Brush Cytology on Pre-Malignant and Malignant Oral Lesions with Histopathological correlation

Introduction: Oral cancer is the sixth most common malignancy worldwide and accounts for 30% of all cancers in India, with 5-year survival rate, except when diagnosed in the early stages. Hence, early diagnosis of oral cancer is very much essential for the sake of the patient. However its burden on the economy for providinghealthcare is substantial and with the increasing incidence of oral cancer in developing countries like India and the other South-East-Asian countries, the role of screening methodologies for early detection of pre – cancerous and cancerous lesions of oral cavity are becoming more vital Methodology: An observational cross-sectional study conducted in the departments of Otolaryngology & head neck surgery in close association with department of Pathology in a tertiary based teaching institute in North Bengal, India, during April 2021 to March 2022. All the patients aged above 18 years, who visited the outpatient department of Otolaryngology & Head Neck Surgery, and admitted in the ward of the same, having oral lesions which are clinically suspected as pre- malignant and malignant lesions were included in this study. Results: The study population comprised of total 69 cases. Among them 47 cases (~68%) were malignantlesions, 13 (~19%) cases were pre-malignant and 9 (~13%) cases were diagnosed as benign lesions consideringHistopathology result. 30 (63.8%) out of 47 malignant cases show class-5 cytological grading in brush cytology smear, stained with Pap stain. 25.5% of the malignant cases were in class-4 and 10.6% cases were in class-3 whereas, in premalignant cases (n=13), 3 cases were in class-2 and 7 cases were in class-3 and 3 were in class-1. Maximum value of AgNOR counts for benign, pre malignant and malignant lesions were 3.54, 4.16, 7.28 respectively. Conclusion: The brush cytology with PAP grading and AgNOR analysis in clinically suspected    oral lesionscan be used as an early diagnostic tool for diagnosing oral squamous cell carcinoma especially for lower socio-economic status people who present with late stages

Tinnitus in COVID-19 Era – A Study on its Association with SARS-CoV-2 and its Outcome

Introduction Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) virus mainly affecting the respiratory and circulatory system. In many, neuro-otological changes have been noted – tinnitus being one of the leading clinical manifestations which has skipped the limelight due to the other deadly complications of the disease. The study aims to assess the relation between COVID-19 infection and tinnitus, its relation with vaccination against COVID-19 and to assess the change in intensity of tinnitus at the end of 10 weeks after medical treatment in the patients with and without a positive COVID-19 RTPCR (Reverse Transcription-Polymerase Chain Reaction) report. Materials and Methods An institution based prospective comparative study was done in a tertiary hospital in Kolkata, West Bengal between July 2021 to December 2021. All patients aged between 18 and 65 years, with recent onset of subjective tinnitus since March 2020 (COVID-19 1st wave), were included in this study. Intensity of tinnitus was assessed at the end of 10 weeks after medical treatment with the help of Tinnitus Handicap Inventory (THI). Results             Among the 84 patients with tinnitus - 20 had a history of (H/O) COVID-19 infection, 64 didn’t. Among the 20 patients who developed tinnitus post-COVID-19 infection, 2(10%) had been vaccinated while 39 out of the 64(60.9%) patients without a had been vaccinated against COVID-19 disease. At the end of 10 weeks post-treatment, 6 out of 20(30%) patients with a H/O COVID-19 showed an improvement in THI score– of them, 2 were vaccinated while 33 out of 64(51.56%) patients without a H/O COVID-19 showed improvement in THI score – of them 28 were vaccinated against COVID-19. Conclusion Our study concludes that the chances of developing tinnitus is more in those who have not been vaccinated against COVID-19 and post-medication improvement of tinnitus in COVID-19 infected patients was much less than those without a history of COVID-19 infection

Colonization and Antimicrobial resistance patterns of Potentially Pathogenic Micro-Organisms in tracheostomized patients

Introduction: Tracheostomy is one of the most common and ancient surgical procedure performed in  the world but it is like a double-edged sword which not only facilitates respiration, but also impairs the natural resistant barrier, therebyaugmenting the colonization of other secondary pathogenic micro-organisms. Hence, it is important to know the patternof microbiological colonizers in tracheostomized patients, so that adequate empiric antimicrobial coverage can preventdevelopment of hospital acquired pneumonia. This study aims to identify various micro-organisms colonizing lower airway in tracheostomized patients. Materials and Methods: An observational cross-sectional study was conducted in a tertiary based teaching hospital in North Bengal, India during July 2021 to July 2022. A total of 56 patients were included in the study. Results: Positive Cultures on day 0 were found in 20.8% & 65.6% of patients in wards and ICUs respectively. Out of the positive cultures isolated on day 0, Staphylococcus aureus was the most common organism (80%) obtained from ward patients whereas, Acinetobacter baumannii was most common organism (47.61%) in ICU admitted patients. On day 7, positive cultures were found in 66.6% & 84.4% of admitted patients in wards and ICUs respectively. Staphylococcus aureus was again the most common organism obtained (56.25%) in wards whereas, Pseudomonas aeruginosa was the most common organism (44.44%) obtained in ICU admitted patients followed by Acinetobacter baumannii (33.33%). Conclusion: Culture positivity rates were higher in patients who were previously intubated in Intensive care unit, which establishes the fact that any procedure which warrants airway manipulations, increases the chance of hospital acquired infections.  Antibiotic resistance is very common in ICU admitted patients and has a tendency to increase over time. Hence, upscaling of antibiotics is recommended only after proper sensitivity check of the tracheal aspirates

Sphenochoanal Polyp - "The Forgotten Element?"

Introduction The occurrence of isolated spheno-choanal polyps are not very common and can be very well confused with antro-choanal polyps or adenoids in adolescents and children. Appropriate diagnosis and prompt surgical intervention are essential for its removal.   Case Report We report one such case of a 16 year old female who presented with complaints nasal obstruction and reduced hearing. Endoscopic polypectomy was done with complete removal of the polyp.   Discussion Sphenochoanal Polyp is often misdiagnosed and proper investigations are thus essential for its diagnosis. Surgical Approach is the mainstay form of treatment with complete excision of the polyp

Struck by Lightning and Bitten by Snake

Introduction The simultaneous occurrence of a benign as well as malignant epithelial lesion, albeit incidental, is a rare occurrence. A multi stage procedure had to be adopted for the appropriate management of this patient. Case Report We report one such case of a 65 year old male who presented with a small black lesion on the left side of the nose and complains of left sided nasal obstruction on a much later date.  Discussion The decision to address the benign pathology initially followed by the malignant pathology owing to its indolent course formed the cornerstone in the management of this patient