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Lifestyle changes and alteration in diet brings about metabolic derangement eventually leading to conditions like Dyslipidemia. Raise in lipid level is the major cause and risk factor for Cardiovascular disorders, Diabetes mellitus etc. Globally one-third of incidence of Cardiovascular diseases are attributing by Dyslipidemia. In Ayurveda, this condition falls under the category of Santarpanotthavikara, which starts its pathology from the vitiation of kapha dosha, rasa and Medo dhatu. The prime Nidanas involved in this pathogenesis are Shleshmala ahara sevana, Adhyashana, avyayama and divaswapna. Considering these Nidana s and dosha-dushya vivechana our Acharya s mentioned about the administration of Guru-Atarpana dravyas, Vataghna annapana, Katu, Tikta, Kashaya rasa pradhana, Ruksha Ushna guna lines, treatment modalities like Vamana karma, Ruksha ushna Basti, Lekhana Basti, Ruksha Udvartana to tackle this condition.

Janu Sandhigata vata is one such Vatavyadhi presenting with Sandhi shula, Sandhi shotha, Sandhi atopa and Prasarana Akunchana Vedana, resulting in limited range of movements, there by restricting daily activities of the individual. Janu Sandhigatavata is commonly identified with Osteoarthritis of Knee Joint characterized by pain, swelling & impaired movements. The prevalence of Osteoarthritis rises progressively with age and it has been estimated that that 45% of all people develop Knee Osteoarthritis in life. Osteoarthritis is more common in women than men. The existent line of treatment in contemporary field of medicine includes the administration of analgesics, NSAIDS, Intra articular steroids and surgical intervention in the form of Knee replacement, which all has their own limitation and meanwhile may have deleterious adverse effect. In this regard, there is a need for exploring the safe, effective and affordable line of treatment. Basti karma is a supreme treatment for Vata Vyadhi and also known as Ardha Chikitsa because of its multifaceted actions. Many Basti formulations are mentioned in classics among which Erandamooladi Bati was selected for the study because its dual action, does Vataghna and also relives Kapha Avarana. The results were statistically highly significant within the group.

Subependymal giant cell astrocytomas (SEGAs) are the most common intracranial tumors in Tuberous Sclerosis Complex (TSC). Very few cases of solitary SEGA without a diagnosis of TSC have been described. Most of these previously reported solitary SEGAs were located near the caudothalamic groove or in close proximity to the lateral ventricles. Here, we describe a unique case of solitary extraventricular SEGA in a 17-year-old boy who presented with new-onset seizures in the absence of the clinical and genetic diagnosis of TSC. This extraventricular SEGA was involving white matter and cortex of the occipital lobe and was predominantly hypointense on T1 and T2-weighted images with a markedly hypointense signal on susceptibility-weighted images likely secondary to dense internal calcifications. Solitary SEGA can occur in the extraventricular location in patients without TSC and should be included in the differential diagnosis of a densely calcified supratentorial intra-axial tumor in children, especially during the second decade of life.

Background Beginning in October 2016, the Centers for Medicare & Medicaid Services (CMS) issued expanded guidance requiring accrediting organizations and state survey agencies to report serious infection control breaches to relevant state health departments. This project sought to characterize and summarize The Joint Commission's early experiences and findings in applying this guidance to facilities accredited under the ambulatory and office-based surgery programs in 2017. Methods Surveyor notes were retrospectively reviewed to identify individual breaches, and then the Centers for Disease Control and Prevention's Infection Prevention Checklist for Outpatient Settings was used to categorize and code documented breaches. Results Of 845 ambulatory organizations, 39 (4.6%) had breaches observed during the survey process and reported to health departments. Within these organizations, surveyors documented 356 breaches, representing 52 different breach codes. Common breach domains were sterilization of reusable devices, device reprocessing observation, device reprocessing, disinfection of reusable devices, and infection control program and infrastructure. Eight of the 39 facilities (20.5%) were cited for not performing the minimum level of reprocessing based on the items' intended use, reusing single-use devices, and/or not using aseptic technique to prepare injections. Conclusion The CMS infection control breach reporting requirement has helped highlight some of the challenges faced by ambulatory facilities in providing a safe care environment for their patients. This analysis identified numerous opportunities for improved staff training and competencies as well as leadership oversight and investment in necessary resources. More systematic assessments of infection control practices, extending to both accredited and nonaccredited ambulatory facilities, are needed to inform oversight and prevention efforts.

