Discrepancies in Chest X-Ray among Patients with Tuberculous Cervical Lymphadenitis

Abstract Tuberculous cervical lymphadenitis is not an uncommon entity when it comes to otolaryngology practice and that too in Bangladesh. In tuberculous cervical lymphadenitis the bacilli may reach the neck nodes from the lungs as well, through circulation. This study was done in the department of ENT and Head Neck Surgery, Dhaka Medical College Hospital, Dhaka, from January 2012 to January 2013 and was designed to find out chest x-ray abnormalities in apparently chest asymptomatic confirmed tuberculous cervical lymphadenitis without associate disease. The diagnosis of tuberculous cervical lymphadenitis was confirmed by fine needle aspiration cytology (FNAC) and/or smear for acid-fast bacillus, and chest x-ray (PA view) was done in all confirmed cases (n=183). (13%) and abnormal chest x-ray in 51 cases (27.87%). Pulmonary infiltration, the commonest radiological finding was detected in 32 cases (17.49%), hilar enlargement in 17 cases (9.29%), right paratracheal opacity in 2 (1.09%), obliteration of costophrenic angles in 3 cases (1.64%) and miliary mottling in one case (0.55%). Upper zonal predominance of lung parenchymal infiltrations was noted in 12.57% and right lung involvement in 16.39%. Single zone was affected in 9.84% cases and multiple zones were involved in 7.65% cases. We observed right hilar enlargement in 6.56%, left hilar lymphadenopathy in 4.37% and bilateral hilar lymphadenopathy in 2.73% cases. We concluded that routine chest x-ray PA view should be done in all tuberculous lymphadenitis before categorization and starting of treatment

'Polidon' Approach - A Novel Approach of Mastoidectomy in COVID-19 Pandemic

Background: WHO declared COVID-19 outbreak as pandemic in March, 2020, which was started from Wuhan of china. Mastoidectomy is an aerosol generating procedure. If a patient of COVID-19, either confirmed, suspected or asymptomatic career, requires mastoidectomy urgently, it’s a critical issue for the health care professionals for the highly contagious nature of this novel corona virus. Here, some simple, but novel and very effective measures will be discussed for protection of all health care providers (HCPs). Polythene sheet and Povidone Iodine are the change makers in this novel approach of mastoidectomy, mentioned in this article. So, we named the technique as ‘POLIDON approach’ of mastoidectomy. Method/ Material: Placement of a transparent, sterile polythene sheet which acts as an interface between patient and surgeons and all other OR staffs is an important issue. Meanwhile, extended use of Povidone Iodine (PVP-I) is recommended in different way. Mouthwash for gargling and nasal application either by spray or nasal irrigation or drop will reduce viral load from nose and mouth of patient. HCPs should use PVP-I prophylactically also. Thus the chance of transmissibility of novel coronavirus is reduced Meanwhile, Povidone Iodine should be mixed with irrigating fluid to help in reduction of contamination by bone dust mixed with fluid, produced during surgery. Conclusion: As mastoidectomy is an aerosol generating procedure, and novel coronavirus is highly contagious, so higher level of protection is required. A simple and cheap polythene sheet as barrier drape as well as rational and novel use of Povidone Iodine, i.e. the proposed ‘POLIDON’ approach can significantly reduce the chance of corona virus transmission among the health care professionals working in the operation theatre. Abbreviations: PVP-I- Povidone Iodine, HCP- Health care provider Note: Conflict of Interest: All authors declared, there is no conflict of interest. Funding: None to declare Ethical Approval: Clearance certificate was acquired from the Ethical review committee of Dhaka Medical College