An observational study of dengue fever in a tertiary care hospital of eastern India.

BACKGROUND: Dengue fever (DF) has become a significant resurgent tropical disease in the past 20 years all over the globe. The recent outbreak in West Bengal has once again underlined our failure in vector control and prevention. Our study outlines the clinical spectrum as well as the geographical expansion of the disease beyond urban confines. MATERIAL AND METHODS: All patients with acute febrile illness positive for IgM antibody for Dengue virus were taken as cases. The patients were subjected to clinical examination and baseline investigations so as to fill in a structured proforma. RESULT: The total number of patients were 180 of whom 92 (51.1%) were male and 88 (48.9%) were female. The maximum number of patients belonged to the age group 20-29 years (26.9%). The patients mostly hailed from Kolkata followed by Nadia, 24- Parganas(S), Murshidabad and Midnapur. The most common presentation apart from fever and bodyache were gastrointestinal symptoms. 42% patients complained of abdominal pain, 24% had vomiting, 9.6% diarrhoea. Bleeding manifestations occurred in 23% of patients. CNS features were documented 10.4%. Case fatality came out to be 3.8%. Investigations revealed thrombocytopenia in 55% and leucopenia 32.7%, transaminitis in 72% Evidence of organomegaly (22.2%) and serositis (42%) were detected. Complications included intracranial haemorrhage, DIC, pancreatitis, myocarditis and even a solitary case of splenic rupture. CONCLUSION: The current outbreak was affecting both the genders equitably and mostly the younger age group from rural as well as urban areas. A febrile illness characterised by myalgia, mild bleeding and gastrointestinal symptoms, it was more or less promptly responsive to early conservative therapy like fluids, FFP and platelet transfusion where required.

Bacteriological Profile and Antibiotic Sensitivity Pattern in Tubotympanic Variety of CSOM in Northern Part of West Bengal.

The principal treatment for active tubotympanic CSOM is meticulous aural toilet and instillation of a topical antimicrobial agent. The aim of the study is to evaluate the current bacteriological profile of active tubotympanic CSOM and the sensitivity pattern to most of the currently available antibiotics. We conducted a prospective study in a tertiary care hospital in the northern part of West Bengal. Patients presenting with active tubotympanic CSOM who did not receive antimicrobial therapy in the last 21 days were included in the study. Middle ear discharge was collected by an ENT specialist under strict aseptic precautions. The isolates were grown on blood agar and identified according to standard microbiological and biochemical methods. The antibiotic sensitivity profile of the isolates was determined by Kirby-Bauer disc diffusion method on Mueller Hinton agar. Out of total 198 samples the commonest micro-organism isolated was Staphylococcus aureus (35.86%) followed by Pseudomonas aeruginosa (19.19%). Staphylococcus aureus was highly sensitive to linezolid and vancomycin followed by ciprofloxacin. Pseudomonas aeruginosa was highly sensitive to polymyxin B followed by meropenem, cefoperazone plus sulbactam, and ciprofloxacin. The present study indicates that there can be a variation in the bacterial aetiologies of CSOM and their sensitivity pattern due to widespread use of antibiotics. Hence it is prudent to conduct periodic evaluation of microbiological pattern and antibiotic sensitivity of CSOM.

Schwannoma in Soft Palate: A Rare Case Report with Review of Literature.

Schwannoma is a benign tumor originating from Schwann cells of the nerve sheath. Approximately 25-45% of the schwannomas are seen in the head and neck region and are found rarely in the oral cavity (only 1%). The most common intra-oral site is tongue, followed by floor of the mouth, buccal mucosa, palate, gingiva and lips. We report a rare case of schwannoma in the soft palate in a 22 years old female. She presented with 6 months history of a painless swelling in palate. The provisional diagnosis was made as some benign neoplasm of minor salivary gland. The tumour was excised intra-orally under general anesthesia. Histopathologic examination showed neural tissue arranged in predominantly Antoni A pattern and formation of verocay bodies. It is difficult to diagnose this tumor based on clinical appearance. Therefore final diagnosis can only be done after histopathological examination of the lesion. Prognosis is good and recurrence is unknown.

