An unusual giant isolated mucosal malignant melanoma of nasal cavity – A case report

AbstractThe mucosal malignant melanoma arises from the melanocytes present in the mucosal membrane. It carries a poor prognosis due to local recurrence, neck node involvement and distant metastasis, making it difficult to identify the possible treatment. The key and critical issue for the management of the malignant melanoma of the nasal cavity is early diagnosis in order to start primary modality of treatment like surgical excision and radiotherapy with adequate follow up. We report a case of malignant melanoma of the nasal cavity in a 65years old male with presentation of recurrent epistaxis and nasal obstruction. Rarity of this isolated lesion confined to nasal cavity with a giant size warrants its attention for reporting this case

COLONIZATION AND ANTIBIOTIC RESISTANCE DYNAMICS OF PATIENTS AT INTENSIVE CARE UNIT (ICU)-OUR EXPERIENCE

introduction: Multidrug resistant strains are developed day by day due to empirical therapy in intensive care unit (ICU). Both gram positive and gram negative strains are found in ICU are drug resistant bacteria. In this study, the prevalence of drug resistance bacteria in ICU were determined.Materials and Methods: The clinical samples; ascitic fluid, blood, central line tip, ET aspiration  pleural fluid, pus from liver abscess, sputum, tracheal aspiration, urine and wound swabs were collected from ICU patients and cultured in specific medium. Subsequently antibiotic sensitivity pattern of isolated bacteria were carried out with disc diffusion methods.Results: A total number of 794 clinical samples were cultured in specific medium and it revealed 191 of single colonies, 145 were double colonies and 87 were 3 or multy-colonies. A total of 963 bacteria were isolated among them 180 were gram positive bacteria, BYC were 135 and rest were gram negative bacteria. There was no significantly difference in growth of microorganisms with respect to clinical samples as t test revealed P= 0.87. Among the gram negative bacteria; Klebsiela pneumonia were predominant and Proteous mirabilis was lowest. Tigecycline and colistin were most effective antibiotics agonist all bacteria. Conclusions: Urine samples of the patient's revealed higher number of organisms where as pus from liver abscess found only one number of growths. The antibiotic stewardship programs must lead to significant decrease in all antibiotic used in the ICU setting. However, this result may be required further work to determine the fruitful necessary for success.Key words: Antibiotics, Intensive Care Unit, Bacterial infections, Drug resistance

BELL'S PALSY AMONG INFANTS - OUR EXPERIENCES IN A TERTIARY CARE HOSPITAL OF EASTERN INDIA

Objectiv:The most common etiology of unilateral facial palsy is Bell's palsy, also called as idiopathic facial palsy. Bell's palsy in infant is rare and an uncommon clinical entity and often taken as pediatric emergency by parents. Paralysis of facial nerve has a tremendous impact on patient as well as parents particularly when a pediatric patient is affected.  It is regarded as a diagnosis of exclusion.  Bell's palsy in infants is rare than adults and diagnosis is made on the basis of exclusion.Aim and Objectives:Clinical diagnosis and management of Bell's palsy among infants from a tertiary care hospital of eastern India.Material and Methods:In this prospective study, we have documented detail clinical manifestation and management of infants of Bell's palsy from the pediatric age group. When an infant presents with facial nerve paralysis, a full clinical history and detailed examination were recommended for accurate diagnosis.  Simultaneously, the parents were reassured and the prognosis was explained to the parents.  Oral steroids along with physiotherapy were started in the outdoor basis.Results:We diagnosed six infants of Bell's palsy in age group of 5 months to 12 months. Among them 4 females and rest 3 were male. These Infants showed improvement with complete recovery in 83% cases within 3 weeks whereas partial recovery was seen in rest.Conclusion:In this study, we find out that, oral steroids along with physiotherapy and eye care are effective for Bell's palsy in infants.Keywords:Bell's palsy, infant, facial nerve, oral steroid

