Rhabdomyolysis-Induced Acute Kidney Injury (AKI) in a Young Bodybuilder: A Case Report.

Acute kidney injury (AKI) is a serious medical condition that can have many causes, including rhabdomyolysis. Rhabdomyolysis is the breakdown of muscle tissue that can lead to the release of muscle fiber contents into the bloodstream. This can cause serious damage to the kidneys, leading to AKI. In this case, a young bodybuilder was diagnosed with rhabdomyolysis induced by AKI after consuming Ibuprofen for a casual fever. The etiology of AKI in rhabdomyolysis is complex, with multiple factors contributing to the development of the condition. These include muscle trauma, dehydration, infection, and drug toxicity. In this case, Ibuprofen may have contributed to the development of AKI, as it can cause kidney damage when taken in large doses. Additionally, the bodybuilder's physical activity may have contributed to the development of rhabdomyolysis, as intense exercise can cause muscle damage. Treatment for AKI in rhabdomyolysis patients typically involves aggressive fluid resuscitation, electrolyte replacement, and dialysis if necessary. Additionally, the underlying cause of the rhabdomyolysis must be identified and treated. In this case, the patient should be monitored closely for any signs of kidney damage, and the Ibuprofen should be discontinued. In conclusion, this is a case of a relatively common presentation with uncommon circumstances. It is crucial to have a heightened understanding of the likelihood of AKI in patients with rhabdomyolysis and the impact of drug toxicity in exacerbating the condition. Early diagnosis and treatment are essential for the successful management of AKI.

Menopause and its Effect on Voice.

Abstract: This study was designed to study the impact of menopause on voice quality. Cross-sectional Observational study with a total of 100 subjects. All subjects underwent biochemical analysis which included thyroid function tests, estrogen levels, progesterone levels and underwent voice analysis using the VAUGHMI voice analyser software. 50 postmenopausal females as cases and 50 premenopausal females as controls were taken for the study. The females were of the age group 35-55 yrs in order to remove age as confounding factor. The primary outcome measure was Total score, calculated based on harshness, hoarseness and breathiness. The postmenopausal females had a poorer voice quality than the premenopausal females (Total score 1.62 vs 2.48, p < 0.001). There was a significant difference between the fundamental frequency and pitch and perturbation in frequency of the postmenopausal females as compared to premenopausal females. The difference in the perturbation in the intensity of the voice was not significant. No linear correlation could be established between the voice quality and oestrogen or progesterone levels but the intergroup variation of the two parameters was significant. The premenopausal females have better voice quality than postmenopausal females. The relationship between hormonal level and voice quality couldn't be established. Further studies are required to assess the relation of hormone levels & voice quality with the possibility of exploring voice cosmesis. Level of Evidence: Level 3.

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.

Is the Voice of Professional Voice Users With no Vocal Cord Lesions Similar to That of Non Professional Voice Users?

OBJECTIVE: The objective of this study was to analyze if the voice of professional voice users (PVU) is comparable with that of a nonprofessional voice users (NPVUs), both of whom have no obvious vocal cord lesions. MATERIALS AND METHODS: Fifty professional and 50 NPVUs with no obvious vocal fold pathologies underwent voice analysis and videostroboscopic study, and various parameters were analyzed. RESULTS: Majority of the participants were found to be less than 40 years. Teachers formed the largest group (40%) of PVUs. PVUs had a significantly higher incidence of voice-related complaints compared with NPVUs. The former group also showed a higher deviation from the normative data. A significant influence of gender and the duration of work experience was also observed among PVUs. CONCLUSIONS: The voice of an apparently normal PVU is not similar to that of an apparently normal NPVU. Female PVUs and PVUs with a longer duration of work experience show the highest deviation from normative data.

Deep neck space abscesses in children below 5 years of age and their complications.

