Retained foreign body in nose following eye injury.

A man in his 60s presented with diminution of vision of the left eye with nasal bleeding after accidental fall. On examination his left upper eyelid was lacerated and left temporal sclera was punctured which was repaired under local anaesthesia after which he was discharged by ophthalmologists but continued to complain of pain and left nasal obstruction. A non-contrast CT of paranasal sinuses revealed fracture of medial wall of left orbit, left ethmoid haemosinus and a metallic foreign body (FB) in the septum and anterior face of sphenoid. Diagnostic nasal endoscopy performed to remove the metallic FB showed plastic splinters embedded in the mucosa of nasal cavity which was unexpected. Hence, the FB was removed in two sittings because of diagnostic dilemma.

The Effect of Increasing Bath Temperature on the Contractile Responses of the Large Gut in Adult and Neonate Rats.

Introduction Earlier reports on the effect of temperature on gut motility concentrated on experiments conducted on the small intestines of adult animals. The effect of temperature on the large intestine, particularly in neonates, warrants further investigation. The current study investigated the effect of a temperature increase and its mechanism in the colon and rectum of neonate and adult rats. Methods and materials In an organ bath preparation, segments from the colon and rectum were subjected to increasing bath temperatures (37°C-40°C). In other groups, pretreatment with capsazepine (1 µM) and Nω-nitro-l-arginine methyl ester (L-NAME) (100 µM) was done, in different groups, to assess their impact on temperature-induced contractile response. Results Increasing the bath temperature significantly reduced the contractile tension in the colon and rectum. When L-NAME (100 µM)-pretreated segments of the colon and rectum were subjected to different bath temperatures, the contractile tension increased compared to the contractile tension at different bath temperatures without any drug. Capsazepine (1 µM) pretreatment, on the other hand, enhanced the decrease in the contractile tension in the colon and rectum of adult rats compared to the contractile tension produced at different bath temperatures without any drug, while in neonates, capsazepine (1 µM) pretreatment caused a rise in the contractile tension in the rectum with no effect in the colon. Increased bath temperature from 37°C to 40°C increased the contractile frequency in the colon and rectum in both adult and neonate rats. Pretreatment with L-NAME (100 µM) and capsazepine (1 µM) in adults and L-NAME (100 µM) in neonates caused an increase in the contractile frequency in both the colon and rectum; on the other hand, capsazepine pretreatment did not affect the contractile frequency in the colon and rectum of neonate rats compared to the contractile frequency produced at different bath temperatures without any drug. Conclusion The contractile response of rats' large intestines, colon, and rectum to increasing temperatures may involve nitric oxide (NO)-mediated and transient receptor potential vanilloid-1 (TRPV1)-mediated mechanisms. The effects of capsazepine on the colon and rectum of adults and neonates differ, possibly due to the TRPV1-mediated mechanism not developing properly in the neonate and developing later in adulthood.

E-cigarette or vaping product use-associated lung injury: A review of clinico-radio-pathological characteristics.

Aggressive, albeit false marketing of electronic nicotine delivery systems (ENDS) or vaping devices as safer alternatives to cigarette smoking, combined with lack of regulations, has led to its mass adoption, especially among youth. A sudden increase in acute lung injuries was noted in 2019 which was linked to ENDS. It was termed by the Centers for Disease Control and Prevention (CDC) as electronic cigarette or vaping product use-associated lung injury (EVALI). Analysis of bronchoalveolar lavage fluid samples linked EVALI to vitamin E acetate (VEA), which is used as a diluting agent for marijuana oils. Patients with EVALI present with a combination of non-specific respiratory, gastrointestinal, and systemic symptoms. Laboratory results may show elevated inflammatory biomarkers. EVALI is a diagnosis of exclusion and must meet the following criteria: i) history of vaping within last 90 days, ii) abnormal chest imaging, iii) negative evaluation for infection, and iv) no other plausible diagnosis. A spectrum of computed tomography (CT) chest findings has been reported in EVALI, ranging from diffuse alveolar damage to organizing pneumonia, characterized by bilateral ground-glass opacities, consolidation, and septal thickening. A similar spectrum is seen on histopathology, characterized by lipid-laden alveolar macrophages, with varying degrees of infiltrative inflammatory cells and fibrin deposition. Early and accurate identification of the EVALI pattern can help optimize patient care. For example, in diffuse alveolar damage (DAD), a lower threshold for ventilation support and corticosteroid may improve outcomes. Here, we review the etiopathogenesis, clinical management, histopathology, and imaging features of EVALI.

The Well-Being of Healthcare Workers During the COVID-19 Pandemic: A Narrative Review.