On February 26, 2020, the first U.S. case of community-acquired coronavirus disease 2019 (COVID-19) was confirmed in a patient hospitalized in Solano County, California (1). The patient was initially evaluated at hospital A on February 15; at that time, COVID-19 was not suspected, as the patient denied travel or contact with symptomatic persons. During a 4-day hospitalization, the patient was managed with standard precautions and underwent multiple aerosol-generating procedures (AGPs), including nebulizer treatments, bilevel positive airway pressure (BiPAP) ventilation, endotracheal intubation, and bronchoscopy. Several days after the patient's transfer to hospital B, a real-time reverse transcription-polymerase chain reaction (real-time RT-PCR) test for SARS-CoV-2 returned positive. Among 121 hospital A health care personnel (HCP) who were exposed to the patient, 43 (35.5%) developed symptoms during the 14 days after exposure and were tested for SARS-CoV-2; three had positive test results and were among the first known cases of probable occupational transmission of SARS-CoV-2 to HCP in the United States. Little is known about specific risk factors for SARS-CoV-2 transmission in health care settings. To better characterize and compare exposures among HCP who did and did not develop COVID-19, standardized interviews were conducted with 37 hospital A HCP who were tested for SARS-CoV-2, including the three who had positive test results. Performing physical examinations and exposure to the patient during nebulizer treatments were more common among HCP with laboratory-confirmed COVID-19 than among those without COVID-19; HCP with COVID-19 also had exposures of longer duration to the patient. Because transmission-based precautions were not in use, no HCP wore personal protective equipment (PPE) recommended for COVID-19 patient care during contact with the index patient. Health care facilities should emphasize early recognition and isolation of patients with possible COVID-19 and use of recommended PPE to minimize unprotected, high-risk HCP exposures and protect the health care workforce.

Objectives To summarize patient notifications resulting from unsafe injection practices by health care personnel in the United States and describe recommended actions for prevention and response. Patients and Methods We examined records of events involving communications to groups of patients, conducted from January 1, 2012, through December 31, 2018, in which bloodborne pathogen testing was recommended or offered because of potential exposure to unsafe injection practices by health care personnel in the United States. Information compiled included: health care setting(s), type of unsafe injection practice(s), number of patients notified, number of outbreak-associated infections, and whether evidence suggesting bloodborne pathogen transmission prompted the notification. We compared these numbers with a similar review conducted from January 1, 2001, through December 31, 2011. Results From 2012 through 2018, more than 66,748 patients were notified as part of 38 patient notification events. Twenty-one involved exposures in non-hospital settings. Twenty-five involved syringe and/or needle reuse in the context of routine patient care; 11 involved drug tampering by a health care provider. The majority of events (n=25) were prompted by identification of unsafe injection practices alone, absent any documented infections at the time of notification. Outbreak-associated hepatitis B virus and/or hepatitis C virus infections were documented for 11 of the events; 8 involved patient-to-patient transmission, and 3 involved provider-to-patient transmission. Conclusions Since 2001, nearly 200,000 patients in the United States were notified about potential exposure to blood-contaminated medications or injection equipment. Facility leadership has an obligation to ensure adherence to safe injection practices and to respond properly if unsafe injection practices are identified.

Ayurveda is a science of life which emphasize on treating the disease as well as the prevention of disease. In present scenario due to sedentary life style, stress, improper food habits, environmental and genetic factors there is an alarming rise in metabolic disorders like Sthoulya, Madhumeha, Prameha Pidaka, arshas, jwara. In these conditions there is involvement of Mahadoshas and abhishyanda Srotas due to which there will be excessive kledata in Sarva Shareera, to mitigate this and to avoid snehavyapat there is an essentiality of Rukshana karma before Shodhana. Rukshana is a modality which falls under apatarpana line of treatment, one which causes or increases the rukshata in Shareera and mitigates kapha, medas. It is adopted in both internal and external form. Internally in the form of kashaya, arishta, takrapana and externally in the form of Udvartana, Takradhara, Ruksha sweda. In metabolic disorders the main culprits are kapha and medas. Rukshana adopted will be beneficial to do vilayana of kapha, medas and also helps in treating and counteracting the complications of metabolic disorders.

