Deep neck space infection is characterized by infections of the deep neck space either in the form of abscess or cellulitis. Common infective conditions like aero-digestive tract infections like tonsillitis, pharyngitis and dental infections can lead to infection of the deep neck spaces. This can prove fatal in the form of acute respiratory obstruction, descending mediastinitis and septic shock. This was a descriptive cross-sectional study conducted in Department of Otorhinolaryngology in Nepal Medical College from July 2017 to June 2019. All the patients diagnosed as deep neck abscess were enrolled in the study and pus was collected and sent for gram stain and culture and sensitivity. Out of 87 patients, 50 were females and 37 males. The mean age was 24.2 years. Peritonsillar abscess was the commonest space involved followed by submandibular abscess and Ludwig’s angina (36.8%,24.1% and 11.5%). Upper respiratory tract infections (32.2%) and dental caries (27.6%) were the commonest source of infection. Empyema thoracis was seen as a complication in a patient of Ludwig’s angina. Growth in the sample accounted for 33.3%. The commonest organism found was Coagulase negative Staphylococcus (10.3%), followed by Mycobacterium tuberculosis (6.9%), Staphylococcus aureus (4.6%), Enterococcus species (3.4%) and methicillin-resistant S. aureus (3.4%) respectively. The growth between the culture with or without previous antibiotic exposure were statistically significant (p-value-0.04) which suggest that inadvertent use of antibiotics lead to difficulty in identifying causative organism. Deep neck abscess is a dreadful condition, therefore proper knowledge, early detection and timely intervention of the disease can prevent complications.
Chronic obstructive pulmonary disease (COPD) is a major global health problem. It is a complex disease characterised by chronic inflammation in the airways by noxious particles. Episodes of increased symptoms called as acute exacerbations are associated with accelerated decline in the lung function. Blood cultures to find out the causative organism in these cases are time consuming. Complete Blood Count (CBC) parameters like Total leukocyte count (TLC), hemoglobin (Hb), platelet count, Mean Platelet Volume (MPV), Platelet Distribution Width (PDW) are found to be related with COPD and its acute exacerbation. An observational hospital based descriptive study was conducted for a period of six months in the Department of Pathology and Medicine of a tertiary care centre. A total of 144 patients of COPD with acute exacerbation (AECOPD) were included in the study. The mean age of the patients was 70.47 ± 9.49 years with female preponderance (61.1%). Though mean hemoglobin level (13.25 ± 2.70 gm %), (95% CI 12.80-13.69) showed statistical significance, other CBC parameters had no obvious difference among the different groups of AECOPD patients. But we cannot deny on the clinical significance of these parameters. The TLC and platelet count were slightly lower in the AECOPD patients with cor pulmonale when compared with AECOPD patients without cor pulmonale. Similarly, platelet parameters like MPV and PDW were slightly higher in the AECOPD patients who are smokers. Though these parameters were not statistically significant, they are found to be cost effective, time saving and clinically significant which would definitely help in the management of AECOPD patients. Hence, these parameters can be used as an easily measurable AECOPD biomarker.
from the nose or epistaxis is a common presentation in the Ear, Nose and Throat (ENT) department. Various factors are responsible for nose bleed. It has been observed that 60% of the people experience at least one episode of epistaxis in their life time and 6% seek medical attention for this condition. 1 The incidence of epistaxis at the hospital is more during the dry and cold seasons. The frequency of admission is greatest in the autumn and winter months. 2 This seasonal variation correlates with fluctuations in the environmental temperature. 3 In the few reports found in literature, most research supports that there is a correlation between the frequency of epistaxis and at least one of the meteorological factors i.e. temperature, humidity and atmospheric pressure. However, the studies done on this topic are still few. There are various classifications for epistaxis. It is clinically classified as primary if there is no proven cause and secondary if there is a definite identifiable cause. It is also classified according to age as childhood and adult. Another way of classifying epistaxis is based on the site of bleeding, where the bleeding can be anterior or posterior in relation to the piriform aperture. 4 The causes of epistaxis are local and systemic. A careful history, physical examination and laboratory assessments are required for proper diagnosis. This study was done to observe the frequency of primary epistaxis at Nepal Medical College and Teaching Hospital (NMCTH) and its correlation to the seasonal variations of temperature and humidity. M A T E R I A L A N D M E T H O D S :Two hundred and sixty two consecutive patients attending ENT outpatient department of Nepal Medical College and Teaching Hospital (NMCTH) with nose bleed were included in the study. The study period was 2 years from August 2008 to July 2010. The study group comprised both hospitalised and not hospitalised patients. Nose bleed without any known cause or primary cases of epistaxis were included in this study. The exclusion criteria were patients with obvious causes for epistaxis, patients with trauma, coagulopathies, tumours and systemic causes. Out of 262 patients,105 cases were primary epistaxis. Daily temperature and humidity as documented by the Department of Hydrology and Meteorology of the Government of Nepal were recorded during this study period. The daily arithmetic averages (mean) of temperature and humidity were taken from which the mean monthly temperature and relative humidity were calculated. The frequency of epistaxis on a monthly basis was recorded and the seasonal variations were observed. Statistical analysis with Pearsons correlation coefficient was used to see the correlation between EPISTAXIS AND ITS RELATION WITH TEMPERATURE AND HUMIDITY O b j e c t i v e :The objective of this study was to observe the frequency of primary epistaxis and its relation with temperature and relative humidity. M a t e r i a l s a n d M e t h o d s :This was a prospective study which included 262 patients with epistaxis attending th...
<p class="abstract">Thyroid hemiagenesis is a very rare congenital abnormality, in which one thyroid lobe fails to grow. Most of the patients are usually associated thyroid disease. The prevalence of thyroid hemiagenesis ranges between 0.05% and 0.2% within the literature. We hereby report a case of 29 years male with left lobe thyroid hemiagenesis with right lobe thyroiditis presented with a feature of hyperthyroidism. Thyroid hemiagenesis can be associated with hyper or hypothyroidism. In our case patient had a feature of hyperthyroidism with dearranged TFT. In our case we detected thyroid hemiagensis incidentally with the help of ultrasonography. Ultrasonography was the investigation that detected thyroid hemiagenesis. Ultrasonography is the most cost-effective means of diagnosing thyroid hemiagenesis. We further performed the thyroid scan to detect any hyperfunctioning thyroid gland or ectopic thyroid. Thyroid scan helped detect thyroiditis in the right thyroid lobe.</p>
Nasal occlusive dressings are routine after nasal surgeries to arrest hemorrhage, to prevent septal hematoma, and to prevent postoperative adhesions. However, patients describe nasal packing and its removal as their worst experience. Various types of nasal packs are available. Medicated ribbon gauge is the traditional form of nasal pack which consists of an open-mesh cotton as a carrier whereas “Polyvinyl Acetate’ sponge is a compressed dehydrated material, an improvised one which increases in size and compresses blood vessels when rehydrated with normal saline. As Polyvinyl acetate sponge is smooth and spongy, it causes less pain and abrasion while in-situ and removal. This was a prospective comparative study done in tertiary hospital of Nepal. Patients were subjected to either polyvinyl acetate sponge or ribbon gauge nasal pack following nasal surgery. Comparisons were made in terms of pain score, maintenance of hemostasis and wound healing. There were 154 patients in the study with 104 males and 50 females. The pain score when nasal pack was in-situ was similar in both groups whereas it was lesser in the polyvinyl acetate group on its removal. However, bleeding and adhesion were found to be similar. Crust formation was less in polyvinyl acetate group. Six synaechia were noted in ribbon gauge group only. Pain was significantly less during removal of polyvinyl acetate pack.
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