Unusual Presentation of Non-Hodgkin Lymphoma of Two Cases: Case Report.

Lymphomas are a diverse group of neoplastic disorders arising primarily in lymph nodes. They have been majorly classified into Hodgkin and Non-Hodgkin lymphomas(NHL). NHL can be of B, T and Null cell categories having further subtypes based on their histological characteristics. Lymphomas can be nodal and extra nodal. The head and neck area are the second most common site of extra nodal lymphoma, with tonsils being the most common site of involvement; other sites include the nasopharynx and tongue base. B- Cell type being the most common type. Predominantly occurs in elderly. Presentations depends on the site involved. Various modalities like surgical treatment, chemotherapy (or) radiotherapy is available. Each stage has varied survival rates and prognosis and responses to the treat depending on the patient factors. In this paper,  we report two cases of patients with non-Hodgkin lymphoma of tonsil, where the preoperative clinical diagnosis and radiological diagnosis was inconclusive and final diagnosis was established based on histopathological examination.

Covid-19 and Obstructive Sleep Apnea: The Theatricals and Quality-of-Life Impact.

COVID-19 caused by SARS-CoV2 has reached pandemic proportions. The fear of Covid-19 has deterred many to abandon efforts for seeking timely medical help. In this setting, Obstructive sleep apnea (OSA)-like covid/non-covid cohorts have presented. Atypical pathologies can present like OSA and take the clinician unawares. With this series of misfits suffering silently, it would be unwise to underestimate its impact on quality-of-life (QOL). To determine the effect on quality-of-life by pathologies mimicking OSA and assess Covid-19 as a cause for delayed presentation. This was a prospective cross-sectional study. 127(N). Recent onset of symptoms of OSA. Study duration March 2020 to September 2021. Pittsburgh Sleep Quality Index (PSQI) screening done. Study criteria defined. Sleep parameters calculated. Primary surgical intervention given. Non-responders were put on CPAP therapy. QOL assessment done with sf-36 and SAQLI. Fear of Covid-19 scale (FCV-19S) quantified to study cause for temporal delay. Correlations computed. Level of Evidence-Level 3. 97 candidates completed study. Demographic and anthropometric details noted. Mean range was 43.85 ± 11.39 years. Male predominance. Overall AHI-19.73 ± 8.72. Moderate impact on QOL by sf-36/SAQLI. 78n Primary surgical candidates fared well. Polysomnography (PSG) and Continuous positive airway pressure (CPAP) titration/trial characteristics for 19n available. Statistically significant improvement in QOL after treatment completion. Correlations were meaningful. Body Mass Index (BMI) as a single factor was not influential on OSA-mimickers. Fear of Covid-19 significantly impacted emergency medical aid acquisition. OSA mimicking atypical airway pathologies may need emergent treatment not only from a surgical point-of-view but also from the QOL of the patient. On the contrary, these also unmask sub-clinical OSA, especially in patients with low/normal BMI. This category of recent onset OSA, if fortunately picked up at the earliest possible presentation, may hopefully not go through the significant QOL impact suffered by chronic OSA candidates.

A Prospective Study on Middle Ear Risk Index (MERI) and Outcome of Tympanoplasty with a Note on quality-of-Life (QOL).

Chronic Otitis Media (COM) is a major indication for tympanoplasty. It is important to predict the outcome of surgery and give proper counselling for the patient. This avoids untoward expectations. To measure the outcome of patients who underwent tympanoplasty for mucosal type of chronic otitis media (COM) using Middle ear risk index (MERI) score. Any possible correlation of MERI score with outcomes? Assess quality-of-life. Prospective analytical comparative cohort study. Sample size was 75. All patients underwent tympanoplasty for mucosal type of COM with hearing loss. The patients were categorised into mild, moderate and severe groups based on the MERI score. The hearing benefit was calculated from the pre- and post-op difference in PTA. The graft uptake status was graded. The relation between MERI score, graft status and hearing benefit were analysed and compared. QOL was assessed by COMOT-15 questionnaire. Patients with a high MERI score had lower rate of graft uptake, whereas, patients with mild MERI had greater hearing benefit and those with severe MERI had lesser hearing benefit postoperative. MERI score is a prognostic tool to predict the outcome of tympanoplasty. It has an inverse relation with graft uptake and hearing benefit. Based on MERI score, the chances for surgical success and hearing benefit could be explained to the patient to give them realistic expectations.

Clinical Audit on Symptomatology of Covid-19 Healthcare Workers and Impact on Quality-of-Life (QOL) Due to Continuous Facemask Usage: A Prospective Study.

Covid-19 due to Sars-Cov-2 infection has reached pandemic proportion. Many healthcare workers are involved in managing both COVID-suspected and confirmed cases. It is mandatory for healthcare workers to have droplet and contact precautions by means of Personal protective equipment (PPE), facemask, face shield or eye protection. Prolonged usage of medical mask results in various adverse effects. This study is an attempt to know the common effects of prolonged face mask in healthcare workers and its resultant quality-of-life (QOL). To study the common effects of prolonged face mask and its impact on QOL of healthcare workers during the COVID 19 crisis. This was a prospective cross-sectional study conducted over 6 months among 2750 healthcare workers. A questionnaire requesting demographic details and most common side effects after prolonged usage of face mask was circulated. We also attached a short form-12 (sf-12) questionnaire to assess its impact on QOL. Out of 2750 personnel, 299 were excluded. Male preponderance was noted. Study was conducted on candidates using 3ply mask or above. Age range was between 18 and 65 years with mean age being 37.61 ± 15.23 in mask users < 5 h per day, 32.2 ± 10.02 in 5-10 h group and 30.19 ± 8.15 in 10 h group. 8.48% (n = 174) had comorbidities. QOL impacted. The complaints with face mask use definitely are troublesome with increase in severity with duration of mask usage. This definitely has a proportional impact on the healthcare workers' QOL.

Comparison of treatment modalities in syndromic children with obstructive sleep apnea--a randomized cohort study.

INTRODUCTION: Obstructive Sleep Apnea (OSA) is a common medical problem in adults that is becoming increasingly recognized in children. It occurs in the pediatric age group, from newborns to teens. More recently, many specialists have estimated OSA prevalence to be between 5 and 6%. However, in syndromic children, the prevalence of OSA can be from 50 to 100%, having a significant effect on their Quality-of-Life. As they are a challenging population for management, it is essential to evaluate them thoroughly before planning appropriate intervention. OBJECTIVE: To compare the efficacy of Adenotonsillectomy (T&A) and Continuous Positive Airway Pressure (CPAP) in syndromic children [Down syndrome (DS) and Mucopolysaccharidoses (MPS)] with Obstructive Sleep Apnea (OSA). MATERIALS AND METHODS: In a prospective, randomized, cohort comparative study, 124 syndromic children (DS and MPS) aged between 6 and 12 years were recruited from a private MPS support group and the Down Syndrome Society, Chennai. A standard assessment was performed on all children who entered the study including a full overnight Polysomnogram (PSG), Epworth Sleepiness Scale-Children (ESS-C) and Quality-of-Life (QOL) tool OSA-18. The children with positive PSG who consented for the study (n = 80) were randomly distributed to two groups, T&A group & CPAP group. The children were followed up with repeat PSG, clinical evaluation, ESS-C and Quality-of-Life (QOL) tool OSA-18 for a period of 1 year. OBSERVATION AND RESULTS: Follow-up was available for 73 syndromic children. Both the groups, T&A group and CPAP group, showed statistically significant (p < 0.05) improvement in Apnea-Hypoapnea Index (AHI), ESS-C, QOL from the intervention. In our study, T&A showed equal outcome compared to CPAP. The contrasting feature between the two groups was that CPAP use gave immediate sustained improvement while T&A gave gradual progressive improvement of symptoms over a period of 1 year. CONCLUSION: On average, T&A gives equal outcomes as CPAP and it can be suggested as a first-line treatment in this group of syndromic children.