Outcome of Sublingual Immunotherapy in Allergic Rhinitis.

Allergic rhinitis (AR) is one of the most common types of allergy worldwide. It has significant negative impact on the quality of life (QOL). One of the available causal treatments of AR is allergen specific immunotherapy which remains effective even after the end of treatment course, unlike symptomatic drugs. AR patients aged above five years, allergic to unavoidable allergen like house dust, mite etc., and refractory to maximal pharmacotherapy were included in present study. Patients allergic to avoidable allergen, taking beta-blocker medication, having other immunological disease, and who were pregnant, breast-feeding or lost to follow up, were excluded from the study. All patients included in the study underwent sublingual immunotherapy (SLIT). The impact of treatment is measured by calculating the difference between SNOT-20 score before and after treatment (which is 6 months interval). Total 30 patients were studied. Paired-t test calculated value of cumulative score and nasal symptom score are 7.853 and 6.85 respectively. Both are greater than table value of 2.46. So paired-t test shows that SLIT is very much effective in treatment of AR. The present study re-establish the fact that SLIT not only reduces AR symptoms, it also improves the QOL. It has very good patient compliance with minimal side effects.

Measurement of quadrupolar asymmetry in prototype rod-type radio frequency quadrupole linac for protons.

An analytical and cold model study of a prototype extended vane rod-type RFQ (radio frequency quadrupole linac) is presented. The bead-pull measurement allowed us to experimentally determine the effect of shaping of the vane-supporting posts and, most interestingly, the size of the vacuum enclosure in the dipolar and quadrupolar field asymmetry. Disk shaped beads of BaTiO3 have been tailor made for this purpose. The special shape of the beads has allowed precise measurements of frequency shifts all along the length of the RFQ. The measured quadrupolar asymmetry and dipole component at a radial distance of 7 mm from the beam axis are within ±1% for the optimized structure. Particle tracking of a 10 mA proton beam with a simulated 3D field for the optimized full scale RFQ with modulated vanes has been carried out. Simulation shows vertical and horizontal shifts of only 0.01 mm and 0.03 mm, respectively, for the accelerated beam at the exit of RFQ. The percentage of accelerated particles lying within an energy width of ±40 keV about 800 keV is increased from 86% for the original enclosure to 88% for the reduced enclosure, whereas the transmission efficiency is 100% for both the cases.

Relook on Mastoid Cavity Obliteration: A Prospective Study.

Canal wall down (CWD) mastoidectomy is the operation of choice for unsafe variety of chronic otitis media. But open mastoid cavity poses many problems. The solution of these problems is obliteration of mastoid cavity that is self-cleaning and easily maintained. In our study we aim to establish the effective technique for mastoid cavity obliteration in CWD mastoidectomy and review its efficacy in producing a dry, low maintenance cavity. This was a non-randomized longitudinal prospective study, performed over 2½ years in the department of ENT in a tertiary care hospital of Kolkata. Patients of chronic otitis media unsafe variety within the age group of 16-60 years were included in our study. Chronic otitis media unsafe variety with intratemporal or intracranial complications, and extensive cholesteatoma or granulation tissue that can't be cleared completely during operation were excluded. There was no statistical significance for hearing improvement between CWD mastoidectomy without obliteration and CWD mastoidectomy with obliteration. There was significant statistical significance for obliteration of cavity, epithelized cavity and dry cavity between CWD mastoidectomy without obliteration and CWD mastoidectomy with obliteration. Persistent discharge and granulation were significantly more in non-obliterated group. The time taken by the ear to become dry is much shorter after mastoid cavity obliteration. Moreover, lifelong aural toilet and dependence on an ENT surgeon is avoided. Inspite of all these, a few pre-conditions must be fulfilled before embarking on this type of surgery.

Pre-auricular Sinus with Post-auricular Extension: An Uncommon Variant.