OBJECTIVES: To study the outcomes and complications of deep neck space abscesses in children less than 5 years of age over a period of 15 years. METHODS: A retrospective analysis of children less than 5 years of age with deep neck space abscesses over a 15-year period was conducted at a tertiary care centre in India. Patients were evaluated with respect to the clinical, radiological and laboratory findings. All patients underwent surgical incision and drainage of the abscess and pus cultures were obtained. The incidence of complications was recorded. The collected data was tabulated and statistical analysis was done. RESULTS: A total of 510 children less than 5 years of age were identified who were admitted for deep neck space abscess over a 15-year period. The mean age was 23.6 months. The most common organism isolated in the pus was Staphylococcus aureus (21%). The incidence of methicillin resistant S. aureus (MRSA) was 9%. Complications were reported in 10% patients. CONCLUSION: Paediatric deep neck abscesses can be managed with prompt surgical management and intravenous antibiotics. Children less than 2 years of age, and those with multiple abscesses or retropharyngeal abscess were more prone to complications.

Speaking and Nonspeaking Voice Professionals: Who Has the Better Voice?

INTRODUCTION: Voice professionals can be classified into two major subgroups: the primarily speaking and the primarily nonspeaking voice professionals. Nonspeaking voice professionals mainly include singers, whereas speaking voice professionals include the rest of the voice professionals. Although both of these groups have high vocal demands, it is currently unknown whether both groups show similar voice changes after their daily voice use. Comparison of these two subgroups of voice professionals has never been done before. AIM: This study aimed to compare the speaking voice of speaking and nonspeaking voice professionals with no obvious vocal fold pathology or voice-related complaints on the day of assessment. METHODOLOGY: After obtaining relevant voice-related history, voice analysis and videostroboscopy were performed in 50 speaking and 50 nonspeaking voice professionals. RESULTS: Speaking voice professionals showed significantly higher incidence of voice-related complaints as compared with nonspeaking voice professionals. Voice analysis revealed that most acoustic parameters including fundamental frequency, jitter percent, and harmonic-to-noise ratio were significantly higher in speaking voice professionals, whereas videostroboscopy did not show any significant difference between the two groups. CONCLUSION: This is the first study of its kind to analyze the effect of daily voice use in the two subgroups of voice professionals with no obvious vocal fold pathology. We conclude that voice professionals should not be considered as a homogeneous group. The detrimental effects of excessive voice use were observed to occur more significantly in speaking voice professionals than in nonspeaking voice professionals.

Diagnostic Efficacy of Computed Tomography in Detecting Cervical Metastases in Clinically N0 Head and Neck Squamous Cell Carcinoma.

The search for a single non-invasive highly accurate diagnostic modality for identification of cervical metastasis in head and neck squamous cell carcinoma (HNSCC) is yet to bear fruit. Thirty proven cases of HNSCC with no palpable neck nodes were selected, requiring surgery for the primary tumour. Detailed clinical evaluation and contrast enhanced computed tomography (CECT) scans were done. Patients underwent elective neck dissection along with surgery for the primary tumour. Specimens were sent for histopathological examination (HPE), considered gold standard. Results of CECT were compared with HPE. Clinical examination had a NPV of 80 % and CECT had a sensitivity, specificity, PPV, NPV, and accuracy of 83, 75, 45.5, 94.7, and 76.7 % respectively. A CECT may be added to the initial assessment of a patient of HNSCC, allowing for earlier diagnosis of nodal metastasis that may allow for a better chance at survival.

Bilateral spontaneous salivary otorrhoea: Case report and a review of the literature.

Spontaneous salivary otorrhoea is an extremely rare clinical entity. Most of the times, salivary otorrhoea results from various forms of trauma. It has also been attributed to the patent foramen of Huschke, and fissures of Santorini. Here, we present a rare case of an 8 year old child presenting with salivary discharge from both the ears. The diagnosis was established on the basis of biochemical and radiological investigations. The patient was managed by surgical exploration and ligation of the fistulous tract.

Hindi language tool for assessing pediatric cochlear implant recipients.