Key Points Question Were infections in patients who received umbilical cord blood products marketed as stem cell treatment associated with product contamination? Findings In this case series, 20 patients in 8 states developed bacterial infections after receiving unapproved products marketed as treatment for conditions including chronic pain and degenerative joint conditions. This national investigation found widespread bacterial contamination of undistributed and distributed products from multiple donors, with whole-genome sequencing indicating a common source. Meaning The findings from this outbreak underscore that unapproved and unproven stem cell products can expose patients to serious risks without clear benefit, including the possibility of product contamination., This case series examines bacterial infections in 20 patients who received umbilical cord blood–derived products marketed as stem cell treatment., Importance The number of clinics marketing stem cell products for joint diseases, chronic pain, and most recently, COVID-19, has increased despite warnings from the US Food and Drug Administration that stem cell products for these and other indications have not been proven safe or effective. Objective To examine bacterial infections in 20 patients who received umbilical cord blood–derived products marketed as stem cell treatment. Design, Setting, and Participants This case series is a national public health investigation including case-finding, medical record review and abstraction, and laboratory investigation, including sterility testing of products and whole-genome sequencing of patient and product isolates. Participants included patients who developed bacterial infections following administration of umbilical cord blood–derived products marketed as stem cell treatment during August 2017 to September 2018. Data analysis was performed from March 2019 to September 2021. Exposures Umbilical cord blood–derived products marketed as stem cell treatment. Main Outcomes and Measures Data were collected on patient infections and exposures. The Centers for Disease Control and Prevention performed sterility testing on undistributed and distributed vials of product marketed as stem cell treatment and performed whole-genome sequencing to compare patient and product bacterial isolates. Results Culture-confirmed bacterial infections were identified in 20 patients (median [range] age, 63 [2-89] years; 13 male patients [65%]) from 8 US states who sought stem cell treatment for conditions including pain, osteoarthritis, rheumatoid arthritis, and injury; all but 1 required hospitalization. The most frequently isolated bacteria from patients with infections were common enteric species, including Escherichia coli (14 patients) and Enterobacter cloacae (7 patients). Of unopened, undistributed products sampled for testing, 65% (22 of 34 vials) were contaminated with at least 1 of 16 bacterial species, mostly enteric. A patient isolate from Arizona matched isolates obtained from products administered to patients in Florida, and patient isolates from Texas matched undistributed product sent from the company in California. Conclusions and Relevance Unapproved stem cell products can expose patients to serious risks without proven benefit. Sequencing results suggest a common source of extensive contamination, likely occurring during the processing of cord blood into product. Patients and health care practitioners who are considering the use of unapproved products marketed as stem cell treatment should be aware of their unproven benefits and potential risks, including serious infections.

Obesity with its devastating consequences is a global health problem of this era. Presently Obesity in India has reached epidemic proportions in the 21st century, with morbid Obesity affecting 5% of the country’s population. The characteristic features of Obesity have close resemblance with Sthoulya in Ayurveda. Sthoulya is one among Santharpanottha Vyadhi, one among the Ashta Nindita Purushas, Kapha Nanatmaja Vyadhi and Dushta Medo Roga. Sthoulya being Bahudoshavasta and Mamsala, Medhura and Bhuri Sleshma Vyadhi. Hence, considering the condition, a comparative study was planned to compare the efficacy of Rookshana Poorvaka Vamana and Virechana Karma. The objective criteria were assessed before and after treatment. The results was statistically highly significant within the group, at the level of P value less than 0.001. Between the groups, Rookshana Poorvaka Vamana Karma group showed better results in comparision of mean difference to that of Rookshana Poorvaka Virechana Karma group.

Eka-Kushta is one among the Kshudra Kushta presenting with Lakshanas like Aswedanam, Mahavastu and Matsyashakalopama. It is of prime importance due to its chronicity and severity which involves a larger extent of the body. This is often compared to Psoriasis. Psoriasis is one of the most common dermatological conditions affecting both males and females upto 2% of world’s population. It is an immune mediated disease characterized by erythematous, sharply demarcated papules and rounded plaques covered by silvery micaceous scale which are variably pruritic. Traumatized areas, infections, stress and medications like beta blockers, anti-malarial drugs may exacerbate psoriasis. Kushta, a disease of Bahudosha, Bhuridosha and Saptakodravya Sangraha is to be treated by adopting repeated Antah Parimarjana as well as Bahir Parimarjanachikitsa. The present study was aimed to assess the efficacy of Bahir Parimarjana Chikitsa in the form Sarvangaudwarthana with Manjistha Choorna, Triphala Choorna and Takradhara with Musta, Asandi, Amalaki Choorna. This is a clinical study wherein 20 diagnosed Eka-Kushta patients of either sex were selected. The overall result in the study revealed that there is statistically significant (p less than 0.001) improvement in patients after the treatment.