The coronavirus disease 2019 (COVID-19) pandemic has turned into a global healthcare challenge, causing significant morbidity and mortality.Healthcare workers (HCWs) who are on the frontline of the COVID-19 outbreak response face an increased risk of contracting the disease. Some common challenges encountered by HCWs include exposure to the pathogen, psychological distress, and long working hours. In addition, HCWs may be more prone to develop mental health issues such as anxiety, depression, suicidal thoughts, post-traumatic stress disorder (PTSD), sleep disorders, and drug addictions compared to the general population. These issues arise from increased job stress, fear of spreading the disease to loved ones, and potential discrimination or stigma associated with the disease. This study aims to review the current literature to explore the effects of COVID-19 on healthcare providers' physical and mental well-being and suggest interventional strategies to combat these issues. To that end, we performed a literature search on Google Scholar and PubMed databases using combinations of the following keywords and synonyms: "SARS-CoV-2", "Healthcare-worker", "COVID-19", "Well-being", "Wellness", "Depression", "Anxiety", and "PTSD."

Lessons From a Rapid Project Management Exercise in the Time of Pandemic: Methodology for a Global COVID-19 VIRUS Registry Database.

BACKGROUND: The rapid emergence of the COVID-19 pandemic globally collapsed health care organizations worldwide. Incomplete knowledge of best practices, progression of disease, and its impact could result in fallible care. Data on symptoms and advancement of the SARS-CoV-2 virus leading to critical care admission have not been captured or communicated well between international organizations experiencing the same impact from the virus. This led to the expedited need for establishing international communication and data collection on the critical care patients admitted with COVID-19. OBJECTIVE: Developing a global registry to collect patient data in the critical care setting was imperative with the goal of analyzing and ameliorating outcomes. METHODS: A prospective, observational global registry database was put together to record extensive deidentified clinical information for patients hospitalized with COVID-19. RESULTS: Project management was crucial for prompt implementation of the registry for synchronization, improving efficiency, increasing innovation, and fostering global collaboration for valuable data collection. The Society of Critical Care Medicine Discovery VIRUS (Viral Infection and Respiratory Illness Universal Study): COVID-19 Registry would compile data for crucial longitudinal outcomes for disease, treatment, and research. The agile project management approach expedited establishing the registry in 15 days and submission of institutional review board agreement for 250 participating sites. There has been enrollment of sites every month with a total of 306 sites from 28 countries and 64,114 patients enrolled (as of June 7, 2021). CONCLUSIONS: This protocol addresses project management lessons in a time of crises which can be a precept for rapid project management for a large-scale health care data registry. We aim to discuss the approach and methodology for establishing the registry, the challenges faced, and the factors contributing to successful outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT04323787; https://clinicaltrials.gov/ct2/show/NCT04323787.

Unusual manifestation of Koch's disease: Gradenigo-Lannois syndrome.

Gradenigo-Lannois syndrome or petrous apicitis is an uncommon but a morbid complication of otitis media. Traditionally treated by surgery, recent advances in imaging and antibiotics have favoured a more conservative approach. Although pyogenic organisms are the leading aetiological agent, petrous apicitis due to Koch's bacilli is not rare. We report two cases of tubercular petrositis presenting as Gradenigo's syndrome with triad of ear discharge, deep-seated retro-orbital pain and diplopia. The first patient represented a mixed infection with pyogenic organism and tuberculosis, which was successfully treated with antibiotics and antitubercular therapy. The second patient showed an acute presentation of Gradenigo's syndrome with chronic otitis media having contact with an active tuberculosis case and showed dramatic response with antitubercular treatment. Tubercular petrous apicitis must be suspected and diagnosed promptly as only specific treatment will lead to symptomatic resolution and avoid complications.

Head-and-neck paragangliomas: An overview of 54 cases operated at a tertiary care center.

BACKGROUND: Head-and-neck paragangliomas (HNP's) are rare autonomic neoplasms associated with high morbidity and mortality. We aimed to study epidemiology, clinicopathological correlation, and management of HNP to assist clinicians in advocating the most appropriate therapy. MATERIALS AND METHODS: Epidemiological parameters, including age and sex distribution, clinical presentation, tumor classification, familial predisposition, multicentricity, and treatment modalities adopted, were analyzed in this retrospective analysis of 54 patients of HNP. RESULTS: Age ranged from 15 to 85 years, with a female preponderance. Among all HNP, carotid body tumor (CBT) (48.1%) was the most common, followed by Glomus Jugulare (24.1%). Majority of the patients presented with neck swelling associated with nerve palsies. A preoperative neurological deficit was most commonly observed with Glomus jugulotympanicum (68.4%). CONCLUSION: CBT is the largest and most common paraganglioma in our study. The familial occurrence warrants meticulous screening for multifocality. Tumor location, neurovascular involvement, malignant potential, and patient factors should guide the designing of management options.

