Supra Maxillary Cell (SMC): An Anatomical variant of Ethmoid Sinus.

65 year old female presented with complaints of Right sided nasal obstruction of 1 year duration, intermittent nasal discharge for the past 6 months, without much significant improvement in medical management. Computerized tomography of paranasal sinuses revealed presence of supra maxillary cell (SMC) which was infected, along with sphenoid sinus (Heterodense lesion-suggestive of probable Fungal sinusitis). Patient underwent Functional Endoscopic Sinus Surgery with Septoplasty under local anesthesia. Among the paranasal sinuses, the ethmoid sinus has the largest number of anatomical variations. Important structures near the ethmoid sinus are usually in danger during the endoscopic sinus surgery due to its extreme anatomical variations. Posterior ethmoid cells can also expand towards and into the Maxillary sinus, which drains into the superior nasal meatus, referred to as the Ethmo maxillary sinus. This clinical report highlights about similar  anatomical variation in the paranasal sinuses. We report a case of similar type of cell, only difference is it drains into middle meatus, situated mostly over the maxillary sinus alone along its entire width and the senior author has coined a term for it as supra maxillary cell (SMC).

Cribriform CSF Leak: Endoscopic Surgical Repair Using Free Septal Mucosal Graft Without Postoperative Nasal Packs.

Cribriform plate is the commonest site of Cerebrospinal fluid (CSF) leak, its fragility and juxtaposition of arachnoid's investment to the bone, where the olfactory nerve pierces the skull, is a vulnerable site for CSF leak. Endoscopic transnasal approach has been the main stay for CSF leak repair over the past 2 decades. The technique and surgical steps of Endoscopic Surgical Repair of Cribriform CSF Leak using Free Septal Mucosal Graft without Postoperative Nasal packs are presented. Transnasal endoscopic CSF leak repair under General anesthesia with free mucosal graft, the critical steps include visualize the site of leak, lateralisation of middle turbinate, defect site cauterised with bipolar cautery. Free mucosal from contralateral side of the septum was placed as overlay technique. Graft stabilised with surgicel after ensuring adequate contact between the graft and the defect site. If the defect site is large then fat harvested from thigh is used as bath plug the defect, then free mucosal graft is kept supported by surgicel. Finally the middle turbinate was medialized and sutured with 3 0' Vicryl with nasal septum to support the graft and also to stabilize the middle turbinate as a quilting stich. No fibrin glue was used in our case series. No nasal packing was done. Patients discharged on 2nd or 3rd postoperative day. This technique provides consistent good results reduced operating time of 40 min, no post-operative morbidity, early mobilisation, with 100% success rate and with added advantage of no nasal packing, patient can easily breathing through the nose postoperatively & no recurrence on long follow up.

Exploring the growth of COVID-19 cases using exponential modelling across 42 countries and predicting signs of early containment using machine learning.

The coronavirus disease 2019 (COVID-19) pandemic spread by the single-stranded RNA severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) belongs to the seventh generation of the coronavirus family. Following an unusual replication mechanism, its extreme ease of transmissivity has put many countries under lockdown. With the uncertainty of developing a cure/vaccine for the infection in the near future, the onus currently lies on healthcare infrastructure, policies, government activities, and behaviour of the people to contain the virus. This research uses exponential growth modelling studies to understand the spreading patterns of SARS-CoV-2 and identifies countries that showed early signs of containment until March 26, 2020. Predictive supervised machine learning models are built using infrastructure, environment, policies, and infection-related independent variables to predict early containment. COVID-19 infection data across 42 countries are used. Logistic regression results show a positive significant relationship between healthcare infrastructure and lockdown policies, and signs of early containment. Machine learning models based on logistic regression, decision tree, random forest, and support vector machines are developed and show accuracies between 76.2% and 92.9% to predict early signs of infection containment. Other policies and the decisions taken by countries to contain the infection are also discussed.

Systematic literature review on novel corona virus SARS-CoV-2: a threat to human era.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the seventh-generation coronavirus family causing viral pandemic coronavirus disease (COVID-19) across globe affecting millions of people. The objectives of this study are to (1) identify the major research themes in COVID-19 literature, (2) determine the origin, symptoms and modes of transmission of COVID, (3) recommend the intervention and mitigation strategies adopted by the Governments globally against the spread of COVID-19 and the traumatization among the public? and (4) study the possible drugs/treatment plans against COVID-19. A systematic literature review and comprehensive analysis of 38 research articles on COVID-19 are conducted. An integrated Research focus parallel-ship network and keyword co-occurrence analysis are carried out to visualize the three research concepts in COVID-19 literature. Some of our observations include: (1) as SARS-CoV-2's RNA matches ~ 96% to SARS-CoV, it is assumed to be transmitted from the bats. (2) The common symptoms are high fever, dry cough, fatigue, sputum production, shortness of breath, diarrhoea etc. (3) A lockdown across 180 affected counties for more than a month with social-distancing and the precautions taken in SARS and MERS are recommended by the Governments. (4) Researchers' claim that nutrition and immunity enhancers and treatment plans such as arbidol, lopinavir/ritonavir, convalescent plasma and mesenchymal stem cells and drugs including remdesivir, hydroxychloroquine, azithromycin and favipiravir are effective against COVID-19. This complied report serves as guide to help the administrators, researchers and the medical officers to adopt recommended intervention strategies and the optimal treatment/drug against COVID-19.