INTRODUCTION: Presently, in India, western material is mainly used for the assessment and planning of habilitation activities for paediatric cochlear implant (CI) recipients. There is no assessment material available in Hindi. Therefore, the present study aimed to develop a parental questionnaire to assess auditory, speech and language skills of paediatric CI recipients in Hindi language for the age range of 3-7 years. METHOD: Most commonly used assessment material/curricula used in Indian cochlear implant clinics and primary school Hindi language teachers were consulted during the development of the parental questionnaire. The developed questionnaire was then given to the parents of 50 normal hearing, Hindi speaking children in the age range of 3-7 years, five experienced speech and language pathologist working in the field of paediatric CI and to the same primary school Hindi language teachers who were consulted in the beginning to validate the content of the questionnaire. Based on the feedback from parents, personal observations and views from other professionals, the questionnaire was modified to incorporate the suggestions and the questionnaire was finalized. The final questionnaire has three subtests (1, 2 and 3) to assess auditory, language and speech skills of the CI recipients respectively. The final questionnaire was given to the Hindi speaking parents of 50 CI recipients in the age range of 3-7 years who fulfilled the eligibility criteria. Both the parents were asked to fill the final questionnaire together in the clinic at 0 (switch-on), 1, 6 and 12 months post switch-on of the implant. RESULT AND DISCUSSION: All the cochlear implant recipients could be evaluated by the questionnaire and none of the recipient scored zero on the questionnaire at any time interval. The developed questionnaire had shown high reliability and internal consistency producing alpha values of 0.9201, 0.7425 and 0.9311 for the subtest 1, 2 and the entire questionnaire respectively. The alpha value was not calculated for subtest 3 as it was a rating scale and not much variation was noticed in this section.

Gunshot Injury with Facial Palsy: An Unusual Case.

As the use of firearms has become increasingly common in the civilian society, the incidences of homicidal as well as suicidal firearm injury have increased several folds. We here present an interesting case of celebratory firing which accidently caused injury in the head & neck region and an unusual trajectory adopted by the bullet which prevented a fatal outcome.

Bilateral first and second arch anomalies: a rare presentation.

Branchial sinuses are one of the most common congenital anomalies present. They are usually unilateral; bilateral cases are present but are rare. The presentation of bilateral branchial sinus anomalies along with bilateral first arch anomalies is very rare. Here, we present a case of bilateral first arch anomalies co-existing with bilateral second arch anomalies in a patient with no related family history and no associated syndrome.

Sutureless tympanoplasty using acellular dermis.

OBJECTIVE: A prospective randomized unblinded controlled trial was conducted by comparing acellular dermis with temporalis fascia as graft materials in tympanoplasty (type 1) in terms of operative time, postoperative pain, graft success rate, and audiologic outcome. STUDY DESIGN: Forty-two patients with (inactive) chronic suppurative otitis media of tubotympanic type were randomized, matched, and divided equally into 2 groups of 21 each. One group underwent tympanoplasty (type 1) via transcanal route using temporalis fascia graft and the other using acellular dermis. Both groups were compared for operative time, postoperative pain, graft success rate, and audiologic improvement in hearing. RESULTS: There was a statistically significant reduction in operative time (P < .05) and postoperative pain (P < .05) in the acellular dermis group. However, there was no statistical difference in graft success rate (P > .05) and hearing improvement (P > .05) between both the groups. CONCLUSION: Results of tympanoplasty using acellular dermis as graft material are comparable to that using temporalis fascia in terms of graft uptake and hearing improvement. However, tympanoplasty using acellular dermis has the advantage of shorter operative time and lesser postoperative pain.

Primary tuberculosis of oral cavity: a rare entity revisited.

Oral lesions of tuberculosis though uncommon, are seen both in the primary as well as the secondary stages of the disease. In secondary tuberculosis, the oral manifestations are accompanied by lesions in the lung, lymph nodes, or any other organ system of the body. This can be detected by the usual clinical history and systemic examination. Primary oral tuberculosis may thus present as a diagnostic challenge to the clinician. Amongst the oral lesions also, tongue is the usual site for tubercular infection, with the upper lip and soft palate being the least affected. The authors report two rare cases of children with isolated primary tuberculosis of the lip and uvula. Interestingly, the first case presenting just as a diffuse swelling of the upper lip, and the second as pain in throat with congestion and granulations on the uvula. We suggest a distinct Indian social habit which predisposes to primary lip and uvular tuberculosis, sites not common in the rest of the world. The habit of doing "datoon" i.e. brushing of the teeth with neem twigs in rural India, which at times causes trauma on the palate and thus predisposing to seedling of the wound with mycobacterium tuberculosis.

The lifeline express--a mobile ear clinic for rural India.

