperostosis (DISH) is a skeletal pathology characterized by paravertebral osteophyte formation and calcification and ossification of the anterior longitudinal vertebral ligament. It is being increasingly recognized as a cause of dysphagia and rarely leads to obstructive airway symptoms such as snoring, dyspnea on exertion, and laryngeal stridor. We report an unusual case presenting with acute respiratory distress due to obstructing laryngeal edema and bilateral arytenoid sclerosis, with the fixation of left cricoarytenoid joint in association with DISH.

Pilonidal Sinus of Nasal Dorsum: A Common Disease at Uncommon Site

Pilonidal Sinus of Nasal Dorsum: A Common Disease at Uncommon Site Though most commonly found in sacrococcygeal region, pilonidal sinus, it can also be seen in rare localizations like umbilicus, forehead, scalp, clitoris interdigital area, penis, abdomen, neck and axilla. Occurrence of this lesion in the nasal pyramid and dorsum is all the more uncommon. A 45 year old male, a known hypertensive presented to ENT OPD of AVBRH with complaints of swelling over the nasal dorsum since birth. Local examination revealed a deformed external nasal pyramid with a swelling located in midline over the nose at junction of bony cartilaginous dorsum. A sinus opening was seen over the swelling with hair coming out through it. The lesion was reported histopathologically as a pilonidal sinus.

Eustachian dysfunction in chronic otitis media with bilateral concha bullosa: Is it chance finding?

Concha bullosa is reported to have a role in paranasal sinus infections. Role of asymptomatic concha bullosa in causation of Eustachian dysfunction and chronic otitis media is not well established with only few reports. Here, we report a case of a 42-year-old female patient who presented with bilateral hearing loss with no nasal complaints. On otoscopy, her tympanic membranes showed bilateral retractions with reduced mobility on the right side. Nasal endoscopy revealed incidental finding of bilateral concha bullosa confirmed on computed tomography scan of paranasal sinuses. Bilateral conchoplasty was done. In immediate postoperative period, patient had subjective as well as objective improvement in hearing status and Eustachian function. Consequently, we inferred that bilateral concha bullosa has etiological role in Eustachian dysfunction due to increased nasal resistance. Hence, conchoplasty provides immediate improvement in a dilatory function of Eustachian tube with hearing improvement.

Heterotopic salivary gland presenting as a discharging sinus in the base of the neck.

We report a case of congenital heterotopic salivary gland with draining sinus in the lower neck on the right side of a 10-year-old female, which we initially thought to be a branchial fistula. Heterotopic salivary glands are rare lesions in the neck and when present appear very similar to branchial cleft sinus or fistula. This congenital lesion is rare. This is probably the first report from India. It is important to report this case to raise the awareness of this condition.