Extrapulmonary Tuberculosis: An Otorhinolaryngologist's Perspective.

Objective: The study aimed to determine the clinical manifestations and epidemiology of extrapulmonary tuberculosis (EPTB) of the head and neck in the otorhinolaryngeal regions. There is an increase in the incidence of EPTB in recent years because of increase in immunocompromised states and development of resistant bacteria. The clinical symptoms and signs of EPTB of the otorhinolaryngeal regions overlap with that of malignancies and other diseases in otorhinolaryngology thereby requiring correct early diagnosis so as to avoid unnecessary surgeries and procedures with initiation of appropriate anti tuberculous treatment under RNTCP. Study design: Our prospective study was done on 45 patients who attended the ENT OPD at a tertiary care centre in Southern India over a period of 18 months with diagnosed EPTB of the otorhinolaryngeal regions. Results: The study included 29 (64.4%) patients who presented with cervical lymphadenopathy, 11 (24.4%) patients with tuberculous laryngitis, 3 (6.6%) patients with tuberculous otitis media and 1 each with nasal and oral cavity tuberculosis. In our study 6 (13.3%) patients had co-existing pulmonary tuberculosis, 8 (18%) had diabetes, 5 (11%) had past history of tuberculosis and 7 (16%) had contact with patient with tuberculosis. Conclusion: A high index of suspicion of EPTB must be kept among patients where (i) the clinical symptoms are out of proportion to the signs, (ii) common treatment fails or (iii) there is persistence or recurrence of symptoms despite therapy. The challenge is in confirming diagnosis which requires histopathological examination (HPE) of the tissue specimen. The timely diagnosis and initiation of anti tuberculous treatment (ATT) as per RNTCP helps in complete recovery thereby reducing morbidity.

Clinico-radiological Co-relation of Carcinoma Larynx and Hypopharynx: A Prospective Study.

The successful management of laryngeal and hypopharyngeal cancers requires accurate diagnosis, staging, assessment of patient wishes, and the selection of the most appropriate treatment for the individual patient. Imaging plays an important complementary role to clinical examination and endoscopy in the evaluation of laryngeal and hypopharyngeal cancers. The combined information allows the disease to be staged accurately. To correlate carcinoma larynx and hypopharynx clinically and radiologically and to know the accurate pre-therapeutic stage of the disease. A total of 50 cases were included in this study. After clinical TNM staging, CT scan was done to know the real extent of tumor, volume and nodal status. After that, TNM staging was revised based on radiological findings. The number of people who had been upstaged and downstaged after CT evaluation was measured. There were total of 50 cases of carcinoma larynx and hypopharynx in this study. There were 26 (52%) cases of carcinoma larynx and 24 (48%) cases of carcinoma hypopharynx. There were significant changes in T stage after radiological evaluation. Major changes were observed in T2 and T3 stages. Majority of cases (17) were having N1 disease after radiological evaluation. On comparing clinical and radiological staging of neck nodes, it was observed that upstaging occurred mainly in N0. Overall after radiological evaluation, 48% of our cases were upstaged, 48% remained in same stage and 4% were downstaged. By combining both clinical and radiological evaluation in laryngeal and hypopharyngeal cancers, a correct pre therapeutic staging can be obtained and thereby prompt treatment can be given.

Evaluation of biological properties and clinical effectiveness of Aloe vera: A systematic review.

Aloe vera ( lú huì) is well known for its considerable medicinal properties. This plant is one of the richest natural sources of health for human beings coming. The chemistry of the plant has revealed the presence of more than 200 different biologically active substances. Many biological properties associated with Aloe species are contributed by inner gel of the leaves. Most research has been centralized on the biological activities of the various species of Aloe, which include antibacterial and antimicrobial activities of the nonvolatile constituents of the leaf gel. Aloe species are widely distributed in the African and the eastern European continents, and are spread almost throughout the world. The genus Aloe has more than 400 species but few, such as A. vera, Aloe ferox, and Aloe arborescens, are globally used for trade. A. vera has various medicinal properties such as antitumor, antiarthritic, antirheumatoid, anticancer, and antidiabetic properties. In addition, A. vera has also been promoted for constipation, gastrointestinal disorders, and for immune system deficiencies. However, not much convincing information is available on properties of the gel. The present review focuses on the detailed composition of Aloe gel, its various phytocomponents having various biological properties that help to improve health and prevent disease conditions.

Esthesioneuroblastoma as a collision tumor.

Esthesioneuroblastoma is an uncommon malignant neoplasm of nose and paranasal sinuses. Esthesioneuroblaslvma presenting as a collision tumour is very rare. The case of such a rare presentation is being reported here in a patient with previous history of squamous cell carcinoma uvula, post irridiatted; who now developed a bleeding nasal mass which proved to be a collision timour c ontaining both squamous cell carcinoma and Esthesioneuroblastoma on biopsy.

Penetrating oesophageal foreign body.

The behaviour of impacted foreign bodies in the Oesophagus is very often unpredictable. Though penetration with subsequent migration into the thyroid gland is an extremely rare event, with only occasional reports in medical literature, this possibility should always be borne in mind because of the likelihood of serious complications like aorto-oesophageal fistula, subctavian-oesophageal fistula and retropharyngeal abscess. The usual presenting features are persistent pain and foreign body sensation with no evidence of the foreign body on converntional oesophagoscopic examination.

Pneumothorax following tracheostomy and its management.

Although pneumothorax is a known complication of tracheostomy, bilateral pneumothorax is comparatively rare. The case of suuh a complication is being reported here in a patient with a glottic carinoma who underwent emergency trackeostamy and developed hilaterluttrl pneuimothoriax and its subsuente. management is discussed.

Synthesis of B-ring homologated estradiol analogues that modulate tubulin polymerization and microtubule stability.

2-Methoxyestradiol is a cytotoxic human metabolite of estradiol with the ability to bind to the colchicine site of tubulin and inhibit its polymerization, and its 2-ethoxy analogue is even more potent. On the basis of a hypothetical relationship between the structures of colchicine and 2-methoxyestradiol, a B-ring-expanded 2-ethoxyestradiol analogue was synthesized in which the B-ring of the steroid is replaced by the B-ring of colchicine. The synthesis relied on the B-ring expansion of available 6-keto estradiol derivatives as opposed to a total synthesis of the homologated steroid framework. The relative configurations of the acetamido substituents in both epimers of the final product were determined by NOESY NMR and confirmed by X-ray crystallography. The epimer having the 6alpha-acetamido substituent was more active as an inhibitor of tubulin polymerization, and it was also more cytotoxic than the 6beta-epimer. These results are consistent with the proposed structural resemblance of 2-methoxyestradiol and colchicine. Several of the synthetic intermediates proved to be potent inhibitors of tubulin polymerization. On the other hand, a 3,17beta-diacetylated, B-ring-expanded analogue of 2-ethoxyestradiol having a ketone at C-6 resembled paclitaxel (Taxol) in its ability to enhance tubulin polymerization and stabilize microtubules. The corresponding 3-acetate and the 17beta-acetate were both synthesized, and it was determined that the 17beta-acetate, but not the 3-acetate, conferred on the steroid derivative its paclitaxel-like activity.