Review article on COVID-19 and Guillain-Barré syndrome.

The tale COVID infection pandemic or as far as we might be concerned better, COVID-19, has assaulted society on a worldwide scale. For the unenlightened, the sickness is brought about by the specific infection Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). It is only from time to time that we have a pandemic seething on that has carried with itself a particularly humongous size of harm and on each and every front of the human culture, be it clinical, practical, social or pretty much anything. Theemerging coronavirus disease 2019 (COVID-19) has neurological symptoms comparable to that of the Extreme Acute Respiratory Syndrome Coronavirus (SARS-CoV) and MERS-CoV. Medical symptoms such as pain in head, vomiting, nausea, dizziness, muscle pain, anosmia, ageusia, and disorder of consciousness are present in COVID-19 affected people. These signs confirm that the COVID-19 infection affects the nervous system. But nerve affecting manifestations of COVID-19 infection are underreported. Guillain-Barré Syndrome (GBS) is a condition that often arises in various forms. According to the evaluation case reports so far from the start of COVID-19 infection, GBS could be associated with COVID-19 infection. There was a systematic review and published cases that suggested that a broad age range with male predominance was affected. There were respiratory and/or systemic symptoms in most patients and they developed GBS manifestations after COVID-19. However, asymptomatic cases of COVID-19 have also been identified. The distribution of clinical variants and electrophysiological subtypes is close to that of classical GBS, with a higher prevalence of classical sensorimotor form and acute inflammatory demyelinating polyneuropathy. It seems like it is important to pay attention to the neurological effects of COVID-19.

Surgery for vertigo: 10-year audit from a contemporary vertigo clinic.

OBJECTIVE: To present the profile of patients undergoing surgical treatment for vertigo at a contemporary institutional vertigo clinic. STUDY DESIGN: A retrospective analysis of clinical charts. METHODS: The charts of 1060 patients, referred to an institutional vertigo clinic from January 2003 to December 2012, were studied. The clinical profile and long-term outcomes of patients who underwent surgery were analysed. RESULTS: Of 1060 patients, 12 (1.13 per cent) were managed surgically. Of these, disease-modifying surgical procedures included perilymphatic fistula repair (n = 7) and microvascular decompression of the vestibular nerve (n = 1). Labyrinth destructive procedures included transmastoid labyrinthectomy (n = 2) and labyrinthectomy with vestibular nerve section (n = 1). One patient with vestibular schwannoma underwent both a disease-modifying and destructive procedure (translabyrinthine excision). All patients achieved excellent vertigo control, classified as per the American Academy of Otolaryngology - Head and Neck Surgery 1995 criteria. CONCLUSION: With the advent of intratympanic treatments, surgical treatments for vertigo have become further limited. However, surgery with directed intent, in select patients, can give excellent results.

Long term surgical and hearing outcomes in the management of tympanomastoid paragangliomas.

OBJECTIVE: To analyze the long term outcomes after surgery in tympanomastoid paragangliomas. STUDY DESIGN: Retrospective study. METHODS: The charts of 145 patients with tympanomastoid paragangliomas managed between 1988 and 2013 were reviewed. The clinical features, audiological data, pre- and postoperative notes were noted. The tumors were staged according to the modified Fish and Mattox classification. The surgical approaches for all patients were formulated according to the surgical algorithm developed at our center. RESULTS: 34 (23.5%), 46 (31.7%), 22 (15.2%), 18 (12.4%) and 25 (17.2%) patients were diagnosed to have TMP class A1, A2, B1, B2 and B3 tumors respectively. Gross tumor resection was achieved in 141 (97.2%) patients. The facial nerve was uncovered in four patients and infiltrated in three. The cochlea was found eroded in seven cases. The mean follow-up was 48.4 months. Recurrence was seen in one patient (0.7%). In the cases where the facial nerve was preserved (n=143), the nerve function was graded as HB grade 1 in 138 patients (97%). Postoperatively, the mean AC showed an improvement in all categories except in class B2 and B3, which corresponds to the classes that include patients who underwent subtotal petrosectomy. CONCLUSION: We report the long term surgical outcomes in tympanomastoid paragangliomas in the largest series published till date. It is possible to completely eradicate all types of tympanomastoid paragangliomas with minimum sequelae by choosing the correct surgical approach to achieve adequate exposure for individual tumor classes as described in our classification and algorithm. LEVEL OF EVIDENCE: IIb.

Anatomical variations of the external branch of the superior laryngeal nerve in relation to the inferior constrictor muscle: cadaveric dissection study.

OBJECTIVES: To determine anatomical variations in the external branch of the superior laryngeal nerve in relation to the inferior constrictor muscle, and to propose a rational approach for the preservation of the nerve in thyroid surgery based on anatomical principles. METHOD: A cadaveric dissection study of the anatomy of the external branch of the superior laryngeal nerve in relation to the inferior constrictor muscle was conducted. Twenty-nine formalin-fixed cadavers of both sexes (age 50-70 years), with normal necks, were examined. RESULTS: In relation to the Friedman classification, three anatomical variations of the external branch of the superior laryngeal nerve were found. Type 1 variation was found in 57.1 per cent of cases, type 2 in 26.8 per cent and type 3 in 16 per cent. CONCLUSION: The prevalence of type 3 variation of the external branch of the superior laryngeal nerve suggests that the nerve will not be encountered in a certain percentage of individuals as it lies under the cover of the inferior constrictor. Therefore, there is no justification for attempting to identify the nerve in all cases.

Balloon mitral valvuloplasty during pregnancy.

OBJECTIVES: Balloon mitral valvuloplasty (BMV) has been performed safely during pregnancy with good results. Reports are few on long-term effects of BMV on childhood development. METHODS: BMV was performed in 40 pregnant women (age 23.4+/-4.8 years) with severe mitral stenosis at 24.2+/-4.6 weeks of gestation. RESULTS: Mitral valve area increased from 0.82+/-0.34 to 1.9+/-0.4 cm(2) (P<0.001). One patient had pericardial tamponade. Mean fluoroscopy time was 5.5+/-3.8 min. There was no maternal death, no abortion, no intrauterine growth restriction and one stillbirth. All 39 babies were normal at birth. One baby died at 7 months due to pneumonia. On follow up for 36+/-15 months, all 38 babies maintained normal growth and development without any thyroid disease or malignancy. CONCLUSIONS: During pregnancy BMV is feasible, safe and effective. Maternal and fetal outcomes are excellent. Growth and milestone of development are not affected.

Relationship of metabolic syndrome with quantum of coronary artery disease in Indian patients with chronic stable angina.

BACKGROUND: The current study was aimed to ascertain presence and severity of coronary artery lesions in patients of Type 2 diabetic mellitus (DM) with coronary artery disease (CAD), in our population, by using scoring system analysis of the coronary angiography. METHODS: 147 consecutive patients with Type 2 DM of chronic stable angina (CSA) were enrolled in the study with 147 age- and sex-matched patients of CSA who did not have diabetes to serve as control. All of them underwent coronary angiography and were evaluated by using four scores to quantify the coronary artery lesions. The scores analyzed were coronary score, extent score, severity score, and atherosclerosis score. Other major risk factors such as smoking and hypertension lipid profile were also evaluated. RESULTS: Type 2 diabetics with CAD had higher coronary score (0.91 +/- 0.63 in diabetics vs. 0.43 +/- 0.39, p < 0.001), extent score (4.91 +/- 3.1 vs. 2.3 +/- 1.8, p < 0.001), severity score (1.85 +/- 0.41 vs. 1.2 +/- 0.32, p < 0.001), and atherosclerosis score (0.52 +/- 0.31 vs. 0.21 +/- 0.26, p < 0.001) as compared to non-diabetics with CAD. Left main stem involvement, 2-vessel disease, and 3-vessel disease were also more frequent in the diabetics. These diabetes also had higher incidence of obesity, hypertension, and dyslipidemia. CONCLUSIONS: In our population, diabetics suffer from higher prevalence of diffuse and extensive coronary atherosclerosis. The grades of stenosis in coronary arteries are also higher in diabetic patients when compared with non-diabetics with CAD, as was the prevalence of other components of the metabolic syndrome.

Myocarditis as an initial manifestation of systemic lupus erythematosus.

We report a case of systemic lupus erythematosus (SLE) whose initial presentation was in the form of myocarditis. The patient did not have arthritis, fever or butterfly rash. Presence of LE cell phenomenon, positive ANA, anti-DS DNA antibodies, leucopenia and high ESR with polyserositis indicated the diagnosis to be SLE. Therapy with steroid resulted in complete recovery. The patient developed atrial fibrillation during her course of acute illness which is being reported for the first time.

Percutaneous balloon angioplasty of membranous obstruction of the inferior vena cava.

BACKGROUND: Membranous obstruction of the inferior vena cava is common in African and Asian countries. METHODS AND RESULTS: Between January 1999 and January 2002, 19 patients were prospectively studied. The mean age of the patients was 38+/-6.9 years. All of them had swelling of the abdomen and ankle edema. Five patients (26.3%) had jaundice, 9 (47.3%) had hepatomegaly, and 5 (26.3%) splenomegaly. Ultrasonography could detect the site of obstruction in 18 patients (94.7%). Vena cavography demonstrated obstruction of the inferior vena cava at the level of the diaphragm, with 2 patients (10.5%) having additional intrahepatic obstruction. The mean pressure gradient was 22+/-3.5 mmHg. Seventeen patients underwent balloon angioplasty using a Joseph balloon. The procedure was successful in 15 patients (88.2%). The post-angioplasty mean pressure gradient was 5+/-1.4 mmHg. On follow-up, 3 patients (20%) developed features of restenosis: out of them, 2 underwent successful redilatation. CONCLUSIONS: Balloon angioplasty of membranous obstruction of the inferior vena cava is feasible with a high success rate, without any rupture of the inferior vena cava.

Estimation of chromium in ores and beneficiated products: an ultrasonic approach.

Cr(III) slowly forms a violet complex with EDTA at pH 3.5 +/- 0.2 under normal conditions. The complex formation can be catalyzed by irradiating the reacting mixture with ultrasonic waves. Quantitative formation of the complex was possible with ultrasonic waves of 15 W/cm(2) intensity within 7.5 min of sonication. This method may be successfully applied to the determination of chromium in ores and beneficiated products containing 20-60% Cr(2)O(3) without separating the analyte from the matrix elements.