SINONASAL VERRUCOUS CARCINOMA Case series and review of literature

Verrucous carcinoma is a low grade malignancy and is a variant of squamous cell carcinoma. It is a rare tumour of the Sino nasal tract. The neoplasm occurs in older people usually in the seventh or eighth decade of life. Our cases were sinonasal in origin and patients affected were young.

To evaluate the levels of glycated hemoglobin, serum calcium, magnesium, phosphate, uric acid and microalbuminuria in patients with newly diagnosed type 2 diabetes mellitus

Background: Over the past three decades, the number of people with diabetes mellitus has more than doubled globally, making it one of the most important public health challenges to all nations. Therefore, the present study was undertaken to compare the levels of HbA1c, serum calcium, serum magnesium, serum phosphate, serum uric acid and microalbuminuria in patients with newly diagnosed type 2 diabetes mellitus with normal healthy individuals.Methods: This is a cross sectional study and was undertaken in the Department of Biochemistry, SKIMS-MC&H, Bemina, Srinagar. Total 300 subjects included in this study were divided into 2 groups. Group I: included 150 normal healthy individuals, who were in the age group 30-80 years, of either sex. Group II: included 150 newly diagnosed patients of Type 2 diabetes mellitus in the same age group. Fasting blood samples were drawn and investigated for serum calcium, magnesium, phosphorus, uric acid, blood sugar and HbA1c. 24-hours urine was taken for estimation of microalbuminuria, and these values were compared with those of normal healthy subjects. Means ± standard deviation were calculated and student t-test was applied to find out significance level.Results: Mean serum levels of FBS, HbA1c, calcium, magnesium, phosphate, uric acid were 89.71 ± 9.22, 4.68 ± 0.47, 9.61± 0.84, 2.23 ± 0.41, 3.45 ± 0.46, 4.21 ± 1.04 in controls (group-I) and 145.57 ± 76.61, 8.94 ± 2.38, 8.09 ± 0.18, 1.92 ± 0.27, 2.82 ± 0.68, 7.01 ± 0.27 in cases (group-II) respectively (<0.001). Microalbuminuria showed significant mean difference between cases and controls 35.01 ± 41.30 and 15.35 ± 2.60 (<0.001).Conclusion: There is decrease in serum calcium, magnesium and phosphate levels, all these plays an important role in the regulation of glucose level in the blood. Hence oral supplementation of all these ions other than diet is recommended.Increased serum uric acid and microalbuminuria was seen with reduced glucose tolerance hence early estimation of both the parameters should be done while monitoring case of Type-2 diabetes and thus will help to decrease the incidence of renal complications.

Genetic diversity of Epimedium elatum (Morren & Decne) revealed by RAPD characterization

Epimedium elatum (Morren &amp; Decne) is a rare perennial monotypic medicinal herb of Berberidaceae family, endemic to high altitude shady coniferous forests of Northwestern Himalayas in India. Traditionally, it has been used in local health care system for treatment of many ailments. In the present study, a total of ten RAPD markers were used for assessment of genetic diversity in twenty accessions of E. elatum, collected from diverse ecozones in Jammu and Kashmir. Ten primers amplified a total of 100 polymorphic bands with average of 10 bands per assay unit. Primer OPO-07 generated maximum number of bands (15) &amp; produced highest polymorphic information content (0.39), marker index (5.96) and resolving power (8.9), thereby distinguishing E. elatum genotypes. The study showed moderate level of genetic polymorphism in twenty accessions of E. elatum. RAPD data set revealed association between genetic diversity and eco-geographic distribution of most E. elatum genotypes, and thereby proved useful tool for their genetic/molecular characterization. There is an urgent need for developing quick conservation strategies to save its natural germplasm from extinction in the Northwestern Himalayas

Dwindling status of Epimedium elatum (Morren & Decne) and its geographical distribution in Kashmir Himalaya, India