Objectives: To study use, effect and adverse drug reaction (ADR) of the drugs and its impact on quality of life in patients suffering from Pemphigus vulgaris (PV). Materials and Methods: Prospective, observational study was carried out in newly diagnosed patients of PV. Baseline and follow-up data at 2, 6 and 12 weeks; disease severity (Kumar’s score), Quality of Life [Dermatology Life Quality Index (DLQI)] and ADR were recorded. Data analyzed by one-way and repeated measure ANOVA test. Results: Total 84 patients were included [Group A: Corticosteroid (n=29), Group B: Corticosteroid + Azathioprine (n=30), Group C: Corticosteroid + rituximab (n=25)]. Significant reduction ( P nd and 3 rd follow-up as compared to baseline and 1 st follow up and at 3 rd follow-up as compared 2 nd follow-up in group A, B and C. Mean difference between baseline and 3 rd follow up of Kumar’s score and DLQI was significantly higher in group C as compared to group A ( p p p p P p Conclusion: Corticosteroid with rituximab is associated with better efficacy and improvement in QOL but more expensive than corticosteroid alone / in combination with azathioprine for the treatment of Pemphigus vulgaris. Key words: Pemphigus vulgaris, Kumar’s score, Dermatology life Quality Index, Corticosteroid, Rituximab.

During January 22-March 23, 2018, a local health department in Washington was notified of two patients who received a diagnosis of acute hepatitis C virus (HCV) infection. Neither patient had behavioral risk factors associated with HCV acquisition; however, both had received injectable narcotic (opioid) drugs from the same nurse during separate visits to an emergency department (ED) at a local hospital on December 6 and December 16, 2017. Investigation revealed that the nurse had accessed the automated drug dispensing system at a higher frequency than had other staff members, admitted diverting* patients' injectable narcotic and antihistamine drugs for personal use, and tested positive for HCV antibodies (anti-HCV) on March 19, 2018, but did not have quantifiable HCV RNA. Specimens from both patients were sent to CDC for genetic testing, and HCV viral variants analysis found a significant level of genetically similar HCV variants in both patients, indicating a common source of infection. Further investigation was conducted to confirm the infection source, identify other potentially exposed patients, and treat any new patients who received an HCV diagnosis. Monitoring frequency of access to drug dispensing systems can help identify staff members with abnormal dispensing patterns, including diversion activities (1). U.S. health care facilities are required to prevent, identify, and report any loss, diversion, or theft of controlled substances (2).

The adrenal glands in children can be affected by a variety of benign lesions. The diagnosis of adrenal lesions can be challenging, but assessment of morphologic changes in correlation with the clinical presentation can lead to an accurate diagnosis. These lesions can be classified by their cause: congenital (eg, discoid adrenal gland, horseshoe adrenal gland, and epithelial cysts), vascular and/or traumatic (eg, adrenal hemorrhage), infectious (eg, granulomatous diseases), enzyme deficiency disorders (eg, congenital adrenal hyperplasia [CAH] and Wolman disease), benign neoplasms (eg, pheochromocytomas, ganglioneuromas, adrenal adenomas, and myelolipomas), and adrenal mass mimics (eg, extralobar sequestration and extramedullary hematopoiesis). Multimodality cross-sectional imaging helps to define the origin, extent, and relationship of these lesions to adjacent structures, as well as to guide treatment management. The anatomic and functional imaging modalities used to evaluate pediatric adrenal lesions include ultrasonography, computed tomography (CT), magnetic resonance imaging, and iodine 123 metaiodobenzylguanidine scintigraphy. Identifying the imaging features of nonmalignant adrenal lesions is helpful to distinguish these lesions from malignant adrenal neoplasms. Identifying characteristic imaging findings (eg, enlarged adrenal glands, with cerebriform surface, and stippled echogenicity in CAH; a T2-hyperintense mass with avid contrast enhancement in pheochromocytoma; low CT attenuation [