Functional Near-Infrared Spectroscopy to Probe tDCS-Induced Cortical Functioning Changes in Tinnitus.

There are limited treatment options for successful management of tinnitus, which is highly prevalent worldwide. The pathogenetic role of auditory cortex activation changes in tinnitus has been reported by various functional studies that suggest that the emerging neuromodulation techniques may pave way toward better treatment response. The current case report depicts the use of functional near-infrared spectroscopy (fNIRS) based on the assessment of improvement in auditory cortex functioning in chronic tinnitus by transcranial direct current stimulation (tDCS).

Correlating the treatment outcome with tumor staging, grading, and various treatment modalities in patients with esthesioneuroblastoma.

OBJECTIVE: Although till date no management protocol for esthesioneuroblastoma (ENB) has been standardized due to tumor rarity, still multimodality approach shows better treatment outcomes as compared to surgery alone. The objective of this study was to analyze the clinicopathological spectrum of ENB and to correlate treatment response with tumor staging, histopathological grading, and various treatment modalities. MATERIALS AND METHODS: Twenty-one consecutive patients with biopsy-proven ENB were studied and evaluated for response to treatment in the form of complete tumor resolution. Results were analyzed and correlated with stage and grade of tumor and form of therapy received. RESULTS: There was male preponderance (3.2:1) with age ranging between 7 and 63 years (median of 25 years). Survival rates significantly dropped with increasing tumor stage (63.6% in stages A and B vs. 30% in stages C and D) and grade (100% in Grades 1 and 2 vs. 31.25% in Grades 3 and 4). The recurrence rate was 80% in surgery alone group, which came down to 43.7% if surgery was supplemented with other modalities. In cases where multimodality treatment plan was used, endoscopic procedures fared equally as open surgical procedures. CONCLUSION: Hyam's grade and Kadish stage are important prognostic indicators of treatment outcome, with survival rates dropping with increasing tumor stage and grade. Multimodality treatment protocols have improved the disease outcome, making endoscopic surgery equivalent to radical surgeries regarding result outcomes and giving other advantages such as better cosmesis, less treatment-related morbidities, decreased hospital stay, and better cost-effectiveness.

Glottic neurogenic tumor: A highly uncommon site for schwannomas.

Schwannomas are benign encapsulated neurogenic tumors, arising from Schwann cells embedded in neurilemal sheath as multinucleated syncytial network. Head and neck schwannomas account for 25%-45% of all schwannomas, majority developing in parapharyngeal space. Laryngeal schwannoma in itself is a rarity, and a glottic origin further complicates its diagnosis. To the best of our knowledge, this is the second case of glottic schwannoma being reported in medical literature. Symptomatology is attributable to mass effect of a slow-growing laryngeal tumor, ranging from sore throat to stridor. The gold standard method for their excision is still debatable. For small tumors, endoscopic or direct laryngoscopic approach is preferred, but for large glottic tumors, external approach is advocated for better exposure and facilitating mucosal grafting. Index case is being presented not only for its rare site of origin, but also to stress on the importance of meticulous histopathological examination to advocate appropriate treatment.

Transverse Vaginal Septum With Secondary Infertility: A Rare Case.

STUDY OBJECTIVE: To demonstrate the technique of laparoscopic vaginal reconstruction in a rare case of mid-vaginal septum with secondary infertility. DESIGN: A step-by-step explanation of the technique using videos and pictures (Canadian Task Force classification IV). SETTING: Transverse vaginal septum is a rare condition, with an incidence of only 1 in 30,000 women. It is usually a congenital mullerian fusion defect; few cases of acquired septum have been reported. Roughly 40% of cases occur in the mid-vagina. Transverse vaginal septum typically presents with primary amenorrhea and hematocolpos. The goal of surgery is to create a patent vagina with restoration of fertility. The laparoscopic approach has proven superiority over the open technique. INTERVENTIONS: Laproscopic vaginal reconstruction was performed in a 24 year female with transverse vaginal septum. Dissection was done laproscopically up to mid vagina. Incision was given on vagina excising the septum followed by reconstruction. CONCLUSION: The laparoscopic approach to vaginal reconstruction avoids the abdominal incision, with its associated pain and possible adhesion formation. It also provides a better view for dissection. In this patient, a patent vagina was created in a single operation, with no postoperative dyspareunia, and fertility was restored.

Large lipid-rich mammary analogue secretory carcinoma of parotid gland: An unusual case.

