A Correlation of Tumour Budding and Tumour-Stroma Ratio with Clinicopathological Factors in Oral Squamous Cell Carcinoma.

Objectives: This study aimed to analyse the association of tumour budding (TB) and tumour-stroma ratio (TSR) with clinicopathological parameters that can be easily viewed on routine haematoxylin and eosin (H&E)-stained slides to provide an easy and cost-effective method for prognosticating oral squamous cell carcinoma (OSCC). Methods: This study was conducted at the ESIC Medical College and Hospital in Faridabad, India, from July 2022 to October 2022. In patients with histologically diagnosed OSCC, TB and TSR were evaluated via routine H&E-stained sections and correlated with clinicopathological parameters. Statistical analysis was performed using Chi-squared test. Results: A total of 50 patients were included. The mean age of participants was 61 ± 12.72, and the male-to-female ratio was 7.1:1. Most of the tumours were located on the tongue (46%), followed by the buccal mucosa (26%), gingivobuccal sulcus (12%) and retromolar trigone (8%). The palate and alveolus were the other sites involved, constituting 4% each. TB and TSR were both found to be significantly associated with the tumour grade, lymph node metastasis and tumour size. A highly significant correlation was also found between TB and TSR (P = 0.001). Conclusions: Both TB and TSR can be easily evaluated on routine H&E sections; they are highly reproducible and were found to be reliable independent prognostic markers in OSCC. Therefore, this simple and cost-effective method of prognostication, which is currently lacking in clinical practice, will help clinicians to identify patients with poor prognosis and thus individualise their treatment plan.

Spheno-Orbital Tuberculosis: A Rare Case.

A 9-year-old girl presented with progressive, painless protrusion of the right eye for 2 months. She also complained of multiple bilateral neck swellings for 2 months. On examination, there was proptosis of the right eye with the eyeball displaced downwards and forwards. The extra ocular movements of the right eye showed limitation of abduction. The vision was normal in both eyes. A detailed clinical evaluation with investigations led to a diagnosis of spheno-orbital tuberculosis. Prompt initiation of anti-tubercular therapy (ATT) led to resolution of the lesion.

Alveolar Rhabdomyosarcoma of the Temporal Region with Metastatic Cervical Lymph Node.

Introduction: Paediatric rhabdomyosarcoma most commonly occurs in the head and neck region. Its treatment is complex, including multi-drug chemotherapy, surgery and radiotherapy. Case report: Here, we report a case of alveolar rhabdomyosarcoma of the temporal region with a metastatic cervical lymph node, in a 15-year-old girl, and its management. The patient received ne-adjuvant chemotherapy, followed by surgery and post operative radiotherapy. Literature was also reviewed for the various treatment modalities for these rare tumours. Discussion: Rhabdomyosarcoma of the temporal region has rarely been reported in the literature. Due to the rarity of these tumours, there are difficulties in creating standardized therapeutic protocols. However, multimodality treatment, including chemotherapy, surgery and radiotherapy, has been shown to improve the overall survival rate.

Sarcomatoid Carcinoma of Larynx: A Rare Case.

Sarcomatoid carcinoma is a rare tumour consisting of both sarcomatous and carcinomatous elements. It accounts for less than 1% of laryngeal malignancies. This case report describes sarcomatoid carcinoma of the larynx in a 54-year-old male managed by total laryngectomy with post operative radiotherapy. Surgery is the treatment modality of choice for this rare entity. However, early stage sarcomatoid carcinoma tumours are better treated with radiotherapy alone similar to early stage squamous cell carcinoma of the larynx with favourable results.

Infantile Fibrosarcoma of the Tongue Base.

Infantile fibrosarcoma is an uncommon soft tissue tumour in infants and children mostly located in the extremities. Its occurrence in the head and neck, particularly in the oral cavity is extremely rare. Here, we report a case of infantile fibrosarcoma of the tongue base in a 9-year-old boy and discuss the complexities in arriving at diagnosis and its management. The patient underwent wide local excision of the tumour. Histopathology was essential in confirming the diagnosis. As per search in English literature, this is the first case of infantile fibrosarcoma of the tongue base to be reported till date. Treatment of choice is wide local excision with or without chemotherapy.

MRSA Causing Necrotizing Fasciitis in 18-Month-Old Boy.

Necrotizing fasciitis is a rare and fulminant infection of the superficial fascia and subcutaneous cellular tissue. It is commonly polymicrobial, with the combination of aerobic and anaerobic bacteria, which contributes to the rapid progression and severity of the disease. The microbes commonly involved include group A streptococcus, Enterobacteriaceae, anaerobes, and Staphylococcus aureus. Over the past few years, skin and soft tissue infections, including necrotizing fasciitis, due to methicillin-resistant Staphylococcus aureus are increasing.

Is there a correlation between viral load and olfactory & taste dysfunction in COVID-19 patients?

OBJECTIVES: To evaluate the correlation between cycle threshold (Ct) value and occurrence of olfactory and taste dysfunction in COVID-19 patients. METHODS: This comparative study included COVID-19 patients diagnosed by reverse transcription- polymerase chain reaction (RT-PCR) based test at our hospital with mild to moderate disease. The demographic details and detailed clinical history of the patient, including history of loss of smell and taste was taken at the time of presentation. The patients were divided into 2 groups, group A: COVID-19 patients with OTD; group B: COVID-19 patients without OTD. 100 contiguous patients were recruited in each group. The COVID-19 test by RT-PCR was done and Ct value of the 3 genes: E (Envelope encoding) gene, N (Nucleocapsid encoding) gene, and RdRp (RNA-dependent RNA polymerase) gene, was used for data analysis. The Ct values of each of the three genes were compared between groups A and B. RESULTS: Group A and B did not differ significantly in terms of basic demographics. The differences in the Ct values of the 3 genes E gene, N gene and RdRp gene, of group A and B were found to be statistically significant (p = 0.005, p = 0.001 and p = 0.002, respectively). CONCLUSION: The patients with OTD had a lower Ct value at diagnosis, and hence, a higher viral load than those without OTD. The evaluation of Ct value and viral load in COVID-19 patients may help in further reducing the transmission of the virus in the community.

Loss of smell and taste in COVID-19 infection in adolescents.

OBJECTIVES: To study the prevalence, clinical course and outcomes of olfactory and taste dysfunction in COVID-19 positive adolescents. METHODS: This prospective study was carried out from May to August 2020. The adolescents, aged 10-19 years, who were detected COVID-19 positive by RT-PCR with mild to moderate disease were included in the study. The following epidemiological and clinical outcomes were studied: age, sex, general symptoms, olfactory and taste dysfunction. RESULTS: Out of 141 patients included in the study, there were 83 males (58.9%) and 58 females (41.1%). The age varied from 10 to 19 years with an average of 15.2 years. Forty patients (28.4%) had olfactory or taste dysfunction. Out of these 40 patients, 28 patients (19.8%) had both olfactory and taste dysfunction. Of the 34 patients (24.1%) who complained of olfactory dysfunction, 16 patients complained of hyposmia and 18 patients complained of anosmia. Dysgeusia was reported by 34 patients (24.1%). The duration of OTD varied from 2 to 15 days with an average of 5.7 days. CONCLUSION: Loss of smell and taste are common symptoms in COVID-19 positive adolescents. It recovers spontaneously within a few weeks, along with the resolution of other symptoms.

Anosmia: A Clinical Indicator of COVID-19 Reinfection.

COVID-19, an ongoing world pandemic, is caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). Many organizations have recognized that COVID-19 patients may have sudden loss of smell or taste and have included these symptoms in their diagnostic guidelines. However, the occurrence of anosmia and dysgeusia in COVID-19 reinfection is yet to be ascertained.

Paediatric nasal dermoids: Our experience.

OBJECTIVES: Nasal dermoids are rare developmental anomalies seen in children. This study reports our experience in a developing country of the clinical and radiological findings as well as the management of nasal dermoids. METHODS: A retrospective analysis was performed, from 2012 to 2017, for 10 patients admitted for the treatment of nasal dermoids at a tertiary care center. The clinical presentation, preoperative imaging (CT/MRI), surgical approach, intraoperative findings, complications and recurrence were reviewed. RESULTS: Ten patients were included in this study, 6 males and 4 females, with an average age of 10.2 years at the time of presentation. Three patients presented with a mass located on the nasal dorsum, 1 had a nasoglabellar mass, 2 patients had a mass located on the nasal dorsum with visible sinus, and 4 patients presented with a sinus on the nasal dorsum, in which 1 patient had a tuft of hair. CT was performed in all the cases. It was not suggestive of intracranial extension in 9 patients, and was non-diagnostic in one patient. Both CT and MRI were performed on 2 patients, with no evidence of intracranial extension. Surgical and radiological findings were concordant in 8 patients (80%). CONCLUSION: Nasal dermoids require preoperative imaging and precise surgical planning to achieve complete removal.

Giant Cell Tumour of Temporal Bone and Infratemporal Fossa: A Rare Case.

Giant cell tumours (GCT) of the bone are uncommon primary bone neoplasms that occur mainly in the epiphysis of long bones. GCT of the skull is rarely encountered, particularly of the temporal bone. We report a rare case of giant cell tumour of the squamous portion of the temporal bone extending to the infratemporal fossa in a 38-year old male. The patient presented with progressive trismus, and swelling and pain in the right temporal region. The patient underwent excision of the mass by maxillary swing approach. The treatment of choice for GCT is complete surgical excision. Based on the location and extent of the GCT in the infratemporal fossa, several surgical approaches have been tried for its excision.

Tongue Base Schwannoma.

Intraoral schwannomas account for 1% of head and neck schwannoma, with tongue base schwannoma being reported rarely. In an English literature search from 1988 to 2014, not more than 38 cases of tongue base schwannoma have been reported. Large tongue base schwannomas pose a significant risk to airway, thereby calling for an early intervention. We report a rare case of tongue base schwannoma in a 25 year old female managed surgically by lateral pharyngotomy approach.

Epidemiological Profile of ENT Emergencies: Our Experience.

Emergencies in otorhinolaryngology are common occurrence. Early diagnosis and management result in reduction in morbidity and mortality. To assess the epidemiology, pattern and distribution of ENT emergencies at a tertiary level hospital. Cross sectional, retrospective, descriptive study over a period of 5 years. Medical records of these patients were studied, noting the age, sex, diagnosis on admission and outcome of emergency care. A total of 38,793 patients, age ranging from 15 days to 85 years were included in the study. The number of male and female patients were 25,971 (66.95%) and 12,822 (33.05%) respectively and the male to female ratio 2:1. The most commonly encountered emergency was epistaxis, which accounted for 25.58% of the emergencies attended. This was followed by ear ache and ear discharge. The ENT emergency ward plays a key role in the management of life-threatening conditions requiring immediate evaluation and management by specialized physician. It is important to prioritize and reduce the number of non-urgency/emergency cases attending the emergencies in order to ensure proper care is given to the emergency cases.

Internal Carotid Artery Bleed: A Rare Complication of Invasive Sphenoidal Aspergillosis.

BACKGROUND: Invasive sinonasal aspergillosis is rarely seen in immunocompetent individuals. It may involve adjacent intracranial and intraorbital structures causing high morbidity and mortality. CASE DESCRIPTION: We report a rare case of invasive Aspergillus sinusitis in a young, immunocompetent woman causing headache and vision loss. Endoscopic débridement under general anesthesia was complicated by rupture of a mycotic cavernous carotid artery aneurysm. This was managed by packing with muscle and fascia followed by endovascular coiling. Subsequently, the aneurysm extended intradurally and caused fatal subarachnoid hemorrhage. CONCLUSIONS: This case emphasizes the need for early diagnosis of invasive fungal sinusitis to prevent intracranial complications and fatal outcome. When the diagnosis is made, aggressive treatment with surgical débridement and adjuvant antifungal therapy is required. Internal carotid artery involvement is a rare but life-threatening complication of invasive fungal sinusitis.

Remineralising Effectiveness of Two Fluoride Varnishes Containing Additives: An In Vitro Study.

PURPOSE: To assess the remineralising efficacy of fluoride varnish containing additives and conventional sodium fluoride varnish. MATERIALS AND METHODS: 72 extracted upper central incisors specimens were randomly allocated to four groups after demineralisation: control; 5% sodium fluoride varnish (FV) (Fluoritop-SR); resin modified glass ionomer-based calcium phosphate containing fluoride varnish (CV) (Clinpro XT); fluoride varnish with xylitol coated calcium phosphate (cXp) (Embrace). Change in surface morphology, calcium phosphorous ratio and fluoride content of enamel were evaluated using scanning electron microscope and energy dispersive X-ray analysis (SEM-EDAX). Change in surface roughness was evaluated using profilometer analysis. All readings were taken at baseline, after demineralisation, at 2 weeks and 4 weeks of remineralisation. RESULTS: At 4 weeks of remineralisation surface roughness values were ranked as follows: control > FV = cXp > CV. Calcium phosphorus ratios were in the order: CV > FV = cXp > control and fluoride content (for treatment groups): CV = cXp > FV. Scanning electron microscopy images showed mineral deposition on the surfaces of the treatment groups with different deposition pattern of minerals. CONCLUSION: Fluoride varnishes with or without additives are effective in remineralisation of early enamel lesions. Glass ionomer-based fluoride varnish results in better remineralisation than xylitol coated calcium phosphate containing fluoride varnish and 5% sodium fluoride varnish.

Dopamine Transporter maging with Tc-99m TRODAT-1 SPECT in Parkinson's isease and its orrelation with linical isease everity.

OBJECTIVES: To evaluate the role of Tc-99m TRODAT-1 Single Photon Emission Computed Tomography (SPECT) in Parkinson's Disease (PD) by assessing the correlation of clinical disease severity, disease duration and age at onset of disease with specific uptake ratio of Tc-99m TRODAT-1 in striatum. METHODS: The study included 63 patients in age range of 40-72 years with clinical diagnosis of PD and nine controls. Clinical history of patients was obtained regarding age at onset of disease and disease duration. Disease severity in each patient was assessed using H and Y stage and UPDRS. Tc-99m TRODAT-1 SPECT was performed and specific uptake ratios were calculated for six regions in bilateral striata, caudate nuclei and putamina. Difference in specific uptake ratios between different stages of disease was analyzed for statistical significance. Specific uptake ratios were correlated with UPDRS, motor score of UPDRS, duration of disease and age at onset of disease using Pearson's correlation co-efficient. RESULTS: Median specific uptake ratio was found to be least in contralateral putamen for all H and Y stages. There was a statistically significant difference between specific uptake ratios of controls vs stage 1, stage 1 vs 2, 1 vs 3, 1 vs 4, and 2 vs 4 for all 6 regions. The difference in uptake ratio between 3 and 4 H and Y stages was significant only for contralateral regions. There was no significant difference in uptake ratio between 2 and 3 H and Y stages. The uptake ratios showed a strong negative correlation with UPDRS and motor score, a weak negative correlation with duration of disease and no significant correlation with age at onset of disease. CONCLUSION: We conclude that Tc-99m TRODAT-1 SPECT can be used to assess the disease severity in PD patients.