Epimedium elatum (Morren &amp; Decne) of family Berberidaceace is a rare perennial medicinal plant, endemic to high altitude forests of Northwestern Himalayas in India. Ethnobotanically, it has been used as an ingredient for treatment of bone-joint disorders, impotence and kidney disorders in Kashmir Himalayas. Phytochemically, it is rich in Epimedin ABC and Icariin; all of these have been demonstrated to possess remarkable biological activities like PDE-5 inhibition (treatment of erectile dysfunction), anticancer, antiosteoporosis antioxidant and antiviral properties. The present investigation reports its traditional usage, comprehensive distribution and conservation status from twenty ecogeographical regions in Kashmir Himalayas, India. The species was reported from Gurez valley for the first time. Numerous threats like excessive grazing, deforestration, habitat fragmentation, tourism encroachment, landslides and excessive exploitation have decreased its natural populations in most of the surveyed habitats. Consequently, its existence may become threatened in near future if timely conservation steps are not taken immediately by concerned stakeholders involved in medicinal plant research. Moreover, use of plant tissue culture techniques is recommended for development of its in vitro propagation protocols. Therefore, introduction of this medicinal plant in botanical gardens, protected sites and development of monitoring programmes are needed for its immediate conservation in Northwestern Himalayas, India

Compliance with Standard Precautions and Associated Factors among Critical Care Nurses in Peshawar, Pakistan and Kunming, China: Comparative Cross-Sectional Study

OBJECTIVES To find the level of compliance and the associated factors of compliance with standard precautions among registered nurses. METHODOLOGY Cross-sectional study was conducted during March and August 2020 in four hospitals, two from each country; Pakistan and China. Data was gathered through a modified version of the adopted questionnaire from 424 registered nurses, selected by a simple random sampling technique. Data were analyzed by SPSS version 26. RESULTSThe overall compliance with SPs among registered nurses in Pakistan was 57.1%, and among the respondents from China was 75.2%. Gender, age and working area were associated with the compliance of SPs. Female nurses from China are 1.72 times less compliant, while the increasing age of Pakistani nurses increases the risk for non-compliance with SPs by 1.7 times. Participants working in Emergency Department in Pakistan were 2.07 times less compliant than those working in Intensive Care Unit/Coronary Care Unit (ICU/CCU). Lack of training increases the risk of being 2.9 times more non-compliant. For Chinese Nurses, less knowledge and a lack of resources were associated with non-compliance in both countries nurses. CONCLUSION Noteworthy numbers of nurses were found non-compliant with standard precaution practices in both study populations. Therefore, strategies like regular training on standard precautions, availability of Personal Protective Equipment and policymaking may improve compliance with SPs practice

A prospective study of hearing impairment in school going children of Ghaziabad city attending a tertiary care hospital

Background:Overcrowding, poor hygiene, socio-economic status, climate, lack of resources to avail medical facilities, poor medical awareness have their bearing on the incidence of hearing loss. The family of each hearing-impaired child has its own cultural, social, educational, and financial background, and its own special needs. The aim of this study is to determine the percentage of hearing impaired school going children in Ghaziabad city.Methods:The material for the present study were a representative sample constituting 1000 school children selected from various localities of Ghaziabad city within age group of 6-12 years. The children belonged to all the strata of society and children from both sexes were evaluated for hearing loss and its underlying etiological factors. Children were subjected to detailed ENT examination in our OPD.  Results:In the present study sample the incidence of hearing loss is 9.3%. The maximum cases 60.22% belonged to the low socio-economic strata. A statistically significant difference of distribution by gender was noticed with a male preponderance (61.29%) as against 38.71% for females. The hearing loss in majority of cases was of a mild degree i.e., 26 to 45 dB (34.41%) of which majority of cases (87.10%) had conductive loss. Wax was the commonest cause of hearing loss (41.94%). CSOM was found in 21.50 % of all cases. Peak prevalence of hearing loss was found at 8 years of age, again declining after that from 20.43 % to 5.38 % by 12 years of age. Also it was observed that 59.14% children were living in crowded localities of city & 40.86% were living in non- crowded/open locality which is again statistically significant (P ≤0.05).Conclusion:The inferences drawn from the present study substantiates the view point of earlier workers that school screening is the most effective method of diagnosing deafness in school going children and should be extended to all schools in all the areas. Proper assessment and diagnosis of hearing loss in children at a very early age is important because an early diagnosis determines the efficacy of methods used for the correction of the hearing loss. Also early diagnosis of hearing impairment is a key to proper rehabilitation. The cases reporting to the hospital for treatment and rehabilitation can be regarded as the tip of the ice-berg and can have more management difficulties when compared to sub-clinical cases.

