ABSTRACT
Purpose: Indian fishermen belong to a marginalized population and are continuously exposed to extreme occupational hazards and sunlight. A high prevalence of visual impairment (VI) is reported in the coastal fishing community. We aimed to investigate the association between VI and sunlight exposure measurement (SEM). Methods: In this cross?sectional observational study, 270 eyes of 135 participants were enrolled from a coastal fishing village. Participants underwent a comprehensive ophthalmic examination, which included best?corrected visual acuity (BCVA), and anterior and posterior segment examination. Ocular Surface Disease Index (OSDI) and SEM questionnaire were administered to estimate the level of dry eye and ultraviolet?B (UV?B) exposure, respectively. VI was defined as presenting visual acuity worse than 6/12 (logarithm of the minimum angle of resolution [logMAR] > 0.3). Results: The mean age and spherical equivalent were 50.56 ± 11.72 years (range: 18–80 years) and 0.36 ± 1.68 diopters (D) (range: ?7.0 to +3.0 D), respectively. Age, SEM, OSDI, fishing as an occupation, and cataract were significantly associated with higher odds of VI in univariate analysis. Refraction, gender, education level, smoking status, amblyopia, systematic, and other ocular diseases were not significantly associated with VI. In the multivariate analysis, age, SEM, and presence of cataract remained significantly associated with a higher risk for VI. The area under the receiver operating characteristic curve values for age and SEM scores demonstrate a fair index of discrimination for the detection of VI. Conclusion: SEM level is directly associated with a higher risk of VI among fishermen. The fishing community might benefit from regular eye examinations and awareness about the harmful effects of sunlight exposure and preventive measures.
ABSTRACT
Background: A patient with a retained intraocular metallic foreign body post?trauma was taken up for vitrectomy and intraocular foreign body removal. Unfortunately, the intraocular magnet was not available at the moment on the table! How a little bit of creativity and innovative thought helped us tide over this crisis is the content of this video. Purpose: To demonstrate magnetization of a metallic surgical instrument for temporary use in the event of unavailability of the intraocular magnet for intraocular foreign body removal. Synopsis: A ferromagnetic substance can be magnetized temporarily using an existing magnet. We obtained a general?purpose magnet and wrapped it in sterile plastic, using which we magnetized normal intraocular forceps and a Micro Vitreo Retinal (MVR) blade by giving about 20–30 strokes over the magnet in a single direction. This aligned the magnetic domains in the metal in a parallel fashion. These Do It Yourself (DIY)? magnetic instruments were then effectively utilized to remove the metallic intraocular foreign body. Highlights: The video showcases effectively harnessing the available resources and tiding over the dearth of a necessary instrument, with the right use of an innovative idea and some creativity!.
ABSTRACT
@#Introduction: The increased prevalence of oral submucous fibrosis (OSMF) in the last few years relates to the increased consumption of areca nut(AN) products. OSMF is a premalignant condition and risk to progression to oral cancer is more when AN is chewed along with tobacco. Moreover, high copper content in AN is responsible for fibroblast dysfunction and fibrosis. This study was conducted with aim to assess and compare pH and copper content of raw AN and popular Indian commercial AN based (with and without tobacco) products. Method: Six samples each of twelve different brands of AN based commercial products i.e. six without tobacco (pan masala) and with tobacco were analyzed for pH and then the samples were dried, and powdered for estimation of the copper content. Results: For the six raw areca nuts (sample 1-6), the pH was found to range from 3.06±1.08 to 5.04±0.81, among the six non tobacco containing samples (sample 7-12), the pH was found to range from 6.03±1.08 to 9.09±0.81, and for six tobacco containing samples (sample 13-18), the pH was found to range from 9.18±0.90 to 11.07±0.09. The mean copper concentration among raw areca nut samples (sample 1-6) was 4.05±0.18 μg/g, among non-tobacco containing samples (sample 7-12) it was 10.17±1.08μg/g and among tobacco samples (sample 13-18),it was 18.09±1.08 μg/g (p<0.001). Conclusion: High copper content present in quid and commercial AN may be a causative factor for an increased fibrosis in OSMF, our findings need evaluation by further research and standardization.
