Abstract Sinonasal papillomas are relatively rare, benign epithelial tumours of the nasal cavity. These lesions generate considerable interest because they are locally aggressive, have a tendency to ...recur and are associated with malignancy. The authors present a unique case of malignant sinonasal papilloma with neck metastasis. In the English literature only one case of such a presentation has been reported.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Background:
In India the proportion of geriatric population is steadily rising. The symptoms of adrenal insufficiency (AI) may overlap with aging. This study aims to describe the profile of AI in the ...elderly.
Aims and Objectives:
To describe the demographic profile, clinical features and laboratory parameters in elderly individuals with biochemically proven adrenal insufficiency and to identify the indications for prolonged steroid therapy in subjects with tertiary AI.
Results:
50 adults aged > 60 years were enrolled for the study, this included 29 males (58%), 21 females (42%), with a mean age of 69.27. The symptomatology of the patients were, abdominal pain (14/7:p<0.05), anorexia (60/30:p<0.05), joint pains (66/33:p<0.05) dizziness (18/9), lack of energy (80/40), myalgia (44/22), fatigue (83/43), in terms of signs proximal myopathy was found to be more in males (p< 0.05). In this study 72% of the population had history of steroid usage, most commonly for joint pains.
Conclusions:
Steroid usage was a common cause for AI in the geriatric population. AI in the elderly can present with vague symptoms. A high index of suspicion is indispensable to test and diagnose this, the carers and HCWs should be cautioned about the ill effects of unprescribed and prolonged steroid medication.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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BSTRACT
Background:
Studies have not proven whether an association exists between diabetic retinopathy (DR) and non-alcoholic fatty liver disease (NAFLD). The reports from various parts of the ...world have not used uniform criteria, and hence, results are inconclusive. Both DR and NAFLD are common conditions encountered in primary care.
Methods:
A total of 130 patients with type 2 diabetes from the medical wards of a tertiary care hospital were enrolled. After documentation of clinical and biochemical data, they underwent ultrasonography (USG) of the abdomen and fibroscan grading of liver. Retinopathy was assessed and classified as per the Early Treatment Diabetic Retinopathy Study.
Results:
The mean age of the patients included in the study was 46.5+/-8.8 with 55% of the participants being male and 45% female. The mean HbA1c was 7.168+/2.4. The association between DR and hepatic fibrosis was assessed by fibroscan (p 0.003) and USG (p 0.001) and was significant on univariate analysis. Multivariate analysis did not confirm this. There was no association between increasing grades of either condition. Although fibroscan and USG significantly concorded in diagnosing NAFLD, fibroscan diagnosed more cases as compared to USG (83 vs 73).
Conclusion:
Larger studies should be conducted to conclusively determine the association in order to investigate pathogenetic factors and treatment strategies.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background
Dentistry is a profession with a high prevalence of work‐related musculoskeletal disorders (WMSD) among practitioners, with symptoms often starting as early in the career as the student ...phase. Ergonomic interventions in physical, cognitive, and organisational domains have been suggested to prevent their occurrence, but evidence of their effects remains unclear.
Objectives
To assess the effect of ergonomic interventions for the prevention of work‐related musculoskeletal disorders among dental care practitioners.
Search methods
We searched CENTRAL, MEDLINE PubMed, Embase, PsycINFO ProQuest, NIOSHTIC, NIOSHTIC‐2, HSELINE, CISDOC (OSH‐UPDATE), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (ICTRP) Search Portal to August 2018, without language or date restrictions.
Selection criteria
We included randomised controlled trials (RCTs), quasi‐RCTs, and cluster RCTs, in which participants were adults, aged 18 and older, who were engaged in the practice of dentistry. At least 75% of them had to be free from musculoskeletal pain at baseline. We only included studies that measured at least one of our primary outcomes; i.e. physician diagnosed WMSD, self‐reported pain, or work functioning.
Data collection and analysis
Three authors independently screened and selected 20 potentially eligible references from 946 relevant references identified from the search results. Based on the full‐text screening, we included two studies, excluded 16 studies, and two are awaiting classification. Four review authors independently extracted data, and two authors assessed the risk of bias. We calculated the mean difference (MD) with 95% confidence intervals (CI) for continuous outcomes and risk ratios (RR) with 95% confidence intervals for dichotomous outcomes. We assessed the quality of the evidence for each outcome using the GRADE approach.
Main results
We included two RCTs (212 participants), one of which was a cluster‐randomised trial. Adjusting for the design effect from clustering, reduced the total sample size to 210. Both studies were carried out in dental clinics and assessed ergonomic interventions in the physical domain, one by evaluating a multi‐faceted ergonomic intervention, which consisted of imparting knowledge and training about ergonomics, work station modification, training and surveying ergonomics at the work station, and a regular exercise program; the other by studying the effectiveness of two different types of instrument used for scaling in preventing WMSDs. We were unable to combine the results from the two studies because of the diversity of interventions and outcomes.
