Morbidity after thyroidectomy is related to injuries to the parathyroids, recurrent laryngeal (RLN) and external branch of superior laryngeal nerves (EBSLN). Mostly these are due to variations in the surgical anatomy. In this study we analyse the surgical anatomy of the laryngeal nerves in Indian patients undergoing thyroidectomy. Materials and Methods. Retrospective study (February 2008 to February 2010). Patients undergoing surgery for benign goitres, T1, T2 thyroid cancers without lymph node involvement were included. Data on EBSLN types, RLN course and its relation to the TZ & LOB were recorded. Results. 404 thyroid surgeries (180 total & 224 hemithyroidectomy) were performed. Data related to 584 EBSLN and RLN were included (324 right sided & 260 left sided). EBSLN patterns were Type 1 in 71.4%, Type IIA in 12.3%, and Type IIB in 7.36%. The nerve was not seen in 4.3% cases. RLN had one branch in 69.34%, two branches in 29.11% and three branches in 1.36%. 25% of the RLN was superficial to the inferior thyroid artery, 65% deep to it and 8.2% between the branches. TZ was Grade 1 in 65.2%, Grade II in 25.1% and Grade III in 9.5%. 31.16% of the RLN passes through the LOB. Conclusions. A thorough knowledge of the laryngeal nerves and anatomical variations is necessary for safe thyroid surgery.

Harlequin syndrome (HS) is known to be associated with conditions like brain stem infarcts and superior mediastinal neurinoma. However, it has not been reported in association with autoimmune hyperthyroidism. We report a case of exacerbation of unilateral sweating in a patient with HS following the onset of toxic goitre. Previous reports have suggested that a tortuous inferior thyroid artery can produce neurovascular compression of the sympathetic chain which was not observed in our patient. Autoimmune aetiology for HS needs to be explored. Increased sweating in hyperthyroid patients needs to be assessed properly so as to prognosticate appropriately.

Many complications have been observed after laparoscopic surgery. Persisting pain in the umbilical port site is due to infection, hernia, endometriosis, metastasis, etc. There is no case report due to neuralgic complex regional pain syndrome, and we have dealt a case which is described with relevant literature review and etiopathogenesis.

Owing to the living condition, tribal community is at higher risk for diet-associated health disorders. The indigenous tribal populations like “The Yanadi”, residing in state of Andhra Pradesh in India. Being in the lower economic strata, they are deprived of proper food and access to basic health facilities is also constrained. Yanadi tribal children exhibit characteristic features of IDA, stunted growth, wasting and lower cognitive skills, which significantly affects their education. The study investigated the prevalence of anemia in 384 male Yanadi tribal schoolchildren aged 6-14 years and multiple approaches were adopted for survey-based data on social, economic and environment variables of the study-cohort was gathered along with anthropometric information. It was observed that huge majority of the tribal parents lacked primary school education and economic condition of such families is under dilapidating state, leading to consumption of improper food. Strikingly, 56% of the children exhibited the commonest symptom of anemia, pale conjunctiva. Overall analysis of the study participating children, following the WHO grading, close to 28% were found to be anemic and hemoglobin content (g/L) was observed to be close in both age groups, 11 to 14 years (11.889±1.123) and 7 to 10 years (11.734±1.309). Largely, the Yanadi tribal children projected cognitive impairment in the form of poor memory function (33%), down regulated cognitive functions (46%), and impaired attention functions (74.5%). It is somewhat relieving to see that anemia amongst Yanadi male children is not as severe as observed in children of other populations, as reported. However, the study projects out impaired cognitive and behavior skills amongst the participants, emphasizing the need of extending the study in a larger cohort.