The objectives of this study were to review the application and feasibility of providing screening, diagnosis, medical and surgical treatment for patients with ear discharge by setting a mobile hospital in rural India. The study was retrospective. The study involved collection of data from 1992 to 2005 from patients with ear diseases. The number of patients operated on for ear conditions and the distribution of free hearing aids were also recorded. Data regarding length of postoperative stay, complications and graft failure rates was collected from local medical centers and analyzed. Out of 304,321 patients, 4,426 were operated on for ear diseases, mostly ear perforations, grommet insertions and cholesteatoma surgeries. A total of 11,913 audiometric evaluations were done and 9,045 hearing aids were distributed. An overall success rate of 78.8% was achieved for achieving a dry ear and approximately 60% reported significant improvement in audiometric thresholds.

Duplication cyst of oesophagus: a case report.

Duplication of the oesophagus is the second most common duplication of the gastrointestinal tract. Children with oesophageal duplication cyst usually present with dysphagia or as asymptomatic thoracic mass found o incidental chest x-ray. We report a case of oesophageal duplication cyst that presented with inspiratory stridor and dyspnoea in a 6 month old boy. Bronchoscopy revealed an external compression on the trachea. Duplication cyst arising from the oesophagus was suggested on CT and MRI. The cyst was surgically excised with resolution of symptoms.

A study of voice changes in various phases of menstrual cycle and in postmenopausal women.

Larynx is responsible for the generation of voice and subsequently impacts on communication, social interaction, personality, and artistic expression. The vocal instrument is comprised of the vibratory body, the respiratory power source, and the oropharyngeal resonating chamber. The lungs are the power supply, the larynx is the vibratory source, and the supraglottal vocal tract (supraglottal pharynx oral cavity, nasal cavity) is the resonator that shapes the sound into words and songs. During the phase of expiration as the diaphragm relaxes and the chest wall recoils, air is pushed through the nearly closed vocal folds. The aerodynamic forces of the air column and myoelastic properties of the vocal folds are responsible for the repeated opening and closing of the glottal tissue that pulses that air column as it flows out. These disruptions in the steady state of tracheal air pressure by glottal activity and vocal fold vibrations result in voice production. Voice is characterized by its frequency intensity and harmonics. The harmonics are hormonally dependent. This is illustrated by changes that occur during male and female puberty. The female voice evolves from childhood to menopause under the varied influences of estrogen, progesterone, and testosterone. These hormones are the dominant factor in determining voice changes throughout life. Female voice has a fundamental frequency one-third lower than that of a child. In males, androgen released at puberty is responsible for the male vocal frequency being an octave lower than that of a child. The females have a reproductive system, which undergoes a regular cyclic change known as the menstrual cycle. Laryngeal changes are evident and fluctuate systematically during the reproductive years with the menstrual cycle. The main objective of this experiment is to provide a solid ground with evidence of changes in voice because of sexual hormones, which will form the base of a multidisciplinary approach to a comprehensive and integrated understanding of premenstrual and menopausal female voice.

Objective acoustic analysis of voice improvement after phonosurgery.

OBJECTIVE: To evaluate voice improvement after phonosurgery by objective acoustic analysis. MATERIAL AND METHODS: This prospective study was conducted in Maulana Azad Medical college New Delhi from December 2002 to 2008. In this study 100 subjects were included comprising of all age groups and either sex. All these patients with organic voice disorder underwent speech analysis using VAUGMI speech analysis program before and after phonosurgery. RESULT: All the parameter of voice analysis were deranged before the treatment but after surgery all the parameters should improvement most significant change was seen in the jitter. CONCLUSION: After doing this study we found that the analysis of hoarse voice using various parameters of acoustic analysis like fundamental frequency, harmonics to noise ratio, jitter, shimmer, S/z ratio helped us in identifying the degree of hoarseness and the severity related to it. Some parameters like jitter and shimmer were able to detect the component of hoarseness in perceptually normal voice and thus patient was helped by doing surgery and voice therapy at the appropriate time.

Ear abuse in school children.

Ear abuse in school children is common in low socio-economic strata and is often associated a long-term morbidity in our country. This paper presents a study of 250 such children with discussion. Incidence of ear abuse with long term learning deficit was found to be 18.4%.