Radiological significance of high-resolution computed tomography for elderly pulmonary tuberculosis patients : an analysis with culture test

Purpose: Pulmonary tuberculosis (PTB) is one of the major health problems in the elderly population, causing significant morbidity and mortality. The aim of this study is to evaluate the significance of the high-resolution computed tomography (HRCT) modality for the diagnosis of PTB, in comparison to culture test. Material and methods: Thoracic HRCT images of the study population, comprising 124 patients clinically suspected for PTB with smear and culture reports, were analysed for sensitivity and specificity of the HRCT test. Features of active PTB were centrilobular nodules, 'tree-in-bud' pattern densities, macro-nodules, consolidations, cavitary lesions, ground-glass opacities, and miliary nodules. Results: Among the study population, 108 cases presented HRCT features of active PTB and the remaining cases were negative but had presented a few features mimicking PTB. As inferred from positive culture test results, 106 cases had active PTB, the remaining cases were culture negative for PTB. False-positive (FP) or 'type I error' cases, and false-negative (FN) or 'type II error' cases were ascertained by Bayes' theorem. Sensitivity (true positive rate) and specificity (true negative rate) of HRCT test were 0.8125 and 0.8571, respectively. Conclusions: For proper diagnosis the predictive capability, as two values of 'a posteriori probability', was computed; the mean value of 'a posteriori probability' for HRCT was 0.6358. When its culture test was positive, the HRCT test was 69.56-92.85% efficient in ascertaining positive results with a sample; on the other hand, when its culture test was negative it was 66.66-100% efficient for a negative result. Thus, the HRCT test is considerably dependable

COMPUTED TOMOGRAPHIC EVALUATION OF INFERIOR TURBINATE HYPERTROPHY IN ADULT INDO-DRAVIDIAN PATIENTS WITH DEVIATED NASAL SEPTUM

Objective: Aim of the study was to evaluate the prevalence and significance of inferior turbinate hypertrophy (ITH) in adult indo-dravidian patients with deviated nasal septum (DNS). Methods: Analysis of sinonasal computerized tomography (CT) images of 86 patients having DNS was done during October 2015-December 2016 for evaluation of severity of the associated ITH. Values of maximum width of medial mucosa, bone and total width of the turbinate were measured. Patients with inflammatory or expansile sinonasal masses were excluded. Results: Total 86 patients with varying degrees of septal deviation with ages ranging from 18 to 72 years (mean age of 42.8 years) were distributed as: Group I, mild cases and Group II, moderate and severe DNS cases. Patients having ITH on the contralateral side of deviation were included in the study group. The dimensions of the ITH were evaluated. The medial mucosal component of the ITH underwent maximum hypertrophy as compared to bone and lateral mucosa components. The average medial mucosa, bone and total turbinate widths of the inferior nasal concha as well as lateral offset in Group II DNS cases were 5.21 mm, 1.76 mm, 9.96 mm and 8.74 mm, respectively. Total width and width of medial mucosa of ITH in relation to the severity of septal deviation was statistically significant (p=0.0001 and 0.0098). Conclusion: Present study evaluated the relationship between DNS and compensatory ITH. The findings support the decision to excise the inferior turbinate at the time of septoplasty, because of the significant mucosal expansion

Bayesian analysis of high-resolution ultrasonography and guided fine needle aspiration cytology in diagnosis of palpable thyroid nodules

Abstract Introduction To evaluate diagnostic accuracy of high-resolution ultrasonography in differentiation of benign and malignant thyroid nodules in comparison to results of guided fine needle aspiration cytology based on the Bayes rule. Objective To assess the validity of ultrasonography results of thyroid nodules in comparison to guided fine needle aspiration cytology findings. Methods This study was done on randomly chosen 80 patients presented with palpable thyroid nodules, undergone real-time sonographic evaluation of thyroid nodules to characterize features, internal consistency, margins, echotexture, calcification, peripheral lucent halo and vascularity. Ultrasonography guided fine needle aspiration cytology studies of thyroid nodules were done. Results Palpable thyroid nodules were highly prevalent in fourth and fifth decades of life with female-male ratio, 4:1. Solid internal consistency was demonstrated by 75% malignant nodules. Hypoechogenicity and intra-nodular micro-calcifications were observed in 92% malignant nodules; 83% malignant nodules had intra-nodular vascularity and absence of peripheral halo. The pre-test prevalence of malignant nodules in the targeted population was 17.5%. As type I error, 2.5% false-positive cases and as type II error, 5.0% false-negative cases were detected. Values of sensitivity and specificity of the ultrasonography test were 71.43 and 96.97%, respectively. Conclusion Malignant thyroid nodules demonstrated ultrasonography characteristics of hypoechoic texture, intra-nodular micro-calcifications, solid consistency, internal vascularity and absence of peripheral halo. The ultrasonography test has 92.5% diagnostic accuracy to differentiate malignant from benign lesions in comparison to the gold standard fine needle aspiration cytology test

Performing Tracheostomy in Intensive Care Unit- A Challenge during COVID-19 Pandemic

