Eschar in Scrub Typhus: A Study from North East India.

INTRODUCTION: Eschar is one of the most important clinical sign which helps in early diagnosis, and consequently initiation of specific treatment and prevention of complications in scrub typhus. AIMS: To study the prevalence and distribution of eschar in scrub typhus and comparison of clinical manifestations and complications among patients with or without eschar. METHODOLOGY: A retrospective hospital based study in patients aged ≥ 18 years admitted to a tertiary care centre in north-eastern India. Scrub typhus was diagnosed based on clinical features supported by serological tests (Immunochromatographic card test, IgM ELISA and Weil Felix test). Chi square test was used for comparing variables. A 'p value' <0.05 was considered as statistically significant. RESULTS: A total of 129 patients of scrub typhus were included in the present study. Male to female ratio is 1.93:1 with the commonest age group being 18-30 years followed by 30-40 years. Eschar was found in 24.8% patients with 9.3% having multiple eschars and the rest had single eschar. Eschar was most commonly found in the inguinal region (28.57%) followed by trunk (25.75%) and lower limbs (22.85%). Presence of multi-organ dysfunction (p=0.008), hepatitis (p=0.005) and lymphadenopathy (p<0.01) were significantly higher in those patients who had eschar. CONCLUSION: The common sites of distribution of eschar are the inguinal region, lower limbs and trunk and multiorgan dysfunction is more commonly associated with eschars.

Atypical presentation of oral and laryngeal tuberculosis in an adolescent.

Extrapulmonary manifestation of tuberculosis (TB) in the adolescent population in the head and neck region may be atypical in the site of involvement, symptomatology and clinical presentation. We report a case of the management of oral and laryngeal TB in an early adolescent female who presented with ulceration over the palate and tonsillar region with uvula destruction and laryngeal symptoms and aim to highlight the atypical extrapulmonary manifestations of TB in the head and neck region in adolescent age group.

Management of Giant Frontoethmoid Osteoma by Combined Approach.

Giant osteomas of the frontoethmoidal region often manifest early with ocular symptoms and intracranial complications. The management involves careful surgical planning of both the approach and reconstruction. In the present case report, a case of giant frontoethmoid osteoma presented with ocular symptoms and cosmetic deformity. The case was managed by a combined endoscopic and open surgical approach along with reconstruction of the sinus wall defect using a pericranial flap and titanium mesh. The outcome was found to be satisfactory with the resolution of ocular symptoms and good cosmesis.

An Unusual Case of Post-Operative Functional Stridor After Emergence From General Anesthesia.

Post-anesthesia stridor due to laryngospasm, laryngeal edema, or any other organic cause is a life-threatening condition requiring immediate intervention. The very rare functional stridor or psychogenic stridor following emergence from general anesthesia may sometimes mimic stridor due to an organic cause, but it is neither fatal nor require immediate airway management. However, if the condition is not diagnosed timely, it may lead to unnecessary manipulation of the airway, such as endotracheal intubation or tracheostomy. We report herein a case of functional stridor in a 48-year-old woman who underwent abdominal-perineal resection for carcinoma rectum. The case was timely diagnosed by the attending anesthetist, and the patient recovered spontaneously, thus avoiding any unindicated airway handling and its associated complications.

Ear, Nose and Throat Foreign Bodies Removed under General Anaesthesia: A Retrospective Study.

INTRODUCTION: For Otorhinolaryngologist, removal of Foreign Bodies (FB) from the ear, nose and throat is one of the common emergency procedures done. Most of the cases especially of the ear and nose can be managed without General Anaesthesia (GA). But in some cases GA may be needed. There are very few studies that address the scenario of ear, nose and throat foreign body that required GA for its removal and the complications associated with it. AIM: This study was conducted with the aim to study the patient's profile, types and distribution of FB removed under GA, and the associated complications. MATERIALS AND METHODS: The present study is a hospital based retrospective, cross-sectional study conducted in the Department of Otorhinolaryngology in association with Department of Anaesthesiology and Critical Care in North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India from year 2009 to 2014. Information was collected from indoor patient file and operation record book. Those patients where foreign body was not found after examination under GA were excluded. RESULTS: A total of 112 cases of foreign body in ear, nose and throat removed under GA were selected. There was variation of age from youngest case being 11 months to 74 years with a slight male predominance. Two third of the patients belonged to paediatric age group. Most of the FB were inanimate with high number of inorganic type found in majority. Foreign body in food passage was found in most cases. Coin and meat bone were the common FB in children and adults respectively. We found no complications related to removal of foreign body from the food passage and nose. But some complications were seen in foreign body of ear and tracheo-bronchial tree. CONCLUSION: Ear, nose and throat FB that required GA were seen in all age groups. FB of food passage constitute the majority. Type of foreign body varies between children and adults. In children most common types were related to toys and their part and food materials. In adults, food materials were most common.