ABSTRACT
Post-burn contractures are common entities seen in developing countries. There are multiple reasons for the development of contractures, most are preventable. In extensive contractures, a strategic plan is necessary to release all contractures and yet not antagonize post-operative positions. It is also necessary to be cost-effective and minimize the number of surgeries needed. Conventionally the release sequence in extensive burn contractures is proximal to distal. In this case report, we discuss an unusual sequence where we released distal contractures before the proximal to achieve optimum results. A 3-year-old child with post-burn contracture of hand, wrist, elbow, and axilla was treated in 2 stages, with the release of wrist contracture and cover with pedicled abdominal flap in the first stage and division of pedicled flap with the release of axilla and elbow contracture in the second stage. Thus, the release of all contractures was achieved without antagonizing post-operative positions and minimized the number of surgeries. A case-based approach may be crucial in making a strategic surgical plan to minimize the rehabilitation phase, rather than following known dictums.
Subject(s)
Humans , Child, Preschool , Surgical Flaps/surgery , Upper Extremity , Plastic Surgery Procedures , Skin Transplantation , Contracture/surgeryABSTRACT
Purpose: To assess and analyze the visual outcomes of patients with retinal vein occlusions in a real?world setting with a long?term follow?up of more than 5 years. Methods: Retrospective analysis of 56 patients having retinal vein occlusions from a tertiary eye center, with a mean follow?up of 7 years was performed. Primary outcome measures were mean change in best?corrected visual acuity (BCVA) from baseline at 6 months, 1 year, 2 years, 3 years, and final visit (?5 years), proportion of patients having BCVA better than 20/40 and worse than 20/200, and mean number of injections. Secondary outcome measures were change in central macular thickness (CMT), development of subsequent retinal vein occlusion (RVO) in same eye or the other eye, and development of neovascular complications. Results: The mean change in letter score was + 11.84 in branch RVO (BRVO), +7.14 in non?ischemic central RVO (CRVO), and ?9.5 in ischemic CRVO at 1 year, which changed to + 8.57, ?5 and ? 24, respectively, at the end of follow?up. CMT had improved from 506 ± 98.8 ?m, 576.44 ± 149 ?m, and 618 ± 178.27 ?m, respectively, at baseline to 267 ± 94 ?m, 345.20 ± 122.61 ?m, and 265.50 ± 107.75 ?m, respectively, in BRVO, non?ischemic, and ischemic hemi RVO (HRVO)/CRVO groups. The total mean number of injections given in BRVO, non?ischemic CRVO, and ischemic CRVO groups were 4.6, 6.6, and 4.1, respectively. None of the patients with BRVO developed neovascular glaucoma (NVG). Non?ischemic to ischemic HRVO/CRVO conversion was noted in 4/11 eyes at a mean duration of 12.6 months. NVG was noted in 7/9 eyes (77.8%) in initial ischemic CRVO/HRVO group and 3/4 (75%) converted eyes. Conclusion: Patients with BRVO have good visual outcomes with anti?VEGF, while in CRVO results may vary considerably owing to patient compliance and treatment burden on long?term follow?up in a real?world setting
ABSTRACT
Introduction: Rise of major Healthcare associated infections (HAIs) can be mitigated by inculcating good infection control practices which can only be possible by proper and timely educational training of healthcare workers. Aim: To reinforce infection prevention and control knowledge and practices of nursing staff through proper training program- To conduct the training in multiple sessions, to assess the immediate outcome of training program by conducting Pre and Post test (in written format only) Materials and Methods: This study was done in a tertiary care hospital in Davangere, Karnataka over a period of 2 years. Healthcare workers including 144 nurses and 12 doctors underwent training in four sessions where knowledge on how to identify, audit and conduct surveillance of major healthcare associated infections, management of needlestick injuries were imparted through interactive lectures and video demonstrations followed by hands on hand hygiene, proper use and disposal of personal protective equipments. Pre and Post test were given to know their basal knowledge and effect of our training intervention. Data was collected, analyzed and tabulated. Results: Out of four sessions covering a total of 144 nurses, 84 were trained before the onset of COVID-19 and remaining 60 were trained in the latter half of 2021, when the lockdown was relaxed in our region. The mean total Knowledge score in pre test and post test was 5.93 � 1.336 and 7.95 � 1.040. The mean difference was -2.021 and it was statistically significant by paired test. (p - 0.001). The mean total practice pretest and post test score was 3.57 � 1.48 and 4.56 � 1.114. Paired t test showed significant mean difference between the pretest and post test score. (p - 0.001). Conclusion: Our training intervention was effective in increasing their awareness on proper infection prevention and control practices. Repeated training and retraining of healthcare care workers have to be carried out to prevent and control healthcare associated infections.