Tuberculosis (TB) of the head and neck has proved to be a diagnostic challenge for otorhinolarynologists around the world and is often misdiagnosed as cancer. To contribute to a better understanding of TB in the head and neck region by assessing its various manifestations, presentations, diagnostic techniques, risk factors, coexisting illnesses and treatment modalities. This was a retrospective study conducted over a 3 year period (2012–2014) in 2 hospitals in South India, among patients diagnosed to have TB of the head and neck. A semi structured proforma was used to capture information from the medical records pertaining to the various objectives of the study. Data was analysed using SPSS version 16.0 and results obtained were depicted as percentages. Chi-square test was used to find association between the variables and p

Incomplete atrophy of thyroglossal tract or retained epithelial cysts, creates the basis for the origin of a thyroglossal duct cyst. Thyroglossal duct cysts are the most common anomaly in thyroid development that occurs in 7% of adult population. In general duct cysts are benign and the incidence of a carcinoma in a thyroglossal duct cyst is very rare, the incidence of which is 1% of all cysts. The vast majority of these are papillary carcinoma (82%), other types of malignancies occurring being mixed papillary and follicular carcinoma, squamous cell carcinoma, follicular carcinoma and anaplastic carcinoma in descending order of frequency. Review of literature has revealed 25 reported cases of squamous cell carcinoma of the thyroglossal duct cyst till date.[1] CASE REPORT We present a case of a forty nine year old male patient, who presented with a swelling in front of the neck which gradually appeared over 4 months with associated change in voice. Further investigations revealed a squamous cell carcinoma with features suggesting the site of origin to be the thyroglossal duct. Sistrunk’s operation was done under general anaesthesia, followed by postoperative concurrent chemoradiotherapy. CONCLUSION Malignancy, although rare, within a thyroglossal duct cyst should be included in the differential diagnosis of neck masses. Aggressive treatment in the form of a combined modality of surgery, radiation and chemotherapy is usually the preferred plan of treatment.

Previous therapeutic models for modifying and managing problem behaviors in children with an Autism Spectrum Disorder have, typically, focused on working directly with the diagnosed child. The exclusion of other family member involvement in treatment displayed a need for creating a systemic model for managing children's problem behaviors. This model proposes Solution Focused Brief Therapy (SFBT) and Structural Family Therapy (SFT) with a focus on the caregivers of children with ASDs to reduce parental stress, increase parental self-efficacy, and ultimately begin to manage child behavior problems.

The purpose of this article is to determine the MRI and CT features of low-grade fibromyxoid sarcoma in children.We retrospectively analyzed images of 11 pediatric patients with low-grade fibromyxoid sarcoma from a phase 3 clinical trial of nonrhabdomyosarcoma soft-tissue sarcoma (Children's Oncology Group Protocol ARST0332). MRI and CT were performed in 10 and four patients, respectively. Location, size, margin, and composition on imaging were correlated with pathologic findings.Tumors were located in the extremities in nine patients, and one tumor each was located in the tongue and lung. Tumors were deep in seven patients and superficial in four patients. All tumors were well defined, solitary, and nonmetastatic at presentation. Tumors were complex solid-cystic in eight patients and completely solid in three patients. On T1-weighted images, all tumors had at least some areas hypointense to muscles, and six had a split-fat sign. On STIR or T2-weighted images, eight tumors had areas hypointense to adjacent muscle, and eight tumors had fluid signal intensity. On contrast-enhanced MRI studies, eight tumors had thick enhancing internal septations, and three had peripheral nodular gyriform enhancement. When we correlated imaging to pathologic findings, areas with hypointense signal intensity on both T1- and T2-weighted images were likely related to fibrous component; areas with fluid signal intensity on T2-weighted images were likely related to myxoid component. On CT, all four tumors were hypodense to muscle, and one tumor showed punctate calcific foci.Low-grade fibromyxoid sarcoma is hypodense to muscle on CT. MRI may identify both fibrous and myxoid components of this rare pediatric soft-tissue sarcoma.

