A Study of Incidence and Management of Postoperative Hypocalcemia in Patients Undergoing Near-Total and Total Thyroidectomy.

To study the incidence and management of postoperative hypocalcemia in participants undergoing near-total (NTT) and total thyroidectomy (TT) at a tertiary health care center. This is an observational prospective study. Patients posted for NTT and TT in our institute and meeting the inclusion criteria were included. A total of 45 participants were enrolled. The serum calcium was measured on postoperative day 2, at the time of discharge and on 3 months follow-up. A combination of injectable and oral calcium supplements with or without vitamin D sachet was used for the treatment of hypocalcemia. Hypocalcemia was observed in 49% cases. Women were observed to develop hypocalcemia at a higher rate than men. Incidence of hypocalcemia was more in TT patients than NTT patients. Cases with malignant pathology were more susceptible to develop hypocalcemia than those with benign pathology. Operated TT with concomitant neck dissection were at higher risk for development of hypocalcemia. There was no significant association between age and incidence of hypocalcemia. Serum calcium measured on postoperative day 2 was a reliable indicator of risk of hypocalcemia. The early measurement of serum calcium level is a reliable indicator of the risk of hypocalcemia. Standardized treatment of hypocalcemic patients with calcium and vitamin D supplements can reduce the incidence and morbidity associated with postoperative hypocalcemia.

Spotlight on the Mucormycosis Outbreak: A Deadly Fungal Infection That Followed the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic along with its treatment has brought myriad potential complications including the heightened risk of secondary fungal infections like mucormycosis. Mucormycosis is a rare angioinvasive fungal infection that has traditionally been highly fatal despite surgical intervention and antifungal medications. AIM: To re-evaluate the risk factors, epidemiology, and possible COVID-19-associated conditions on a larger sample size than the existing data. METHODOLOGY: We studied the possible risk factors, clinical presentations, treatment, and outcome of 203 patients with mucormycosis in a single-center retrospective-prospective observational study for three months at a tertiary care hospital after obtaining due permission from the institutional ethics committee. RESULTS: The mean age of patients was 52 ± 11.5 years, and 92.61% had a history of COVID-19 infection. Around 86.7% of patients were suffering from diabetes mellitus with 50% being already known cases whereas the other 50% developed post-COVID-19 infection; 65.02% of patients were administered corticosteroids during their COVID-19 treatment. About 51.72% of patients required hospital admission and among them, 16.25% of patients required ICU support. The mean oxygen saturation (SpO2) levels on admission were 84.61 ± 12.96%, and 38.92% of patients required mechanical respiratory support. The mean duration between COVID-19 infection and the onset of mucormycosis was 18.80 ± 16.61 days. The most common clinical presentations were facial pain and swelling (26.6%) and ophthalmic symptoms including eye swelling, pain, and ptosis (25.12%). Antifungal treatment was given to all the patients and 89.36% of the patients underwent surgical debridement of fungal mass. At the end of three months, 60.59% of the 188 patients survived with improvement, 13.30% had no improvement and/or deterioration of health, and 18.72% succumbed to mucormycosis. Intracranial involvement and leukocytosis were positively associated with mortality whereas surgical intervention was significant for positive outcomes at the end of three months in patients with mucormycosis (p<0.05). CONCLUSION: The sudden rise of mucormycosis during the second wave of COVID-19 can be attributed to uncontrolled blood sugar levels along with high corticosteroid usage as well as various nosocomial factors during the COVID-19 treatment. Early and aggressive treatment with surgical intervention and antifungal drugs can improve disease outcomes.

A Review on Esthesioneuroblastoma.

Background Esthesioneuroblastoma (ENB) is a rare, aggressive and malignant sinonasal tumour. This tumour makes for a very interesting study because ever since its mention in medical literature, although quite a lot of research has been put into it, a lot is yet to be known about it. Aim To summarize the available literature & document an article on the contemporary practises in the management of ENB. Methods A comprehensive literature review was done using Google Scholar and PubMed database with the key words: "esthesioneuroblastoma", "olfactory neuroblastoma", "Kadish" and "Hyams". Articles published in English were used. Articles published till April 2021 were reviewed. Conclusion ENB has a diverse histological appearance. This tumour has a bimodal age distribution without any gender predilection. Prompt identification and treatment is required for a favourable outcome and requires close collaboration of radiology, pathology, and rhinology. Staging, management and prognosis are determined by regional involvement in non-metastatic cases due to its proximity to neurological structures and locally destructive nature. Immunohistochemistry is a must for accurate diagnosis. Uni-modality of treatment has high chances of local recurrence. Multi-modality provides good results even in advanced stage. A combination of surgery and radiotherapy seems to be the optimum approach to treatment. The exact role of chemotherapy in treatment protocols is still unclear. Cervical lymph node metastases are commonly studied, however its management in patients who present without apparent nodal involvement is not yet clear. An extended follow-up period is recommended in all patients of ENB patients.

Sinonasal Inverted Papilloma: A Narrative Review.

Inverted papilloma (IP) is a relatively rare sinonasal benign lesion, peculiar in its etiology, clinical presentation and treatment. Its resemblance to other sinonasal pathologies and varied approaches, makes it an interesting disease. Recently there have been several advances in the management of IP. This article aims to summarize the contemporary developments thus enabling the readers to understand the years of research behind IP. To integrate the available literature on IP and study the current scenario in its management. A comprehensive literature review was done on Google Scholar and PubMed database using the following key words: "inverted papilloma", "Schneiderian", "sinonasal", "medial maxillectomy". Articles published in English were used. Articles published till May 2020 were reviewed. Years of research have aimed to gain more information regarding the epidemiology, histopathology, staging systems and surgical management of IP. To briefly summarize the research so far, it is safe to say that there exists an association between Human Papilloma Virus and IP. The Krouse staging system is the most commonly used. The treatment itself has changed from a conservative approach to a more aggressive excision with or without external approach and with or without chemoradiotherapy. In IP, whether or not associated with SCC, complete surgical removal of the tumour is advocated as the treatment of choice. With the advancements in endoscopic technique, surgeons have been using it to their advantage for the surgical evaluation and cure of IP, depending upon the stage. Endoscopic treatment is preferred, whereas for lesions less accessible endoscopically, or in those with peripheral extension, open surgery is indicated. Every patient requires counselling before discharge and thorough examination during the follow-up to detect any evidence of recurrence.

Epidemiology, Clinical Features and Management of Rhino Orbital Mucormycosis in Post COVID 19 Patients.

COVID 19 infections may be associated with a wide range of bacterial and fungal co-infections. Mucormycosis is a fungal infection primarily affecting immunocompromised individuals. We have observed sudden rise of mucormycosis cases in post COVID 19 patients. Here we have reported 100 cases of mucormycosis associated with COVID 19. To study epidemiology and clinical features of rhino orbital mucormycosis in post COVID 19 patients. To evaluate efficacy of medical as well as surgical treatment in such patients. This was an observational mixed (retrospective + prospective) study with a duration of 2 months. After noting demographic data, necessary radiological investigation was advised and representative tissue was sent for KOH and histopathological examination. Medical and surgical treatment was planned accordingly. Most patients (55%) presented with complaint of headache and facial pain. Hard palate involvement was observed in 45% patients. Unilateral presentation (68%) was more common. Only 25% patients who presented early had normal vision. We reported 22 patients with complete loss of vision. Eye movements were restricted in 58% patients. Diabetes mellitus is most common predisposing factor (65%). 9 patients required orbital exentration. Only 18% patients required Amphotericin for more than 14 days. Immune dysregulation caused by COVID 19 infection in addition to widespread use of steroids and broad-spectrum antibiotics may lead to the development mucormycosis. Diabetes Mellitus type II is another important risk factor and the presence of both have additional effect in causing mucormycosis. Headache and facial pain should be considered highly suspicious of mucormycosis. Early diagnosis with efficient treatment can improve prognosis.

Occult Primary with Cervical Secondary-Role of CT Scan and Evaluation Under Anesthesia.

The potential of CT, MRI or both to detect a primary tumor ranges from 9.3 to 23% rising to 60% when suspicious radiological findings direct subsequent endoscopic biopsies (Zhuang et al. in Mol Clin Oncol 2:917-922, 2014). Prospective case Study. To know the sensitivity, specificity accuracy rate and P value of CT scan and upper aero digestive tract endoscopy with palpation of nasopharynx and oropharynx to search the primary site of cancer. 53 patient of occult primary with FNAC proved metastatic squamous cell carcinoma were evaluated to find out the sensitivity, specificity, accuracy rate and P value of imaging study and rigid endoscopic examination of upper aero digestive tract with through palpation of oropharynx, nasopharynx and evaluation under anesthesia (EUA). Punch biopsies were taken from suspicious areas and sent for histopathology examination (HPE). Taking HPE as a gold standard (Ishak et al in Rawal Med J 35:209-213, 2010) sensitivity of both EUA and imaging was found to be 100%, Specificity and diagnostic accuracy of EUA and imaging were 96.77, 83.87, 98.11 and 90.57% respectively. P value was <0.0000001 which is highly significant.

Aberrant innominate artery may complicate a potentially safe surgery.

Surgeries of the anterior neck include thyroid surgery, open or percutaneous dilatational tracheotomy, bronchoscopy, mediastinoscopy and oesophagoscopy. These are potentially safe surgeries with mortality rates less than 1%. Today, the most common cause of death following a tracheotomy is haemorrhage and, following thyroid surgery, the causes are haemorrhage, giant goitres and upper airway complications. Bronchoscopies and mediastinoscopies are almost never fatal. While operating around the trachea, no major vessel is encountered in the surgical field. We report a case in which an aberrant innominate artery was encountered crossing anterior to the trachea just below the thyroid isthmus. As it is an uncommon finding, even minor complacency can lead to torrential bleeding culminating in death. Thus, we recommend surgeons to be vigilant for any aberrant artery in the surgical field rather than finding it accidentally; thereby preventing any complications in a potentially safe surgery.

Treatment options in otitis media with effusion.

Secretary Otitis media with effusion (OME) is the accumulation of mucus in the middle ear and sometimes in the mastoid air cell system. The main etiological factor is alteration in mucociliary system of middle ear secondary to ET malfunction which may be primary or secondary. OME is the cause of concern due to its occurance in paediatric age group, highest at 2 years of age, presenting as impairment of hearing leading to delayed speech and language development, poor academic performance and behavioral problems. In spite of this there are no confirmed guidelines of treatment to overcome. Many treatment options are available medical as well as surgical. Prospective study conducted to evaluate various treatment options revealed that auto inflation of ET is the main stay of treatment. If the ET malfunction is due to any reasons like adenoids, deviated nasal septum, hypertrophied turbinates or any other cause surgical intervention of the same gives 100% results. Medical management gives good results but recurrence is equally common.