ABSTRACT
Background: Among major metabolic disorders of glucose metabolism, diabetes mellitus is the most common one, in which Insulin deficiency and insulin resistance are the common observations. It is a renowned fact that long-standing hyperglycaemia is associated with oxidative stress, caused by an increase in the reactive oxygen species. Adenosine deaminase(ADA) is a purine metabolic enzyme that degrades adenosine. Gamma-glutamyl transferase (GGT) maintains antioxidant levels by maintaining reduced glutathione in the cells. Ceruloplasmin is a known acute phase reactant. Aim: 1. To Study and compare the levels of Serum FBS, PPBS, ADA, GGT and Ceruloplasmin in T2DM patients and nondiabetic subjects. 2. To study the correlation between these parameters and blood sugar levels in cases. Materials and methods: A descriptive cross-sectional study was done at Subbaiah medical college in Shimoga, taking 50 T2DM patients and 50 controls. Serum levels of fasting blood sugar(FBS), Postprandial blood sugar (PPBS), Adenosine deaminase, Gamma-glutamyl transferase and Ceruloplasmin were estimated. Data were analysed in SPSS software 17 using independent student t test. p < 0.01 was considered significant. Results: Increased levels of ADA, GGT and ceruloplasmin in cases were found, and they were statistically significant. Pearson correlation of these inflammatory markers with FBS and PPBS showed a positive significant correlation.
ABSTRACT
Background: There are conflicting results concerning the ideal time for etching primary dentin and its effect on the bond strength of adhesive restorative materials. Aim: To assess in vitro, the effect of varied acid concentration and etch time on the morphological features and tensile bond strength of primary dentin. Materials and Methods: Forty healthy primary molars were prepared by exposing the dentin of the occlusal surface, creating a smear layer. A 3 mm × 3 mm test indow was demarcated, and specimens were randomly allocated to four groups (n = 10): Group 1A 10% phosphoric acid, 7 s; Group 1B 10% phosphoric acid, 15 s; Group 2A 37% phosphoric acid, 7 s and Group 2B 37% phosphoric acid, 15 s. Surface analysis was done using atomic force microscope and scanning electron microscope. For tensile bond strength evaluation, 24 specimens prepared as mentioned were mounted in acrylic blocks and allocated to four groups according to the prescribed etching protocol. Resin rods were bonded and tested in tension after 24 h (n = 6). Data were analyzed statistically using unpaired t-test. Results: Etching of primary dentin using 37% phosphoric acid for 7 s produced the highest tensile bond strength of 9.51 ± 2.19 MPa. Conclusion: Etching time of 7 s may improve the adhesion of resin restorative materials with primary dentin.
