Removal of Open Safety Pin in Larynx: A Challenging Event for an Otolaryngologist

Inhalation of foreign body is a serious event. The numbers of foreign bodies that become impacted in the larynx are small and require urgent recognition. We describe the case of a 12 year old girl with an impacted open safety pin in the larynx. The sharp end of the safety pin was upward, below the level of the vocal cords and had pierced the soft tissue. Tracheostomy was required to secure the airway and the child had an uneventful recovery. We discuss the management and describe our method of removal of the foreign body with a brief review of literature

A Rare Case of Post Septic Temporomandibular Joint Ankylosis

Temporomandibular joint ankylosis involves fusion of the mandibular condyle to the base of the skull. It is a major clinical problem that affects many patients suffering from facial trauma, infection or systemic disease. The treatment of Temporomandibular joint ankylosis poses a significant challenge because of technical difficulties and a high incidence of recurrence. This report describe a rare case of a 16 year-man with complete inability to open his mouth, diagnosed with unilateral post septic left bony Temporomandibular joint ankylosis. The surgical approach consisted of gap arthroplasty followed by vigorous physiotherapy

Spectrum of goitrous lesions in patients at a tertiary care center of Sikkim

Background: Sikkim is declared as a goitre endemic state with an estimated prevalence of 54%. The spectrums of diseases include simple goitre, thyroiditis, adenoma, carcinoma, multinodular goitre and Graves′ disease. The present study aims to determine the pattern of thyroid swelling in a hospital setup at Sikkim. Materials and Methods: This study is a retrospective analysis of records of all patients presenting with thyroid swelling in a tertiary care hospital at Gangtok, Sikkim during the period of 4 years between 1 st January 2008 and 31 st December 2011. Patients were diagnosed by clinical examination, FNAC, USG, CT scan and hormone estimation. Histopatholgical confirmation was done in surgical cases. Clinic opathological and demographic data of 166 such patients were obtained and analyzed for the present study. Results: The most common goitrous disease was simple goitre (69.27%) followed by thyroiditis (10.24%), toxic goitre (7.83%) and malignancy (12.65%). Papillary variant was the commonest carcinoma. Overall female:male ratio was 4.9:1. The prevalence goitrous lesion was highest in the middle age group between 30-39 years, while the extremes of age (below 10 years and above 70 years) were rarely involved. Conclusions: The prevalence of goitre in Sikkim is still very high despite iodisation programs by the Government. There is urgent need for more data on autoimmunity and goitrogens status to explain the high prevalence of goitre in this population

Importance of achieving the composite endpoints in diabetes

Well-conducted randomized controlled trials are instrumental in providing vital data on safety and efficacy of new molecules under consideration for approval. However acquiring such data involves huge cost and focused scientific endeavor. Selection and reporting of endpoints of a therapy is essential to assess the effect(s) of an intervention on overall disease control and guidelines have suggested the use of composite endpoint (CEP) in clinical trial design over individual endpoints to demonstrate the compound effect. Composite endpoints have been preferred for their ability to assess the net clinical benefit of an intervention, avoid misinterpretation associated with competing risks, avoid the challenge of using a single outcome to validate the study objectives and reduce the sample size requirements in trials on patients treated for diabetes. Concerns for misinterpretation or difficulty in interpretation of trial results involving CEPs arise when differences in the components with respect to either clinical importance or event rates, or magnitude of treatment effect exist and when there′s a possibility of biases due to competing risk. Suggestions for construction of composite endpoints and reporting the results of trials involving CEPs have been presented to improve the interpretations of overall effect of new interventions