MORTALITY PATTERN OF UNDER-FIVE CHILDREN – A HOSPITAL-BASED CROSS-SECTIONAL STUDY IN A TERTIARY CARE HOSPITAL OF INDIA

  Objective: Under-five mortality is a major public health challenge particularly in developing countries like India. The study was undertaken a hospital-based cross-sectional study to see the pattern of childhood mortality in a tertiary care hospital of Eastern India.Methods: This study was a hospital-based cross-sectional study on under-five children, carried out in the Department of Pediatrics in a tertiary care hospital from January 2013 to December 2014. All the children admitted to the inpatient Department of Pediatrics from 1 month to 5 years were included in the study group and those who died were further explored.Results: Maximum number of death occurred due to central nervous system infection (25.5%) followed by acute respiratory tract infections (19.5%) and complicated malaria (17.2%). Death occurred due to measles and its complication was 1.1% during the study. The percentage of death was higher among rural children (65.2%), children belonged to joint families (63.3%), backward classes (82.8%), low education, and the 1st order birth (49.1%).Conclusion: Specific efforts to combat under-five mortality are needed. In order of priority, the promotion of female education, gender equity, family planning, and addressing the vast socioeconomic differentials in Odisha is important steps to improving under-five survival

A CORRELATIVE STUDY ON SPINDLE CELL SARCOMA WITH CYTO-HISTOLOGICAL GRADING BY CONVENTIONAL METHODS IN AN INDIAN TERTIARY CARE TEACHING HOSPITAL

Objective: Spindle cell sarcomas constitute an important component of soft tissue sarcomas, where accurate grading is more important than histologic subtypes to plan treatment strategies and determine prognosis. To assess whether histologic criteria for grading sarcomas could be applied to fine needle aspiration biopsy (FNAB) specimens of adult spindle cell sarcomas without knowledge of sarcoma subtypes. Furthermore, correlate this grading with histologic Federation Nationale Des Centres de lutte contre le cancer (FNCLCC) grading system and find out the percentage of accuracy of FNAB grading. Methods: Hundred cases were studied by fine needle aspiration cytology (FNAC), among them 50 cases found to be spindle cell sarcoma; in only 42 cases surgical specimens were available. Each aspiration being spread into two or more slides. Subsequently, biopsy was done and studied. Technique used - grading of FNAB specimens and corresponding surgical specimens. Result: Grading of FNAB specimens done taking into account four parameters - nuclear atypia, nuclear variation (nuclear contour, chromatin, nucleoli, and nuclear overlap), mitotic figure, and necrosis. Grading of surgical specimens done by FNCLCC system. The overall results were correlated for both FNAC and biopsy concordance and statistically analyzed. From there the sensitivity and specificity were calculated as 95.23% and 80.76%, respectively. Conclusion: Histologic criteria for grading sarcomas in adults could be applied to FNAC specimens of spindle cell sarcomas with 88% accuracy. While comparing the diagnosis given by FNAC and biopsy, it revealed the true positive were 40 cases, true negative 42 cases, false positive 10 cases, and false negative (FN) 2 cases.Â

SURVEILLANCE OF MICROBIAL FLORA FOR INFERTILITY COUPLES IN AN INDIAN TERTIARY CARE TEACHING HOSPITAL

Objective: Infertility has been known to cause serious social and emotional problems in India. Microorganisms may be a primary cause for thisinfertility. This study was carried out to know the prevalence of microorganisms in the infertility couples of a tertiary caring teaching hospital.Methods: One thousands of couples were screened for the infertility test presented at the outpatient Department of Obstetrics and Gynaecology.The suspected infertility couples were tested for microbial contamination in their reproductive sample. Simultaneously, the demographic data of allpatients were documented, and all the data were analyzed with SPSS 20 software.Result: From one thousand couples, 288 couples were found infertility symptoms, whereas 67.71% were primary infertility problems and rest weresecondary. It is due to male factor (27.08%), female factor (50%), and both (4.86%) but 18.05 were unexplained. From vaginal swabs, 186 and semen145 microbial colony were grown. However, Chi-square (χ) showed that there is no significant difference between the growth of microbial colony from semen or vaginal swap as p=0.06. Eight varieties of bacteria (387) and Candida albicans (37) were documented. 2Conclusion: With respect to older ages of the infertile couples, it is more chances to infections. Antibiotic should be prescribed to primary infertilitycouples and infections can be avoided the cross transmission during intercourse.Keywords: Primary infertility, Candida, Semen, Antibiotic, Vaginal swab