ABSTRACT
Background: Menopause is a biological event characterized by the complexity of factors. On an average one-third of the women’s life consists of the post-menopause years, and health care programs for women do not address concerns beyond reproductive ages. The aim of this study was to describe the magnitude of menopause-related symptoms, the pattern of health care seeking, and associated factors. To assess the prevalence of gynecological disease in post-menopausal women.Methods: This cross-sectional study was done in Karpaga Vinayaga Institute of Medical Sciences and Research Center - obstetrics and gynecology OPD. Over a period, months in the year 2019. Stages of reproductive aging workshop (STRAW) revised criteria and nomenclature are used for the ascertainment of menopause and inclusion of the women in the study. It provided a comprehensive basis for staging since there were more complexities on ascertainment of menopause explained. The STRAW criteria are considered as the gold standard for assessing menopausal stages.Results: A total of 600 participants were included in the study. The proportion of women who had at least one menopause-related symptom was 95.95 (95% CI 93.73-97.54) and 58.3% of women had severe symptoms. Severities of symptoms in psychological, physical, vasomotor, and sexual domains were 56.7%, 70.5%, 49.3%, and 10.2% respectively. Premature menopause (p<0.016), induced nature of menopause (p<0.031), dyslipidemia (p<0.006) and other medical condition (p<0.003) were associated with severity of menopausal related symptoms.Conclusions: A high proportion of women are affected by menopause-related symptoms. Care seeking for all symptoms is not uniform, indicative of a lack of knowledge about the treatable nature of many of these symptoms. Sensitization of both women and the health care system may serve to address this issue of menopause-related symptoms and the possibility of treatment for these.
ABSTRACT
Temporomandibular joint (TMJ) dislocation is an uncommon but debilitating condition of the facial skeleton. The condition may be acute or chronic. Acute TMJ dislocation is common in clinical practice and has been managed easily with manual reduction. Chronic recurrent TMJ dislocation is a challenging situation to manage. In this article, we discuss a case referred by the department of oral medicine for conservative management of the recurrent dislocating TMJ. This case was managed conservatively using physical therapy as the first line of management. At the end of the intervention the patient was pain free and had achieved normal function of the TMJ
ABSTRACT
Background: Persistent thin endometrium affects <1% of patients. Various treatments have been proposed with no satisfactory results. GCSF is one such treatment modality which improves endometrial thickness and implantation. Aim of this study was to analyse the effects of dose and the site of instilling intrauterine G-CSF in COS IUI cycles in patients with unexplained infertility and to note the pregnancy rates among them.Methods: It is a 3-year retrospective study done in obstetrics and gynecology department of AJ Institute of Medical Sciences and Research Centre, that included all unexplained infertility cycles with controlled ovulation stimulation-IUI protocols where for a thin endometrium GCSF was used. The method of ovarian stimulation, the drug and dose used, the trigger for ovulation and the ovarian and endometrial response was noted. The day of the intrauterine GCSF and the dose and the site of instillation was noted. The endometrial response to GCSF the outcome for pregnancy was noted. All the data was analyzed statistically.Results: Significant endometrial response was seen with a dose of 100 mg,150 mg and 300 mg. Pregnancy outcome was better when GCSF was instilled just above the level of the os. GCSF instilled at the level of the fundus increases the possibility of ectopic pregnancy.Conclusions: Instillation of GCSF of 100 mg dosage just above the os; is a safe and effective method for improving the endometrial thickness and increasing pregnancy rate.
ABSTRACT
Background: Menstrual cup is an alternative to sanitary pads, which has received attention in relatively small-scale studies in high income, and low- and middle-income countries, including among schoolgirls. Made of high-grade medical grade silicone (biodegradable) have the advantage of reuse, and can potentially last up to 10 years. Objective of this study was to assess and analyse the awareness regarding menstrual cup among the women of reproductive age group.Methods: Data collected from the selected eligible participants by an interviewer administered study proforma. It is a descriptive cross-sectional study over 1 month in women in reproductive age in A. J. Institute Mangalore, Karnataka, India.Results: A total 82% were aware about menstrual cup but only 2.6% have used it.Conclusions: One challenge of menstruation that is taken for granted in affluent countries is the simple question of how to manage or contain the menstrual flow and what happens to a girl or woman who is not able to do this successfully. Menstrual hygiene management is therefore an increasingly important (yet often unrecognized) issue that is heavily intertwined with girls’ education, empowerment, and social development.