Pre-auricular sinus usually presents in front of the auricle without any diagnostic dilemma. But confusion arises when it presents with post-auricular swelling, abscess or discharging sinus. Here we describe series of pre-auricular sinus with post-auricular extension, a "variant type" of pre-auricular sinus and their management. A prospective study was done in the department of ENT in a tertiary care hospital of West Bengal from April 2015 to March 2018. After control of infection and proper pre-operative investigations patients, sinus was excised using bi-directional approach. The sinus tract along with a thin rim of conchal cartilage and pre and post-auricular cuff of skin was excised in toto. Among 76 cases of pre-auricular sinus, seven had "variant type". There were five males and two females in the variant group. Five patients were in the first decade of life and two patients were in the second decade of life. Four patients presented with post-auricular scar, two patients presented with post-auricular discharging sinus and one patient presented with post-auricular abscess. Wound healing was perfectly normal in all patients. None had recurrence till 1 year follow up. Pre-auricular sinus may present as "variant type" with post-auricular abscess or discharging sinus. So when a patient presents with post-auricular abscess or discharging sinus, pre-auricular region and pinna should be examined carefully. This helps to avoid unnecessary investigations and interventions which only complicate future management of these patients.

Series of Atypical Rhinosporidiosis: Our Experience in Western Part of West Bengal.

Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. It usually presents as sessile or pedunculated granular polyp, red in colour with multiple yellowish pin-head sized dots. Atypical presentations due to involvement of extra-nasal sites may produce diagnostic dilemma. Very high incidence of rhinosporidiosis and that too with atypical presentations in the rural western part of West Bengal, encourages us to undertake this study. The present study was conducted in a tertiary care hospital in the rural western part of West Bengal from July 2013 to December 2016. Patients presenting with rhinosporidiosis in extra-nasal sites and with atypical presentations were included in the study. Rhinosporidiosis confined to nose and patients who lost follow up were excluded from the study. All patients were treated with wide excision and cauterization of base. Among total 114 patients of rhinosporidiosis, 16 had atypical presentations (14.04%). Nine patients (56.25%) presented with a mass hanging in the oropharynx, some mimicking oropharyngeal malignancy. Two patients (12.50%) presented with acute respiratory distress and stridor. One patient (6.25%) presented with disseminated rhinosporidiosis with involvement of the skin, subcutaneous tissue, muscle, bone, penis and urethra. Recurrence was noted in only two patients (12.50%) in nasopharynx. This chronic disease may present with different acute presentations. Proper clinical eye may avoid pre-operative biopsy which may lead to extensive bleeding. Recurrence can be reduced with meticulous and complete removal. Regular post-operative follow-up with endoscopy is must to detect and treat early recurrence.

Conidiobolomycosis: An Unusual Fungal Disease-Our Experience.

Conidiobolomycosis is a rare mycotic disease caused by Conidiobolus coronatus. Very few cases have been reported in English literature. Often it is clinically misdiagnosed as soft tissue tumour. A prospective case study was done from 2006 to 2015 in a tertiary care hospital of West Bengal, India. The objectives of our study were to describe the epidemiological and clinical features and treatment of Conidiobolomycosis to prevent disfigurement. Patients clinically suspected to be suffering from Conidiobolomycosis were subjected to biopsy followed by histopathological and mycological examinations. Then they were treated with oral saturated solution of potassium iodide along with other drugs. Total six cases were histopathologically proved to be suffering from Conidiobolomycosis. Fungus was isolated and identified in one case. Complete resolution was seen in five patients. Conidiobolomycosis should be brought into mind as differential diagnosis of subcutaneous swelling in the rhinofacial region.

Odontogenic Tumours of Jaw: A Prospective Study on Clinico-Pathological Profile and Their Management.

Odontogenic tumours are a group of heterogeneous diseases that range from hamartomatous or non-neoplastic tissue proliferations to benign neoplasms to malignant tumours with metastatic potential. They are rare, comprising about <2-3% of all oral and maxillofacial biopsy specimens. The aim of the present study was to determine the clinico-pathological presentation of this heterogeneous group of lesions and review of literature. The present study was conducted in the ENT department of a Government Medical College and Hospital, West Bengal, India, over the period of 5 years from January 2011 to December 2015. It included a total of 15 patients who were clinico-radiologically diagnosed as odontogenic tumours, and were given appropriate treatment. Their diagnostic and management approaches are discussed. Among 15 odontogenic tumours, 13 were benign and two were malignant. Male to female ratio was 2:3. Mandible to maxilla ratio was 1.8:1. The patients were in between 4 and 56 years of age with highest incidence in 3rd decade of life. All patients are doing well till date with a minimum follow-up of 1 year. Incisional biopsy is considered as gold standard for preoperative diagnosis but FNAC can offer clinicians a less invasive alternative. CT is the choice of investigation for study of lesion, analysis of its extension and surgical planning. The challenge to proper management lies in balancing between conservative and radical approach to reduce morbidity and recurrence both. Final diagnosis is made by post-operative histopathological examination.