To assess national trends in ectopic pregnancy incidence among assisted reproductive technology users and identify risk factors associated with ectopic pregnancy.We identified 553,577 pregnancies reported to the National ART Surveillance System between 2001 and 2011. Of those, 9,480 were ectopic, of which 485 were heterotopic. As a result of small numbers, ectopic and heterotopic pregnancies were combined for analysis. We assessed temporal trends in annual ectopic pregnancy rates using Poisson regression. We used log-binomial regression models with generalized estimating equations for correlated outcomes within clinics to calculate unadjusted and adjusted risk ratios for the association between ectopic pregnancy and selected patient characteristics and treatment factors.The rate of ectopic pregnancy declined from 2.0% (n=735, 95% confidence interval [CI] 1.9-2.2) in 2001 to 1.6% (n=968, 95% CI 1.5-1.7) in 2011 (P for trend.001). The ectopic pregnancy rate ranged from 2.0% (n=7,469, 95% CI 1.9-2.0) for fresh, nondonor cycles to 1.0% (n=641, 95% CI 0.9-1.1) for fresh, donor cycles. Among fresh, nondonor cycles, the rate of ectopic pregnancy was 1.6% (95% CI 1.4-1.7) when one embryo was transferred compared with 1.7% (95% CI 1.7-1.8), 2.2% (95% CI 2.1-2.3), and 2.5% (95% CI 2.4-2.6) when two, three, or four or more embryos were transferred, respectively (adjusted risk ratios 1.11, 95% CI 0.94-0.30; 1.33, 95% CI 1.12-1.56; and 1.49, 95% CI 1.25-1.78).Ectopic pregnancy incidence after assisted reproductive technology has decreased over time, but factors such as multiple embryo transfer increase the risk of ectopic pregnancy.II.

Fibroblast growth factors and fibroblast growth factor receptors (FGFRs) play important roles in human axial and craniofacial skeletal development. FGFR1, FGFR2, and FGFR3 are crucial for both chondrogenesis and osteogenesis. Mutations in the genes encoding FGFRs, types 1-3, are responsible for various skeletal dysplasias and craniosynostosis syndromes. Many of these disorders are relatively common in the pediatric population, and diagnosis is often challenging. These skeletal disorders can be classified based on which FGFR is affected. Skeletal disorders caused by type 1 mutations include Pfeiffer syndrome (PS) and osteoglophonic dysplasia, and disorders caused by type 2 mutations include Crouzon syndrome (CS), Apert syndrome (AS), and PS. Disorders caused by type 3 mutations include achondroplasia, hypochondroplasia, thanatophoric dysplasia (TD), severe achondroplasia with developmental delay and acanthosis nigricans, Crouzonodermoskeletal syndrome, and Muenke syndrome. Most of these mutations are inherited in an autosomal dominant fashion and are gain-of-function-type mutations. Imaging plays a key role in the evaluation of these skeletal disorders. Knowledge of the characteristic imaging and clinical findings can help confirm the correct diagnosis and guide the appropriate molecular genetic tests. Some characteristics and clinical findings include premature fusion of cranial sutures and deviated broad thumbs and toes in PS; premature fusion of cranial sutures and syndactyly of the hands and feet in AS; craniosynostosis, ocular proptosis, and absence of hand and foot abnormalities in CS; rhizomelic limb shortening, caudal narrowing of the lumbar interpediculate distance, small and square iliac wings, and trident hands in achondroplasia; and micromelia, bowing of the femora, and platyspondyly in TD. ©RSNA, 2017.

A growing body of empirical research has confirmed an association between chronic pain and cognitive dysfunction. The aim of the present study was to determine whether cognitive function is affected in patients with a diagnosis of chronic neuropathic or radicular pain relative to healthy control participants matched by age, gender, and years of education. We also examined the interaction of pain with age in terms of cognitive performance. Some limitations of previous clinical research investigating the effects of chronic pain on cognitive function include differences in the pain and cognitive scale materials used, and the heterogeneity of patient participants, both in terms of their demographics and pathological conditions. To address these potential confounds, we have used a relatively homogenous patient group and included both experimental and statistical controls. We have also specifically investigated the interaction effect of pain and age on cognitive performance. Patients (n = 38) and controls (n = 38) were administered a battery of cognitive tests measuring IQ, spatial and verbal memory, attention, and executive function. Educational level, depressive symptoms, and state anxiety were assessed as were medication usage, caffeine, and nicotine consumption to control for possible confounding effects. Both the level of depressive symptoms and the state anxiety score were higher in chronic pain patients than in matched control participants. Chronic pain patients had a lower estimated IQ than controls, and showed impairments on measures of spatial and verbal memory. Attentional responding was altered in the patient group, possibly indicative of impaired inhibitory control. There were significant interactions between chronic pain condition and age on a number of cognitive outcome variables, such that older patients with chronic pain were more impaired than both age-matched controls and younger patients with chronic pain. Chronic pain did not appear to predict performance on the Wisconsin Card Sorting Task, which was used a measure of executive function. This study supports and extends previous research indicating that chronic pain is associated with impaired memory and attention. Perspective: Compared to healthy control participants, patients with chronic neuropathic or radicular pain showed cognitive deficits which were most pronounced in older pain patients. This research was conducted with the financial support of the Irish Higher Education Authority under the Programme for Research in Third Level Institutions, Cycle 4. The technical and administrative assistance of Ms. Karen Walsh, Dr. Daniel Kerr, and Dr. Kate McDonnell-Dowling is gratefully acknowledged. peer-reviewed