Physical ergonomic interventions. Based on one study, there is very low‐quality evidence that a multi‐faceted intervention has no clear effect on dentists' risk of WMSD in the thighs (RR 0.57, 95% CI 0.23 to 1.42; 102 participants), or feet (RR 0.64, 95% CI 0.29 to 1.41; 102 participants) when compared to no intervention over a six‐month period. Based on one study, there is low‐quality evidence of no clear difference in elbow pain (MD −0.14, 95% CI −0.39 to 0.11; 110 participants), or shoulder pain (MD −0.32, 95% CI −0.75 to 0.11; 110 participants) in participants who used light weight curettes with wider handles or heavier curettes with narrow handles for scaling over a 16‐week period.
Cognitive ergonomic interventions. We found no studies evaluating the effectiveness of cognitive ergonomic interventions.
Organisational ergonomic interventions. We found no studies evaluating the effectiveness of organisational ergonomic interventions.
Authors' conclusions
There is very low‐quality evidence from one study showing that a multi‐faceted intervention has no clear effect on dentists' risk of WMSD in the thighs or feet when compared to no intervention over a six‐month period. This was a poorly conducted study with several shortcomings and errors in statistical analysis of data. There is low‐quality evidence from one study showing no clear difference in elbow pain or shoulder pain in participants using light weight, wider handled curettes or heavier and narrow handled curettes for scaling over a 16‐week period.
We did not find any studies evaluating the effectiveness of cognitive ergonomic interventions or organisational ergonomic interventions.
Our ability to draw definitive conclusions is restricted by the paucity of suitable studies available to us, and the high risk of bias of the studies that are available. This review highlights the need for well‐designed, conducted, and reported RCTs, with long‐term follow‐up that assess prevention strategies for WMSDs among dental care practitioners.
Cerebral cavernous malformations (CCMs) are intracranial vascular malformations that can exist as a single lesion or mixed vascular lesions. The most common mixed form is the coexistence of CCM with ...an associated developmental venous anomaly (DVA). In this paper, we aim to give a comprehensive review of CCM, DVA, and their coexistence as mixed lesions. A PubMed search using the keywords "Cerebral cavernous malformations, Developmental venous anomaly, Mixed Cerebral cavernous malformations with Developmental venous anomaly" was done. All studies in the English language in the past 10 years were analyzed descriptively for this review.
The search yielded 1,249 results for "Cerebral cavernous malformations," 271 results for "Developmental venous anomaly," and 5 results for "Mixed Cerebral cavernous malformations with Developmental venous anomaly." DVA is the most common intracranial vascular malformation, followed by CCM. CCM can have a wide array of clinical presentations like hemorrhage, seizures, or focal neurological deficits or can also be an incidental finding on brain imaging. DVAs are benign lesions by nature; however, venous infarction can occur in a few patients due to acute thrombosis. Mixed CCM with DVA has a higher risk of hemorrhage. CCMs are angiographically occult lesion, and cerebral digital subtraction angiography is the gold standard for the diagnosis of DVA. Mixed lesions, on the other hand, are best diagnosed with magnetic resonance imaging, which has also been effective in detecting specific abnormalities. Asymptomatic lesions are treated through a conservative approach, while clinically symptomatic lesions need surgical management.
Individual CCM or DVA lesions have a benign course; however, when they coexist in the same individual, the hemorrhagic risk is increased, which prompts for rapid diagnosis and treatment.
Abstract Human retro-viral disease and the myriad opportunistic infections associated with it continue to pose a diagnostic challenge to clinicians. Disseminated Kaposi sarcoma (KS) and KS-associated ...immune reconstitution inflammatory syndrome (IRIS) are entities that can be associated with adverse clinical outcomes unless recognized early by the treating physician. We present the case of a 36-year-old homosexual HIV-positive male who presented with unusual symptoms of KS and KS IRIS with lower gastrointestinal bleeding and respiratory distress devoid of any cutaneous manifestations.
Background: Diabetes Mellitus (DM) and hyperglycaemia (HG) have been identified as risk factors for morbidity and mortality in coronavirus disease 19 (COVID-19) infection. However, a detailed study ...of various categories of HG and the impacts and characteristics of each of these on COVID-19 was considered important to address this metabolic disorder in COVID-19. Aims: This study aimed to describe the patterns of HG and its impact on the clinical outcomes in hospitalised patients with COVID-19 infection. Methodology: Data on 1000 consecutive patients with COVID-19 were analysed using Statistical Package for Social Sciences (SPSS) version 20.0 software (SPSS Inc., Chicago, IL, USA). Results: A total of 1000 patients were included for analysis The overall mean age of the study group was 52.77 + 19.71 with 636 (63.6%) male patients; 261 had mild, 317 moderate, and 422 severe infections; and 601 had HG (New-onset DM 66, known DM 386, steroid-induced HG 133 and stress HG 16). The HG group has significantly higher levels of inflammatory markers and worse outcomes. Blood glucose levels were higher in patients with known DM. The ROC cut-off of total steroids to predict mortality in the HG group was 84 mg versus 60 mg in the normoglycaemia group. The ROC cut-off of FBS to predict mortality in the overall HG group was 165, with AUC 0.58 (95% CI 0.52, 0.63, P = 0.005), whereas that for pre-existing DM and steroid HG were 232 and 166, which were also significant. There was a wide variation in mean glucose levels against time. Conclusion: HG is an independent predictor of mortality, with the highest significance in the steroid-induced category. COVID-19 morbidity and mortality can be minimised by identifying the blood glucose range for best results and instituting appropriate treatment guidelines.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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