Cut Throat Injury: Our Experience in Rural Set-Up.

Cut throat injuries are one of the emergency conditions managed by ENT specialists. If not treated in time, they may lead to death. Prevention of these complications depends on immediate resuscitation by securing the airway by tracheostomy or intubation, prompt control of hemorrhage and blood replacement. The present study was conducted to study the sociodemographic profile of patients of cut throat injury, motives behind cut throat injury, site and depth of the injury, treatment given at our hospital and outcome. A prospective study was done in the department of ENT in a tertiary care hospital of rural West Bengal between January 2014 and December 2015. Patients who were brought dead and minor neck injury were excluded from the study. Endotracheal intubation where possible, or emergency tracheostomy was done below the level of injury. Ryle's tube was inserted where necessary. Injured structures were repaired in layers. Among 22 patients there were 18 male and 4 female. The peak age of incidence was in the 4th decade of life. Suicidal cut throat injury was the most common mode of injury. Most of the injuries were in the zone II (72.73%). Three patients died due to severe haemorrhage and/or aspiration. Decannulation was possible in 9 out of 12 patients. Cut throat injuries have become a major cause of morbidity and mortality in our society. Patients with injury of larynx or upper trachea need preliminary tracheostomy. Post-operative endoscopy identifies nerve injuries and stenosis problems.

Single-Stage Trans-mastoid Drainage of Otogenic Brain Abscess: A Single-Institution Experience.

Brain abscess is the ultimate otogenic complication, both in severity and difficulty of management. In developing countries with high incidence of cholesteatoma, brain abscess is not a rare complication. In India, brain abscesses constitute about 8 % of all intracranial lesions. The surgical treatment of brain abscess is very controversial. This prospective study was done in ENT department of a tertiary care hospital in Kolkata, during the period from May 2009 to April 2014. 22 such cases of otogenic brain abscess managed by single-stage trans-mastoid drainage along with meticulous mastoid clearance. On the basis of clinical, radiological and operative findings, data of all patients with otogenic brain abscess were analyzed. There was male predominance and 9 (40.91 %) of them were younger than 20 years. 15 (68.18 %) cases were of cerebellar abscess and in 7 (31.82 %) cases were of the temporal abscess. Lateral sinus thrombosis was the most common associated complication found (22.73 %) in our study. All the patients peri-operatively revealed cholesteatoma. All the patients recovered well and there was no recurrence of symptoms on a minimum 15 months follow-up. This approach suits the otologists in clearing the cause and effect of pathology, at the same sitting. This single-stage approach decreases the peri-operative morbidity and mortality of the two-stage procedure. It also decreases the hospital stay and financial burden.

Endonasal dacryocystorhinostomy with mucosal flaps: our experience.

The endoscopic dacryocystorhinostomy (DCR) has distinct advantage over external DCR. There is no ugly scar on the face, less intraoperative bleeding, it is a daycare procedure and patient is discharged on the same day evening. Endoscopic DCR is considered to be a superior alternative technique to the conventional external DCR. Patients diagnosed with nasolacrimal duct obstruction between Jan 2009 and Jan 2011 were included in the study. One hundred and twenty endo DCR were performed with conventional 'cold steel' instruments. The technique involved complete exposure and marsupialization of the lacrimal sac. The surgical technique involved the creation of nasal mucosal and large posterior lacrimal flaps at the medial lacrimal sac wall and the two flaps were placed in close apposition. Success was defined as complete resolution of epiphora and a patent lacrimal system, evaluated by lacrimal irrigation and endoscopy, 1 year postoperatively.