COVID-19 is a rapidly spreading infection caused by novel corona virus. It is challenging to the medical community in an unprecedented degree. Clinicians and health care workers are at added risk of infection during the procedure performing at the intensive critical care unit. Tracheostomy is a common surgical procedure performed at ICU for prolonged ventilation of the patient. Performing tracheostomy is currently a challenging for otolaryngologist at the ICU because of high chance of spreads of the virus to the surrounding health care workers and also to the other patients. The location for this procedure in ICU should be well ventilated after the procedure and the pressure in the room must be maintained negative or neutral. The health care personnel particularly Otolaryngologists have a central role for managing this situations where they are assessing the patients, preventing the contamination to other assisting staff and other patients. As there is progressive rise of the COVID-19 patients worldwide, it is surely expected that several patients may need intubation and mechanical ventilation. So, in this condition, patient my require tracheostomy for prolonged ventilation. Because of the very minimum literature available  regarding tracheostomy in the COVID-19 pandemic, so this review article will surely increase awareness among health care personnel and surgical team for prevention of the transmission of the infection from tracheostomy to medical staffs and other patients

Surveillance of bacteria Pseudomonas aeruginosa and MRSA associated with chronic suppurative otitis media

Abstract Introduction: Suppurative otitis media is a critical disease causing perforation of the tympanic membrane associated with changes of the mucoperiosteum of the middle ear cleft. Objective: To isolate causative bacteria from chronic suppurative ear discharges and to ascertain their antibiotic profiles, of patients attending outpatients department in 3 years. Methods: For isolation of bacteria, samples of ear discharges were grown in suitable media and bacteria were subjected to antibiotic profiling by the Kirby-Bauer's method with presently used antibiotics. Results: A total of 1043 bacteria were isolated, including Pseudomonas aeruginosa and methicillin resistant Staphylococcus aureus, along with 121 fungal isolates. Among 371 P. aeruginosa isolates, tobramycin 30 had the highest susceptibility rate 93.2%, followed by ceftazidime 30, 91.5% and amikacin 10 µg/disk 64.4%. Of 359 S. aureus isolates, there were 236 coagulase negative S. aureus + methicillin sensitive S. aureus isolates, while 123 isolates were methicillin resistant Staphylococcus aureus with 95.2% isolates susceptible to cloxacillin 15, 83.3% isolates to erythromycin 15 and 78.5% isolates to gentamicin 30 µg/disk. Of 1164, 49 patients presented post aural abscess, 12 patients had intracranial complications, 9 patients had facial palsy and 3 patients had labyrinthitis. More than 90% P. aeruginosa and 90% S. aureus isolates were sensitive to tobramycin 30 and cloxacillin 30 µg/disk, respectively. Conclusion: Multidrug resistant strains of P. aeruginosa were more prevalent than those of S. aureus in ear discharges. Tobramycin and cloxacillin may be included in the formulatory antibiotic regimen to overcome bacterial infections in chronic suppurative otitis media

A case of expansile ancient schwannoma of the nose and paranasal sinuses

A rare case of a unilateral nasal mass involving the left nasal cavity and the paranasal sinuses in a 54-year old man with progressive left nasal obstruction is presented. A polypoid mass in the left nasal cavity was evident from anterior rhinoscopy. Computed tomography scan revealed soft tissue attenuation in the left nasal cavity and paranasal sinuses with an erosion of the nasal septum and the compression of the lamina papyracea of left orbit with an extension to its extra-conal space, which suggested the expansile nature of the mass. It was excised endoscopically and found to be an ancient schwannoma, known from histopathological and immunohistochemical studies, which was a rare occurrence in nose and paranasal sinuses

Evaluation of Tumor Necrosis Factor-Alpha Gene (−308 G/A, −238 G/A and −857 C/T) Polymorphisms and the Risk of Gastric Cancer in Eastern Indian Population

Introduction: Gastric cancer (GC) is one of the leading causes of cancer-related decimations worldwide. The gastric infection at both the stomach and duodenum with Helicobacter pylori causes inflammation by the tumor necrosis factor-alpha (TNF-α). The aim of the study was to associate and evaluate the three TNF-α gene polymorphisms at positions −308 G/A, −238 G/A, and −857 C/T with the risk of GC. Methods: A total of 156 individuals (consecutively diagnosed 95 GC patients and 61 controls) above the age of 18 years were enrolled in the study. Healthy individuals with normal upper gastrointestinal endoscopy (UGIE) irrespective of their family history of GC or peptic ulcer were included as controls. The cited three TNF-α gene polymorphisms were evaluated using polymerase chain reaction-restriction fragment length polymorphism (RFLP). Results: There was no significant difference in the distribution of gene polymorphisms as genetic factors, TNF-α−308 GA/AA (22.1% vs. 14.8%, p = 0.2), TNF-α−238 GA/AA (21% vs. 19.6%, p = 0.8), and TNF-α−857 CT/TT (8.4% vs. 11.5%, p = 0.5), between GC cases and healthy controls. A subgroup analysis of H. pylori-positive patients showed that there was no significant difference in the distribution of GA/AA polymorphisms in TNF-α−308 (15(45.5%) vs. 3(23%); p = 0.17) and −238 (12(36.3%) vs. 2(15.4%); p = 0.17), and the distribution of TT/CT −857 CT/TT (13(39.4%) vs. 2(15.4%); p = 0.13), among the GC cases and controls. Conclusion: The statistical comparisons of GA/AA vs. GG genotypes at −308 (with OR = 1.6, 95% CI: 0.6–3.8), −238 (OR = 1.09, 95% CI: 0.4–2.4) and TT/CT vs. CC genotypes at −857 (OR = 0.7, 95% CI: 0.2–2.1) did not suggest any association of TNF-α with GC in the population herein. Hence, the TNF-α (−308 G/A, −238 G/A and −857 C/T) may not be the associating factor for GC incidence determined by the PCR–RFLP method