ABSTRACT
Background: Aim of this study was to study effect of oral 25% dextrose for pain relief in newborns undergoing venepuncture.Methods: This is a case control study conducted in NICU, Cheluvamba hospital attached to Mysore medical college and research institute during the period between September 2018 to November 2018. Babies with gestational age between 34 to 40 weeks of gestation who had clinical indication for blood sampling were included in the study. Neonates who are critically ill, suffered perinatal asphyxia and having congenital anomalies were excluded from the study. Hundred newborn babies admitted to NICU who had clinical indication for blood sampling were enrolled in the study. Study population were divided into 2 groups, dextrose (cases) and non-dextrose group (controls). The data analysis included gestational age, postnatal age, weight, sex, heart rate, oxygen saturation, crying time and behavioural pain assessment.Results: Mean pain score, crying time and heart rate at 5 minutes of venepuncture were studied in both the groups. Mean pain score in dextrose group was 2.68 and in non-dextrose group was 7.18 with significant p value of 0.0062. Mean crying time in dextrose group was 8.98 minutes and in non-dextrose group was 42 minutes with significant p value of 0.001. Mean heart rate in dextrose group was 142 beats/minute and in non-dextrose group was 146bpm with p value of 0.08.Conclusions: Pain in the newborns should be recognised and adequately treated. Lingual 25% dextrose can be used as safe and effective analgesia in neonates undergoing minor invasive procedures like venepuncture.
ABSTRACT
Background: Self medication with analgesics is prevalent worldwide due to easy procurement of over the counter drugs. Present study was done to assess knowledge, attitude, practice and perception of self medication of analgesics among MBBS students at Dr. B. R. Ambedkar Medical College, Bengaluru, Karnataka.Methods: A cross-sectional study was conducted on 5th term MBBS students of Dr. B. R. Ambedkar Medical College, Bengaluru in November 2019. A pre-designed validated questionnaire was used to collect information on knowledge, attitude, practice and perception of self medication of analgesics. Data was analysed using descriptive statistics.Results: 83.3 % of 5th term MBBS students practiced self medication with analgesics. Majority of students had some knowledge on self medication with analgesics. Common reason for using analgesic self medication was headache (59.7%) and nonsteroidal antiinflammatory drugs (90%) were commonly used analgesics. Analgesics were used for quick relief (73.3%) and source of information was from medical textbooks (61.6%). Students stopped taking analgesics after symptoms disappeared (75%). Students agreed that self medication is acceptable for medical students (63.3%) and medical license is required for better administration of drugs (51.3%).Conclusions: This study has found that self medication with analgesics was common among undergraduate medical students for minor illness. It is necessary to create awareness and educate students regarding dangers of analgesic self medication.
ABSTRACT
Background: Vacuum extraction and forceps are the two options when an instrument is needed to facilitate a vaginal birth. Vacuum extraction has recently gained popularity because of new designs of vacuum cups with reduced risk of injury to the neonate. Vacuum extraction is one of the evidence-based interventions that can prevent complications by shortening the second stage of labour. The present study has been carried out to evaluate the maternal and neonatal morbidity, mortality and failure associated with vacuum assisted vaginal deliveries, at a Government tertiary care hospital in Mandya, Karnataka, India.Methods: The study was a record-based study including a total of 207 women who underwent vaginal assisted delivery in the form of vacuum assisted deliveries in a period of 6 months from January 2019 to June 2019 at the Government tertiary care hospital in Mandya, Karnataka, India. Records of women who had vacuum assisted deliveries and records of their newborn children were accessed.Results: In our study 41.5% of the subjects were in the age group of 21-25 years. Nearly 3/4th (74.4%) of the subjects were primigravida. More than half (54.1%) of the study subjects had to be put under vacuum assisted techniques for delivery because of the prolonged second stage of labour, failure rate was 0.4%. Out of 207 vacuum assisted deliveries maternal complication rate was 8.21%, 17.3% neonates had NICU admission and 14.97% had perinatal complications.Conclusions: Vacuum assisted vaginal delivery is comparatively a better choice in preventing the complications caused due to prolonged second stage of labour thus reducing the cesareans rate. It is a safe alternative to cesareans delivery in rightly chosen case. Vacuum assisted delivery by a skilled person and a proper technique is associated with lesser maternal and neonatal morbidity.
ABSTRACT
Background: The advanced contraceptive devices available nowadays have minimal side effects and utmost efficacy. The use of safe and effective contraception is the need of the hour in India. Inj. Depot medroxy progesterone (DMPA) has been found to provide effective, long acting and reversible contraception in lactating mother and post-abortal patients. Objective of this study was to describe the profile of women utilizing inj. DMPA as a contraceptive, to determine its compliance and to assess the factors affecting discontinuation of inj. DMPA (Anthara) at the government tertiary care institute in Mandya.Methods: The present study was a record-based study of 18 months (January 2018 to June 2019). The records of 266 women who utilized inj. DMPA as contraception in our institution was analysed.Results: It was observed that out of 266 women 48.5% were from age group of 21-25 years and 64.3% were primipara. Most of the women who initiated inj. DMPA (Anthara) were in the lactational period (56.0%). Most common side effect was irregular bleeding (54.8%). Discontinuation rate was 55.6% after first injection and 16.9% after second injection and gradually reduced with subsequent injections. The most common reason for discontinuation was irregular spotting per vagina (53.9%).Conclusions: Inj. DMPA is a safe, effective, long acting contraceptive taken once in three months. Many women in early reproductive age and lactational period are using inj. DMPA (Anthara) for contraception because of its convenience of dosing and is easily made available at government health care centres free of cost and has no effect on lactation. Discontinuation rate can be reduced by proper counselling.
ABSTRACT
Introduction: Spleen plays an important function in immunity and haematological functions. So, nowadays totalsplenectomy is replaced by splenic conservative surgeries. Partial removal of spleen is possible, as the spleenis divided into various segments, supplied by its own artery. The present study was undertaken to know about thesegmental branches of splenic artery.Objectives: 1.To study the number of primary segmental branches of splenic artery. 2. to measure the distancebetween the termination of splenic artery and hilum.Materials and methods: The present study was conducted on 79 adult human cadaver spleens by dissectionmethod, irrespective of their age and sex, fixed in 10% formalin solution, collected from the Department ofAnatomy and Forensic Medicine, Mysore Medical College and Research Institute, Mysore.Results: Two primary segmental branches were seen in 56 (70.9%) specimens, three primary segmental brancheswere seen in 19 (24.1%) specimens and four primary segmental branches were seen in 4 (5.1%) specimens. Themean distance between termination of splenic artery and hilum of the spleen was 2.1 cm. and the range wasextending from 0.3 cm to 6.1 cm.Conclusion: The present study adds up to the existing knowledge regarding the segmental branches of splenicartery, the better anatomical knowledge about segmental distribution of splenic artery and its variations areimportant for the partial removal of the spleen.
ABSTRACT
Background: Tuberculosis (TB) is a worldwide public health problem. India has the highest TB burden in the world. India accounted for a quarter of global incident TB cases, 24% of multi drug resistance (MDR) TB cases and highest TB mortality rate in 2017. Thus it is important to understand the profile of TB patients. The objective of the study was to assess the profile of TB cases attending a directly observed treatment short-course (DOTS) center in North Kerala.Methods: A retrospective record based, descriptive study was done in the DOTS center of Government Medical College Kannur, in North Kerala, to assess the profile of TB patients who attended the centre from January 2015 to July 2018. Details of 548 patients were collected from the record maintained at DOTS center. Data was entered in Microsoft Excel and analysed using Epi info7 software.Results: The age group of 21-60 years was most affected. 68.53% of the patients were males. 45.62% of patients had extra-pulmonary TB (EPTB). Among the pulmonary TB patients, 74.27% tested positive for acid fast bacilli. Among cases of EPTB, most common type was TB lymphadenitis (40.8%) followed by tuberculous pleural effusion (22.4%). 87.59% of TB patients were started on category I treatment under DOTS.Conclusions: In our study, affected population was mostly males and those in productive age group. This is the group that has maximum chances of exposure to TB patients. 45.62% patients had EPTB. Total number of cases is on the rise each year, with maximum cases in 2018.
ABSTRACT
BACKGROUND: Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a well-known adverse effect of vincristine (VCR). Literature suggests that Asians are predisposed to develop SIADH following VCR administration. However, data regarding the occurrence of SIADH in children with malignancy are limited. This study aims to analyze the incidence, clinical picture, risk factors, management, and outcome of SIADH during induction chemotherapy for pediatric acute lymphoblastic leukemia (ALL). MATERIALS AND METHODS: A prospective study was conducted among the 166 newly diagnosed pediatric ALL patients who were treated at a tertiary cancer center in India between January 2015 and December 2015. Patients who developed hyponatremia during induction chemotherapy were further investigated for SIADH. RESULTS: The incidence of SIADH was 10.8% (n = 18) with a mean sodium level of 125 mEq/L (114–129 mEq/L). In the preceding 2 weeks, 72% of episodes were associated with the administration of two (n = 6) or three (n = 7) doses of VCR. One child presented with seizures. All the patients were managed with fluid restriction and only two patients required sodium correction with 3% saline. Girls older than 10 years of age showed a marginally significant correlation to develop SIADH (P-value = 0.059). CONCLUSION: We report a higher incidence of SIADH (10.8%) in Indian children, compared to that described in the literature, during induction chemotherapy for ALL. Regular monitoring of sodium levels during this period of chemotherapy is hence essential for the timely diagnosis and appropriate management of SIADH, which in turn will avert complications, including neurological symptoms secondary to SIADH.
ABSTRACT
Papillary thyroid carcinoma usually presents as a palpable thyroid swelling, and presenting as cervical lymphadenopathy is uncommon. Metastasis to the cervical lymph nodes could have several primary sources. A 70 year old male presented with painless left cervical mass which was insidious in onset, gradually increasing in size since past one year. Physical examination revealed an oval left cervical mass, extending from anterior border of sternocledomastoid (SCM) muscle to the posterior triangle of neck at level III, IV and V. Plain and contrast enhanced Computed tomography (CT) of neck and thorax demonstrated an ill defined irregular intensely enhancing multi-lobulated lesion in the left supraclavicular region. Fine needle aspiration cytology (FNAC) was suggestive of either a metastatic lesion or a primary lesion. Level V lymph node biopsy suggested papillary carcinoma thyroid. The patient underwent total thyroidectomy with bilateral lymph node dissection with excision of mediastinal lymph nodes via cervical approach without sternotomy. Histopathological examination of the specimen confirmed Papillary Thyroid Carcinoma (conventional type) with secondaries to the neck. On discharge, the patient was given radioactive iodine therapy for two weeks, followed by lifelong oral thyroxine. No signs of recurrence were noted in the follow up visits. A combination of radiological and histopathological investigations can help to assess a cervical mass of thyroid origin. The transcervical approach is simpler and safer than the transsternal approach and avoids the morbidity of a sternal split.