Submandibular gland extirpation during neck dissection, is it truly justified?

Background: There is no oncologic basis for the extirpation of the submandibular gland (SMG) in early oral squamous cell carcinomas (OSCC) unless the SMG is truly infiltrated by the tumor. The study aimed at assessing the true involvement of SMG in OSCC and to determine whether the gland extirpation in all cases is justified. Methods: This study prospectively evaluated the pathological involvement of SMG by OSCC in 281 patients, who were diagnosed with OSCC and underwent wide local excision of the primary tumor with simultaneous neck dissection. Results: Among 281 patients, 29 (10%) cases underwent bilateral neck dissection. A total of 310 SMG were evaluated. Involvement of SMG was seen in 5 (1.6%) cases. SMG metastases from Level Ib were seen in 3 (0.9%) of cases, whereas 0.6% showed direct SMG infiltration from the primary tumor. The advanced floor of mouth and lower alveolus cases had a higher tendency to infiltrate SMG. In none of the cases, bilateral or contralateral SMG was involved. Conclusion: The findings of this study show that the extirpation of SMG in all cases is truly irrational. Preserving the SMG is justified in early OSCC with no nodal metastasis. However, SMG preservation is case dependent and is an individual preference. Further studies are required to assess the locoregional control rate and salivary flow rate in postradiotherapy cases where SMG is preserved.

Plasma lactate levels and lactate clearance as predictors of outcome in patients with sepsis and septic shock

Background: Severe sepsis and septic shock are the major causes of admission and deaths in the ICU, killing one in four (and often more) and increasing in incidence. In order to improve the clinical outcomes in these patients, it is crucial to obtain early recognition of patients who are at risk of death and to optimize the clinical decision making in a timely manner. In order to monitor the metabolic consequences of shock and hemodynamic management, plasma lactate levels can be used in critical illness. Objective of the study is to estimate plasma lactate and lactate clearance in sepsis and septic shock patients and to correlate plasma lactate and lactate clearance as predictors of mortality.Methods: This study is a prospective observational study conducted over 18months. Children with age of 1 month to 18 years admitted to the Paediatric intensive care unit with sepsis and septic shock were enrolled in the study. ABG at admission to document plasma lactate and lactate repeated at 6 and 24 hrs. Lactate clearance calculated at 6 and 24 hrs. The final outcome in terms of survival or death will be recorded.Results: Majority of the children fall in the class between 1-6 months 51(48.11%). Male comprises 69(65.09%). Among these, Sepsis 36(33.96%); followed by Pneumonia 34(32.07%). Survivors group were 35(33.02%) and non-survivor was 71(66.98%). The Non survivor group was observed to have lower mean values of lactate clearance and found to be statistically significant. Specificity of Lactate clearance was 63.52% and Sensitivity 76.02% respectively. The results were positively associated with lactate level at 24 hours found to be significant effect of survivability when compared to non-survivor.Conclusions: Lactate clearance is vital and markable sign for screening of septic shock at early stage for therapeutic option. Further, 24-hours lactate estimation (cut off values) clearance appears superior to 6 h lactate clearance in predicting mortality in such patients.

Clinicopathological profile of rickettsial fever in tertiary healthcare centre: a prospective case study

Background: Rickettsia are obligate intracellular proteobacteria spread by eukaryotic vectors like ticks, mites, fleas and lice. Rickettsial infections are generally incapacitating and difficult to diagnose; Case fatality rates up to 45 percent is seen in cases with multiple organ dysfunction. The disease continues to be under diagnosed and treated. Objective of this study was to study the clinicopathological profile and outcome of children admitted with rickettsial fever. To study the correlation between Rathi-Goodman-Aghai score and Weil-Felix test. To study the response of rickettsial fever to Doxycycline.''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''Methods: This study is a prospective observational study conducted from December 2017 to April 2019 at a tertiary health care center in South India, involving patients admitted between 2 months to 18 years of age with a diagnosis of Rickettsial fever. Clinical data and investigations were collected and analysed. The response to doxycycline was recorded.'''''''''''''''''''''''''''''''''''''''''''''''' '''''''''Results: Total of 49 patients were enrolled in the study. Most common age group affected was between 1 to 5 years accounting for 32.7% of the cases. 78% of the patients hailed from rural background. Most common presentation being fever, present in 100% of the cases. 81.6% of patients had significant Rathi-Goodman-Aghai score of >14. Weil felix showed significant titres (1:80) in 97.9% out of which serology suggestive of scrub typhus was found in 79.6% patients. There was no statistical significance between rickettsial score and Weil-Felix test (p value= 0.736). 26.5% of the cases required respiratory support and 2% cases required dialysis. 10.2% cases succumbed and 89.8% cases improved.Conclusions: Rickettsial infection is re-emerging with propensity for life threatening complications. There is no statistical significant correlation between Rickettsial score and Weil Felix test. Early treatment has better outcome.

Perceptions Of Undergraduate Medical Students On Use Of Flashcards As A Mode Of Learning Anatomy.

Background & Objective: Anatomy is one of the fundamental subjects taught to the medical students in their first year of medical curriculum. Of its many subdivisions, gross anatomy is one of the vast and important components covered in a short span of one year. The content matter of this subject is very volatile and many undergraduate students face difficulty in learning and recapitulating it. There are many methods adopted by students for learning Anatomy and flashcards is one amongst it. This study was thus planned with an objective to design flashcards for learning gross anatomy, to administer it to the undergraduates for self study revision and to take their perceptions on it. Methodology: The flashcards for gross anatomy of upper limb and lower limb were designed and given to the first year undergraduate students of a premier Medical College in Mumbai. The perceptions of the students on the use of flashcards in learning Anatomy were taken on a prevalidated questionnaire and analyzed. Results: 90% of the students felt that the flashcards helped them to do a quick revision, memorize the content easily and thus perform better in the exams. Conclusion: Flashcards proved to be an effective self study tool for learning gross anatomy

Colorectal malakoplakia in a child presenting as multiple polyposis coli.

Malakoplakia of the gastrointestinal tract is a rare chronic infl ammatory disorder, usually affecting the descending colon, sigmoid colon and rectum. It is commonly seen in adults. Only few cases have been reported in children. We report a case of malakoplakia of colon and rectum in a 7-year-old child who presented with multiple polyposis coli.