Though tuberculosis (TB) primarily affects lungs, extra pulmonary tuberculosis (EPTB) is also common, especially in high disease load areas and mainly manifests in ENT region. To study the different manifestations of tuberculosis in ENT region in terms of presentation, disease process, treatment and outcome. Records of patients diagnosed and treated for TB in the ENT region at our institute's DOTS centre for a two and half year period were analysed for presenting complaints, examination findings, diagnostic features, treatment modes and outcome. Out of 3750 cases diagnosed as TB, 230 had EPTB. 211 cases had ENT manifestations. Majority of the cases were male and in the fourth decade of life. Commonest manifestation was cervical lymphadenopathy with 201 cases. Fine needle aspiration cytology was mostly diagnostic and category I anti TB treatment (AKT) achieved cure. The six cases of TB otitis media presented with ear discharge, sometimes bloody and had varied tympanic membrane findings and facial palsy in two cases with different types and degrees of hearing loss. Diagnosis was confirmed by histology of tissue removed during surgery. Patients completed category I AKT. Hearing and facial palsy did not improve. There were three cases of TB laryngitis and one of nasal TB both of which were confirmed by tissue diagnosis and responded well to AKT. Most of the results in the present study conform to findings of other studies. High degree of suspicion is necessary to reach diagnosis. Category I AKT is effective. Some cases may require surgery.

A difficult airway complicates up to one tenths of cases of elective general anesthesia. Such situations can be anticipated and tackled by fiberoptic flexible bronchoscopy (FFB) assisted tracheal intubation. To study the indications and outcomes of FFB assisted tracheal intubation in patients with anticipated difficult airway, who are undergoing surgery under general anesthesia. Cases who were intubated using FFB assistance were included in the study. Detailed examination was done pre operatively to be able to predict the difficult airway. Intubation was done with the help of a FFB after induction of general anesthesia. There were total 52 cases. Majority were male and in the fourth decade of life. Oral submucous fibrosis was the commonest indication for the procedure. There were two cases of failure, but no significant mortality or morbidity. A difficult airway can be encountered across specialties. It can be anticipated by simple or multi factorial methods. Awake FFB aided intubation is the gold standard in cases of anticipated difficult airway. Failure rates of 4-66 % have been reported. In the present study the failure rate was less than 4 % with no morbidity or mortality. FFB assisted intubation is safe and effective in paediatric patients too. FFB assisted intubation done in an organised and skilled manner is a very important skill to have to tackle cases of difficult intubation. Hence it should be included in training programmes of anesthesia.

Summary A case of ichthyosis vulgaris associated with tuberculoid leprosy is reported. Ichthyotic scales were markedly accentuated within the anaesthetic patches of leprosy. The probable mechanism of the accentuation of ichthyosis by leprosy is discussed.

INTRODUCTION:- Leprosy is one of the major health problems in Nepal, caused by Mycobacterium leprae. Histopathological examination is considered as important tool for proper classification of the disease. This study was carried out to study the histopathological features of leprosy in skin biopsies and classify based on microscopy, bacterial index to correlate with clinical presentations. MATERIAL AND METHODS:- A retrospective observational study was done at Department of Pathology of Universal College of Medical Sciences (UCMS) Bhairahawa for 2 years from 1st November 2015 to 31stOctober 2017 and total 68 cases were analysed. Cases in which histopathological diagnosis of leprosy was made or considered differential diagnosis were selected for study. Ridley and Jopling classification was used histologically to make diagnosis of leprosy. Copies of issued histopathology reports, that are preserved in the department routinely were used to obtain data pertaining to age, sex, clinical information and histopathological findings. RESULTS:- This study included 68 patients diagnosed histologically as leprosy. Histopathological examination of the skin biopsies of 68 patients revealed that, the maximum histopathological cases 28 (41.17%) are BT followed by 15 cases (22.05%) of IL (15) and 9 (13.23%) of TT. Complete parity between clinical diagnosis and histopathology was observed in 55.88 % and disparity was seen in 44.12%. CONCLUSION:- For proper classification of Leprosy, correlation of clinical and histopathological features along with bacterial index is more useful than considering any of the single parameter.

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