Summary
A report of 53 cases of formic acid ingestion with suicidal intention is presented. The patients were seen in one hospital in Kerala State over a 3 year period. Fifteen patients died and 38 patients survived. The pattern of clinical features seen is presented.
Ewing's sarcoma is a small round cell tumor, malignant in nature, typically affecting long bones and pelvis. It is most commonly presented in the pediatric age group. The occurrence of Ewing's sarcoma in the head-and-neck region is rare and is reported to be around 2%–3%, of which chances of having primary lesion are rarer. Among facial bones, mandible is the most commonly affected bone. Primary involvement of zygoma is extremely rare. Here, we present a case of primary Ewing's sarcoma of the left zygoma in a 17-year-old girl. The diagnosis was made after surgical resection, histopathology with immunohistochemistry confirmation, and cytogenetic study.
Hereditary angioedema (HAE) differs from histamine-mediated angioedema in that it is resistant to steroids and antihistamines. Laryngeal attacks of this condition, if not diagnosed timely, carry a mortality rate up to 34%. Rarely, this disease goes undiagnosed until late adulthood and presents a life-threatening episode that poses a management challenge to the emergency physician. We report the case of a 48-yearold man who presented to the emergency department with progressive breathing difficulty two hours after consuming a carbonated drink. Clinical examination revealed supraglottic edema. He did not respond to steroids or antihistamines and required emergency tracheostomy to secure the airway due to failed intubation. Absence of symptoms such as itching or urticaria and inadequate response to steroids pointed to hereditary angioedema. Low complement factor 4 levels with low C1 esterase inhibitor functionality confirmed the diagnosis. This case report highlights the fact that delayed presentation of HAE can be life threatening and the diagnosis should be considered in all non-atopic adult patients with angioedema.
Introduction:
The expression of matrix metalloproteinase-9 (MMP-9), MMP-13, and tissue inhibitor of metalloproteinases (TIMP-1) in head and neck squamous cell carcinoma (HNSCC) could be a useful predictor of tumour differentiation, nodal metastasis, and invasiveness. We conducted this study to ascertain the correlation between the expression of these markers and differentiation of tumour cells.
Materials and Methods:
A prospective observational study was conducted in a tertiary care center. Forty-three cases of proven HNSCC were recruited after obtaining informed consent. Using the surgically excised specimen, tumour differentiation and invasiveness were assessed and correlated with rates of expression of the markers. Chi-square test was done to correlate immunohistochemical (IHC) marker positivity and the degree of differentiation of the tumour, lymph node metastasis, and invasiveness.
Results:
MMP-9, MMP-13, and TIMP-1 were expressed in 72%, 34%, and 18% of cases, respectively. p16 expression was not found in any of the cases. MMP-13 expression correlated with poorer differentiation of the tumour (
p
= 0.03), and relatively younger age at diagnosis (
p
= 0.01). However, there was no correlation with lymphovascular or perineural invasion or lymph node metastasis.
Discussion:
In our study, MMP-13 expression correlated with poorer tumour differentiation and younger age at diagnosis, giving indirect evidence of tumour aggressiveness. IHC markers can provide additional information to prognosticate HNSCC. Identifying potential targets for newer biological therapy is essential in the Indian population as there are biological differences in cancer behavior. Increased expression of the proteolytic MMP-13 correlated with poorer differentiation of HNSCC.
Coronavirus disease 2019 (COVID-19) is a type of viral pneumonia that has paralysed the entire world both in terms of health and economy. It has been recently declared as a global pandemic. All the health care professionals must be aware of the disease entity and take precautionary measures to control its transmission from person to person, particularly in hospital settings. In this article, we propose essential steps that can be implemented at the departmental and institutional levels to do endoscopic diagnostic procedures effectively during COVID-19 outbreak and to break the transmission chain.
Objective: It has been shown that prolonged use of face masks results in physiological changes in the nasal cavity. The objective of this study was to examine the effect of prolonged use of face masks on nasal mucociliary clearance (NMC). Methods: A single group pre-post study was conducted to determine the effects of prolonged use of N95 face mask (≥4 hours) on the NMC rates in health care workers. Saccharin transit time (STT) was used to measure the NMC. STT before and after using an N95 mask for at least 4 hours was measured for all participants in controlled conditions of temperature and humidity. Results: Forty-eight volunteers (20 female and 28 male) completed the study after the enrollment of 57 volunteers. The mean STT before mask use was 580.27 ± 193.93 seconds (95% CI; 523.95-636.58 seconds) and after mask use was 667.47 ± 237.42 seconds (95% CI; 598.53-736.42 seconds). There was significant prolongation of the NMC after prolonged use of N95 mask on performing the paired t-test ( P = .002). The mean prolongation was 87.20 ± 184.97 seconds with an actual effect size of 0.40. Ambient temperature and humidity were not significantly different at the two test instances. Conclusion: Use of the N95 face masks for 4 hours results in prolongation of the nasal mucociliary clearance as measured by STT. Susceptibility to any respiratory infection may be increased following doffing of the personal protective equipment, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) itself.
Covid-19 symptoms are commonly seen in Otorhinolaryngology clinics on a daily basis. This article provides a brief review of the current knowledge regarding SARS Cov-2 including disease transmission, clinical characteristics and occupational hazard. The article focuses on the adequate precautions needed for Otorhinolaryngologists. We, being involved in the frequent manipulation of the aero-digestive tract containing a high viral load carry the biggest threat of an occupational hazard. We should be aware of utmost importance of effective use of full or enhanced Personal Protective Equipment during diagnostic and therapeutic procedures.
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