SURVEILLANCE OF APPENDICECTOMY SPECIMEN WITH HISTOMORPHOLOGICAL EVALUATION

Objective: Appendicectomy is the gold standard treatment in acute appendicitis, and in each case, a specimen should be evaluated thoroughly by a histopathologist to confirm the diagnosis and any unknown pathology. The present study aims to find out age and gender prevalence of appendicitis in a tertiary care hospital in Eastern India and various histological changes in the appendix in routine appendicectomy specimen undergoing surgery for appendicitis.Methods: A total of 780 appendicectomy specimens were studied for acute appendicitis for 2 years. Gender prevalence and age-wise incidence of appendicitis were analyzed statistically. Sections were taken from different parts of formalin-fixed appendix specimen. A thorough histological examination was done to confirm acute appendicitis and to detect any incidental unusual histological changes.Results: Of 780 cases, 343 (44%) were male and 437 (56%) were female. Females are more in number than males (p<0.001). The incidence was more common in the age group of 21–30 years (50.7%). Histological findings revealed normal vermiform appendix in 60 (7.7%), lymphoid hyperplasia in 75 (9.6%) cases, acute appendicitis and periappendicitis in 471 (60%) and 110 (14%) cases, respectively. Gangrenous appendicitis was found in 56 (7%) cases. Unexpected findings were reported in 8 (1.02%) cases, of which Enterobius vermicularis 2 (0.25%) cases, endometriosis 2 (0.25%) cases, mucocele 1 (0.12%) case, and carcinoid in 3 (0.4%) cases.Conclusions: Apart from intraoperative examination, a routine histological study of biopsy specimen reveals at times rare pathological changes which has some impact on clinical co-relation and patient management and might help to avoid any lethal complications

Pediatric Dysphonia - A Review

Dysphonia or hoarseness of voice is defined as a disorder characterized by altered voice quality, loudness, pitch, or vocal effort which impairs the communication or hamper voice-related quality of life. Dysphonia or hoarseness of the voice is a commonly encountered vocal symptom among children. The etiological profiles of dysphonia among children are variable. The laryngoscopic examination is required for identification of the lesions. Pediatric dysphonia is a common cause for referral to pediatric otolaryngologists and management sometimes vary. Voice disorders in children are often due to strenuous speaking, screaming, singing, excess coughing, and habit of clearing throat. Endoscopic and physical examinations are the key behind the assessing dysphonic child. Flexible nasopharyngolaryngoscopy is suitable for accurate diagnosis. Additional examinations are sometimes needed during the assessment. There several treatment options for pediatric dysphonia and often based on the etiology

SURVEILLANCE OF MORTALITY: FROM A TERTIARY CARE TEACHING HOSPITAL OF EASTERN INDIA IN PERSONS WITH AND WITHOUT DIABETES MELLITUS

Objective: There is abundant knowledge about the gravity of global load of diabetes mellitus (DM). There are conflicting reports on the cause of death from different parts of the world. In India, there are not enough studies to establish the cause of death in DM. To find out the mortality pattern in DM and non-DM (NDM) in a tertiary care teaching hospital in Eastern India.Methods: Retrospective analysis of in-hospital mortality in a tertiary care hospital in Eastern India, from January 2012 to December 2015.Results: There were a total of 1590 deaths of which 442 were having DM and 1148 did not have DM (NDM). Mean age of death for nondiabetics was 66.4 years (M:F = 67.5:65.3) and that for diabetics were 62.7 years (M:F = 63.5:60.04) which was not statistically significant (p=0.9) though diabetics died younger by 4 years. On analyzing the specific cause of death, coronary artery disease (CAD) was 14.71% in DM and 1.57% in NDM (p=0.0001). Chronic kidney disease (CKD) was 18.55% in DM and 1.92% in NDM (p=0.0001). Congestive heart failure was 7.27% in DM and 1.83% in NDM (p=0.0001). CVA was 13.57% in DM and 1.66% in NDM (p=0.0001). Infection was the most common cause of death (39.37%) in DM, but in NDM also this was quite high 34.41% (p=0.21). The death due to CVA in DM was more in hemorrhage as compared to ischemic (p=0.00001).Conclusion: We found causes of death in DM were an infection, CKD, CAD, CVA, and CHF in descending order in this part of the world. The diabetes patients had lesser hospital stay than nondiabetes patients (p=0.009)

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation