Outcome of tuberculous meningitis in children aged 9 months to 12 years at the end of intensive phase of treatment.

BACKGROUND: Tuberculous meningitis (TBM) is associated with high morbidity and mortality. Most of the literature focuses on outcomes at the end of therapy when it may be too late for intervention to improve the outcomes. So, the present study addresses outcomes by the end of intensive course of therapy. METHODS: It was a prospective cohort observational study that enrolled 80 patients with TBM between 9 months and 12 years of age. Participants were classified into Definite, Probable and Possible TBM using Marais criteria. Survival/Mortality was evaluated at the end of hospital stay. Demographic, clinical, cerebrospinal fluid and radiological parameters were evaluated for predictors of morbidity and mortality. Standardized tools were used to assess possible impairments in different domains at the end of intensive phase of treatment, namely Gross Motor Functional Classification System for motor functional ability, Pediatric-Mini Mental score examination (MMSE), Blantyre Coma Scale (BCS) score and Vineland Social Maturity Scale (VSMS) for cognitive outcome, Auditory Brainstem Evoked Responses for hearing outcome and using Teller's/Snellen's visual acuity charts to assess visual impairment. RESULTS: A high Mortality rate of 42.5% was seen in the enrolled patients. Out of the total 80 patients, 20% recovered completely while 36.25% survived with disability (morbidity). Motor, Hearing, Cognitive and Vision impairment was present in 33.3%, 4%, 33.3% and 48.9% of the survivors respectively. On multivariate regression, raised intracranial tension and stage III disease were significantly associated with mortality. Morbidity was significantly associated with Stage III disease on multivariate analysis. CONCLUSIONS: Despite advances in treatment, Tuberculous meningitis is associated with high burden of deaths and devastating neurological sequelae. Timely diagnosis and intervention of neurological impairments is needed to improve the outcome of TBM in survivors.

Delayed Presentation of Onodi Cell Mucocele with Optic Neuropathy: A Rare Case and Literature Review.

A mucocele of a paranasal sinus is a mucus filled cystic mass lined by epithelium filling the involved sinus whose ostium is obstructed. While frontoethmoidal mucoceles are common, Onodi cell mucoceles are less frequently seen. Due to its anatomic proximity to optic nerve, it can lead to devastating visual complications. A 29 year old female presented with progressive loss of vision in right eye since 20 days leading to complete loss of vision since 12 days without any nasal complaints. Endoscopy showed fullness in right spheno-ethmoidal region. Computed Tomography scan revealed a mucocoele of the right Onodi air cell causing compression of intracanalicular part of right optic nerve. Despite urgent surgical decompression of mucocele, vision could not be restored. Poor visual acuity at presentation may be associated with bad prognosis. Hence, a high index of suspicion followed by appropriate imaging (CT scan and/or MRI nose and paranasal sinus) is crucial for early diagnosis in case of unexplained progressive diminution of vision, even in setting of no nasal complaints.

Olfactory and Gustatory Dysfunctions in Patients With Laboratory-Confirmed COVID-19 Infection: A Change in the Trend.

To study the presence of olfactory and gustatory dysfunctions in patients with laboratory-confirmed COVID-19 infection in our set up. Longitudinal study, 1st March 2020-15th August 2020, at a tertiary care hospital. RT PCR positive for SARSCoV-2 patients, above 18 years age included. Excluding patients with previous history of changes in smell or taste sensation, severely ill at the time of admission, history of taking drugs at the time of COVID 19 infection that affect the smell or taste sensation. 435 patients included after obtaining an institutional ethical clearance. After an informed consent, these patients were followed up telephonically, to record any subjective improvement in olfactory or gustatory symptoms and an approximate duration of recovery. Olfactory and/or gustatory dysfunction 10.8% (47/435). Mean (SD) age-34.53(10.8) years. Females affected significantly more [X2 (1, N = 435) = 7.45, p value is 0.006, significant at p < 0.05]. Olfactory dysfunction significantly associated with gustatory dysfunction [X2 (1, n = 435) = 182.29, p < 0.00001]. 19.8% (N = 435) of individuals remained asymptomatic. Nasal symptoms rare (4%, N = 47). Mean (SD) recovery olfactory and gustatory dysfunction 12.1 (7.7) and10.8 (6.3) days respectively. Subjective loss of smell or taste dysfunction was far less common. Women and younger population reported olfactory or gustatory dysfunction commonly. Olfactory and gustatory changes without nasal symptoms, suspicion of COVID-19 infection is relevant. Recovery is complete and early.

Diagnostic and therapeutic endonasal rhinologic procedures generating aerosol during COVID-19 pandemic: a systematized review.

INTRODUCTION: Most rhinologic procedures, particularly endoscopic sinonasal procedures, are liable to produce aerosols. The severe acute respiratory syndrome coronavirus 2 (SARS-Co V-2) transmits via respiratory droplets, but the degree of its spread through airborne routes by aerosol is unclear. OBJECTIVE: The aim of this article is to counsel rhinologists on how to modify their conventional practice during the COVID-19 pandemic by prioritising the need of procedures, identifying aerosol- generating procedures and using precise personal protection equipment for various endonasal procedures. METHODS: We did a review of articles indexed for MEDLINE on PubMed, ENT Cochrane, DOAJ and Web of Science databases using the keywords nasal endoscopy, SARS-CoV-2, COVID-19, aerosol generating medical procedures and rhinology to formulate guidelines for the safety of healthcare workers. RESULTS: The review included evidence from 28 articles from the otorhinolaryngology, surgery, infectious disease, head and neck surgery and cancer biology literature. We have provided recommendations and relevant information for rhinologists during the COVID-19 pandemic, based on the available studies and data, to warrant high-quality patient care and requisite levels of infection prevention during rhinology procedures. CONCLUSION: In rhinology, marked care is advised during nasal packing, electrocauterisation and use of high-speed rotating devices in potentially infected tissue as they are considerable aerosol- producing procedures. The choice of personal protective equipment is based on the risk of exposure and possible modes of aerosol generation.

Knowledge, Attitude of Sikkim Primary School Teachers About Paediatric Hearing Loss.

Our purpose of the study was to assess the knowledge and any gaps of early educators regarding hearing impairment, and to attempt to delineate the attitudes and perceptions of the educators regarding the outcomes of their students with hearing disabilities and their views on inclusive teaching, using a questionnaire based study. Only 71 respondents completed the questionnaire. The present questionnaire based study was conducted on 100 primary school teachers, undertaken on randomly selected schools from Gangtok, East Sikkim. Their knowledge and attitudes regarding hearing impairment in children in the areas of cause, diagnosis, investigations, treatment, prevention, special care and inclusion into mainstream schools were assessed. Our study showed that the knowledge of causes, investigation and treatment of hearing impairement [HI] among respondents/teachers was poor. The data was shown statistically significant with P < 0.001. However, responses testing behavior and attitudes towards HI was encouraging. 52.9% respondents disagreed that HI was a social handicap and 88.2% felt that teachers need special training before a HI child is admitted to the school. The results were statistically significant with P < 0.001. The biggest obstacle found for inclusive education of HI children was a lack of proper training to teachers (40.8%) and attitude of other students (29.5%).

Diagnostic and therapeutic endonasal rhinologic procedures generating aerosol during COVID-19 pandemic: a systematized review / Procedimentos endonasais de rinologia diagnósticos e terapêuticos geradores de aerossóis durante a pandemia de Covid-19: uma revisão sistematizada,

Abstract Introduction Most rhinologic procedures, particularly endoscopic sinonasal procedures, are liable to produce aerosols. The severe acute respiratory syndrome coronavirus 2 (SARS-Co V-2) transmits via respiratory droplets, but the degree of its spread through airborne routes by aerosol is unclear. Objective The aim of this article is to counsel rhinologists on how to modify their conventional practice during the COVID-19 pandemic by prioritising the need of procedures, identifying aerosol- generating procedures and using precise personal protection equipment for various endonasal procedures. Methods We did a review of articles indexed for MEDLINE on PubMed, ENT Cochrane, DOAJ and Web of Science databases using the keywords nasal endoscopy, SARS-CoV-2, COVID-19, aerosol generating medical procedures and rhinology to formulate guidelines for the safety of healthcare workers. Results The review included evidence from 28 articles from the otorhinolaryngology, surgery, infectious disease, head and neck surgery and cancer biology literature. We have provided recommendations and relevant information for rhinologists during the COVID-19 pandemic, based on the available studies and data, to warrant high-quality patient care and requisite levels of infection prevention during rhinology procedures. Conclusion In rhinology, marked care is advised during nasal packing, electrocauterisation and use of high-speed rotating devices in potentially infected tissue as they are considerable aerosol- producing procedures. The choice of personal protective equipment is based on the risk of exposure and possible modes of aerosol generation.

Resumo Introdução A maioria dos procedimentos rinológicos, principalmente os procedimentos endoscópicos nasossinusais, é suscetível à produção de aerossóis. A síndrome respiratória aguda grave coronavírus-2 (SARS-CoV-2) é transmitida através de gotículas respiratórias, mas o grau de sua disseminação através de aerossóis por via aérea não é claro. Objetivos Orientar os rinologistas sobre como modificar sua prática convencional durante a pandemia de Covid-19, priorizar a necessidade de procedimentos, identificar procedimentos geradores de aerossol e usar equipamento de proteção individual de precisão para vários procedimentos endonasais. Método Fizemos uma revisão de artigos indexados na Medline por meio das bases de dados PubMed, ENT Cochrane, DOAJ e Web of Science, com as palavras-chave nasal endoscopy, SARS-CoV-2, Covid-19, aerosol-generating medical procedures e rhinology para formular diretrizes para a segurança dos profissionais de saúde. Resultados A revisão incluiu evidências de 28 artigos de otorrinolaringologia, cirurgia, doenças infecciosas, cirurgia de cabeça e pescoço e biologia do câncer. Fornecemos recomendações e informações relevantes para rinologistas durante a pandemia de Covid-19, com base nos estudos e dados disponíveis, para garantir atendimento de alta qualidade ao paciente e níveis necessários de prevenção da infecção durante procedimentos de rinologia. Conclusões Em rinologia, recomenda-se cuidado acentuado durante o tamponamento nasal, eletrocauterização e uso de dispositivos rotativos de alta velocidade em tecidos potencialmente infectados, pois esses procedimentos são consideráveis produtores de aerossóis. A escolha do equipamento de proteção individual é baseada no risco de exposição e nos possíveis modos de geração de aerossol.

NK/T cell lymphoma with inverted papilloma: A rare coexistence.

Natural killer/T-cell (NK/T) lymphomas are an infrequent tumour type of NK and NK-T cells commonly occurring in the upper aero-digestive tract. Most reported cases in the literature are random solitary cases of NK/T-cell lymphoma. A 35-year-old male farmer from Sikkim reported to our institution with NK/T-cell lymphoma (nasal type) with coexistent inverted papilloma of the nose. This case is being reported due to the unique and unusual simultaneous occurrence of these two tumour entities.

Total Reconstruction of Lower Eyelid in a Post-traumatic Patient Using Modified Fricke's Cheek Flap.

Eyelids are very complex structure, reconstruction of which is a challenge to surgeons. Reconstruction of eyelids may be required in a variety of conditions like congenital anomalies, trauma, or postsurgical excision in malignant lesions involving the eyelids. There are numerous ways to reconstruct the eyelids; the best procedure depends on both the skill of the surgeon and the condition of the patient. Fricke' lateral temporal based flap was first described in 1829 for reconstruction of the eyelids and lateral canthal region. This flap had inherent problems regarding cosmetic appearance of the eyebrows. The modified Fricke's flap based on the cheek has the advantage of avoiding such complications. It is very easy and rapid outpatient department (OPD) based procedure with acceptable cosmetic and functional result. It can be done by all ear, nose, and throat (ENT) and head and neck surgeons without any reconstructive training. In this article we are presenting a case of total reconstruction of lower eyelid using the modified Fricke's cheek flap.

Anatomical variations of uncinate process observed in chronic sinusitis.

Chronic Sinusitis, an extremely persistent illness, is surgically best treated by Functional Endoscopic Sinus Surgery. The ostiomeatal complex is the main area targeted and within it uncinate process is the first anatomical structure encountered. The significance of anatomical variations concerning age and sex of uncinate process in chronic sinusitis were evaluated. A prospective study on 50 patients of chronic sinusitis (100 uncinate processes) was done. The results were tabulated and analyzed using Statistical Package for Social Science (SPSS) 16.0. Type I superior attachment of uncinate process (67 %) was the most common variety in all ages and both sexes and a statistically significant relationship between Type I superior attachment of uncinate process and sex was found (p < 0.05). The typical uncinate process was most common (70 %) followed by medial deviation of the uncinate (24 %). This difference in occurrence was significant with respect to both age and sex (p < 0.05). Anatomical variations of uncinate process are not responsible for causing chronic sinusitis. Mere presence of these variations of uncinate is not an indication for FESS.

Persistent deciduous molar as an etiology for a maxillary sinus mucocele.

Mucoceles are accumulations of trapped mucus, forming cystic expansile lesions. Maxillary sinus mucoceles are rare amongst paranasal sinus mucoceles, usually being a late sequel of Caldwell-Luc surgery. We present a case of a maxillary sinus mucocele due to a persistent carious deciduous molar in a middle aged patient, reported to highlight its unusual etiology.

Spectrum of head and neck cancer in children.

AIM: To assess the incidence of different head and neck cancers in pediatric age group in a referral hospital. METHODS: In this prospective study, children below the age of 12 years underwent a thorough clinical, ENT examination and the diagnosis was conformed histologically in all the cases. RESULTS: Fifty-three were diagnosed to be suffering from different head and neck neoplasms among 21,216 children (0.25%). Male-to-female sex distribution was 1.78:1. The lymphomas were the most common (43.39%) followed by the rhabdomyosarcoma (20.75%) and the nasopharyngeal carcinoma (15.09%). Of the lymphomas, the non-Hodgkin's lymphoma was predominant (26.41%). Other lesions were thyroid carcinomas and mucoepidermoid carcinoma of parotid. CONCLUSIONS: Malignancy should always be considered in the differential diagnosis of masses in the head and neck region in children.