A clinical study on association between hearing loss and inflammatory bowel disease in a population attending a hospital

Background: Inflammatory bowel disease usually presents with gastrointestinal stigmata of weight loss, anaemia, and rectal bleeding, but may exhibit prominent extra-intestinal manifestations also such as joint symptoms, skin signs and some other auto-immune manifestations. During the last few years many authors have reported serious complications of IBD manifesting in the Ear-Nose-Throat (ENT) and influencing disease morbidity.Methods: Twenty four patients with active ulcerative colitis (mean age 45 years) were recruited prospectively along with 24 healthy age- and sex-matched controls. Otoscopy, tympanometry and pure tone audiometry were performed. Otoscopy and tympanometry were normal in all patients and controls. Pure tone audiometry showed sensorineural hearing loss over all frequencies in patients with inflammatory bowel disease and compared with controls. The otologic data including age of onset, family history of otologic problems, exposure to noise and audiometric findings were also reviewed.Results: Out of 48 patients with a history of IBD, 24 had documented SNHL, 17 of these patients had a diagnosis of ulcerative colitis and 7 had Crohn’s disease. 22 patients had bilateral SNHL, and 2 patients had unilateral SNHL. Tinnitis were the most common associated aural complaint.Conclusion: Sensorineural hearing loss is very unusual finding, possibly of auto-immune aetiology. We recommend steroid or immunosuppressive therapy in such a patient. Evidence for an autoimmune basis for this condition is reviewed and the potential benefit of systemic corticosteroids emphasized.

Morphological studies and meiotic chromosome analysis of Epimedium elatum (Morr & Decne) - Rare endemic medicinal plant of Northwestern Himalayas in India.

Epimedium elatum (Berberidaceace) is a rare endemic medicinal herb of Northwestern Himalayas in India. Recent ethnopharmacological reports have demonstrated its traditional medicinal use against various bone related diseases in the Kashmir Himalayas. It owes its pharmaceutical importance due to high concentration of flavonoid glycosides like Epimedin A, B, C and Icariin which are known mainly for aphrodisiac, antiosteoporosis, anticancer, antioxidant, antiaging, antifatigue and antiviral activities. It is a neglected medicinal plant in Northwestern Himalayan region and may fall in the list of endangered species due to continuous anthropogenic pressures in its native habitats. In this study, we investigated distributional and altitudinal range of this prized species from twenty diverse eco-geographical zones of Kashmir Himalayas for the first time. We also report here its diversity in morphological attributes both in wild and captive cultivation. The species has a very small population size in most of the surveyed habitats with no natural protection. Under cultivation it showed increased plant height (63.09±4.9cm), more number of leaves (95.53±11cm) and flowers (160.76±20cm), indicating importance of high altitude medicinal garden for its immediate ex situ conservation. Further, the acetocarmine staining and squashing of young anthers confirmed it as a diploid species (2n=12) like other Epimedium species. Chromosome number and meiotic abnormalities are also reported for the first time in the species. Finally, constant anthropogenic pressures in Northwestern Himalayas demand immediate in situ and ex situ conservation programmes for E.elatum

Lincoln ’S Highway - A Forgotten Abscess

Introduction: Carotid space is a deep neck space within the carotid sheath. .Mosher called carotid sheath as the Lincoln Highway of the neck. Abscess in this space is rare to be seen by young Ear, Nose and Throat (ENT) surgeons in this era of early diagnosis and good antibiotics. We are reporting a case of isolated carotid space abscess in a 20 year old male to familiarize young surgeons with this abscess. Case report: A 20 year old young boy came to our Outpatient Department (OPD) with complaints of fever, painful neck swelling, progressive difficulty in swallowing from the last 7 days. Contrast Enhanced Computed Tomography (CECT) was done which revealed abscess located adjacent to carotid artery in the carotid sheath. Incision and drainage was done and carotid sheath was opened and pus drained .Patient was discharged after few days on oral antibiotics. Conclusion: Carotid space abscesses are rarely seen in developed countries. Tender and fluctuating swelling over the carotid artery area points towards it. CECT is the investigation of choice. Needle aspiration should be avoided especially by less trained persons. Small abscesses may respond to intravenous antibiotics but when frank and large abscess is formed, incision and drainage is the treatment of choice