Mammary analogue secretory carcinoma (MASC) of the salivary gland is a malignant tumor which bears morphologic, immunohistochemical and molecular features similar to those of mammary secretory carcinoma. The tumor is considered as a low-grade malignancy perhaps slightly more aggressive than acinic cell carcinoma. High-grade transformation with recurrences, regional nodal involvement, metastases, and cancer-related death has been reported in a few cases. We report an unusual case of large MASC of the parotid gland in a young patient without regional lymph node involvement. To the best of our knowledge till date such a large MASC of the salivary gland has not been reported in the English literature.

Multimodality management of a giant skull base hemangioendothelioma of the sphenopetroclival region.

A 20-year-old man presented with proptosis, nasal obstruction, vision loss and cavernous sinus syndrome, ongoing for 6 years. Imaging and biopsy confirmed a middle skull base epithelioid hemangioendothelioma arising from the left sphenopetroclival region with infratemporal fossa and intracranial-intradural extension into the left temporal lobe. Preoperative embolization of the left internal maxillary artery followed by a combined neurosurgical (front-temporal orbito-zygomatic craniotomy) and otorhinolaryngology (maxillary swing) approach was performed for tumor debulking. Postoperative radiotherapy and maintenance interferon chemotherapy was given to achieve a favorable outcome at 6 months follow-up. We describe the pertinent clinical, genetic, radiological and histopathological features, along with the available therapeutic modalities for a primary giant skull base hemangioendothelioma.

Mucoepidermoid carcinoma of eyelid: A usual tumor at an unusual site.

Mucoepidermoid carcinoma is a malignant epithelial neoplasm comprising mucous, intermediate and epidermoid cells, arising mainly in salivary gland. It is extremely uncommon in ocular region, where it can arise in conjunctiva, lacrimal gland or lacrimal sac. The index case is being presented for its rarity and for highlighting the importance of meticulous sampling for correct diagnosis. A 68-year-old female presented with complaints of ulceration over right lower eyelid for 3 years. She underwent a local surgical excision 2 years ago after which she was asymptomatic for the following 1 year. Histopathological examination of excised specimen showed features of mucoepidermoid carcinoma. Mucoepidermoid carcinoma in ocular adnexa may be difficult to differentiate from its close mimickers like basal, squamous, sebaceous cell carcinoma and apocrine carcinoma. Meticulous sampling, judicious use of special stains and immunohistochemistry are pivotal in establishing the diagnosis.

Laryngeal leiomyosarcoma masquerading as laryngeal carcinoma.

Laryngeal leiomyosarcoma is an exceedingly rare malignant tumour, with fewer than 50 reported cases in scientific literature. Diagnosis is based on immunohistochemistry, supplemented with ultrastructural studies, if required. It is aggressive and associated with variable survival outcomes. A 63-year-old man presented with hoarseness for 7 months and breathlessness for 3 months. Imaging showed a well-defined 3 cm glottic mass. Total laryngectomy was performed. The histopathological examination showed features of leiomyosarcoma. The index case has been presented owing to its rarity, variable clinical manifestations and diagnostic dilemmas and to stress upon the importance of ancillary techniques for confirmation.

In vitro study of acetylcholine and histamine induced contractions in colon and rectum of adult and neonate rats.

Contractile mechanisms of different parts of the gut in adult and neonate may not be identical due to developmental processes. The present study was undertaken to investigate acetylcholine (ACh) and histamine induced contractile responses of colon and rectum in adult and neonatal albino rats. Contractile responses were recorded from isolated in vitro preparations. The dose-response curve for ACh (0.001-100 microM) revealed dose dependent increase in contractile responses. A significantly (P < 0.05) greater contractile responses (g/g wet tissue) was observed in rectum as compared to colon. Atropine pretreatment significantly blocked ACh responses in both rectum and colon. The blockade was higher in adult preparations. The dose-response study for histamine (0.001-100 microM) did not show any significant difference between rectum and colon. Histamine (100 microM) induced contractions were significantly (P < 0.05) increased after pretreatment with pheniramine (100 microM) in adult rectum. This potentiating response of pheniramine was absent in neonate rectum. Such effect was also not seen in colon of both adult and neonate. The present investigation indicates that the contractile responses induced by ACh are similar in both adult and neonate, excepting that the blocking effect of atropine in colon was more pronounced in adult as compared to neonate. Further, the results also indicated different mechanism of histamine action in adults and neonates as evidenced by the significant enhancement of contractions by pheniramine only in adult rectum. Therefore, the present results indicate the existence of a different cholinergic and histaminergic activity in adult and neonate as well as in rectal and colonic tissue.