This report serves as a guide for investigating mucormycosis infections in healthcare. We describe lessons learned from previous outbreaks and offer methods and tools that can aid in these investigations. We also offer suggestions for conducting environmental assessments, implementing infection control measures, and initiating surveillance to ensure that interventions were effective. While not all investigations of mucormycosis infections will identify a single source, all can potentially lead to improvements in infection control.

Progressive multifocal leukoencephalopathy (PML) is an often fatal opportunistic infection of the JC virus resulting in demyelination of the CNS. PML is well-described in patients with multiple sclerosis (MS) exposed to natalizumab. PML is rare in patients with myasthenia gravis (MG) and is also rare following rituximab exposure. We report PML in a patient with MG after immunosuppression that includes rituximab.

Zika virus transmission was detected in the Region of the Americas (Americas) in Brazil in May 2015, and as of March 21, 2016, local mosquito-borne transmission of Zika virus had been reported in 32 countries and territories in the Americas, including Puerto Rico and the U.S. Virgin Islands.* Most persons infected with Zika virus have a mild illness or are asymptomatic. However, increasing evidence supports a link between Zika virus infection during pregnancy and adverse pregnancy and birth outcomes (1), and a possible association between recent Zika virus infection and Guillain-Barre syndrome has been reported (2). Although Zika virus is primarily transmitted through the bite of Aedes species of mosquitoes, sexual transmission also has been documented (3). Zika virus RNA has been detected in a number of body fluids, including blood, urine, saliva, and amniotic fluid (3-5), and whereas transmission associated with occupational exposure to these body fluids is theoretically possible, it has not been documented. Although there are no reports of transmission of Zika virus from infected patients to health care personnel or other patients, minimizing exposures to body fluids is important to reduce the possibility of such transmission. CDC recommends Standard Precautions in all health care settings to protect both health care personnel and patients from infection with Zika virus as well as from blood-borne pathogens (e.g., human immunodeficiency virus [HIV] and hepatitis C virus [HCV]) (6). Because of the potential for exposure to large volumes of body fluids during the labor and delivery process and the sometimes unpredictable and fast-paced nature of obstetrical care, the use of Standard Precautions in these settings is essential to prevent possible transmission of Zika virus from patients to health care personnel.

Objective To evaluate trends and reproductive outcomes of gestational surrogacy in the United States. Design Retrospective cohort study. Setting Infertility clinics. Patient(s) IVF cycles transferring at least one embryo. Intervention(s) Use of a gestational carrier. Main Outcome Measure(s) Trends in gestational carrier cycles during 1999–2013, overall and for non-U.S. residents; reproductive outcomes for gestational carrier and nongestational carrier cycles during 2009–2013, stratified by the use of donor or nondonor oocytes. Result(s) Of 2,071,984 assisted reproductive technology (ART) cycles performed during 1999–2013, 30,927 (1.9%) used a gestational carrier. The number of gestational carrier cycles increased from 727 (1.0%) in 1999 to 3,432 (2.5%) in 2013. Among gestational carrier cycles, the proportion with non-U.S. residents declined during 1999–2005 (9.5% to 3.0%) but increased during 2006–2013 (6.3% to 18.5%). Gestational carrier cycles using nondonor oocytes had higher rates of implantation (adjusted risk ratio [aRR], 1.22; 95% confidence interval [CI], 1.17–1.26), clinical pregnancy (aRR, 1.14; 95% CI, 1.10–1.19), live birth (aRR, 1.17; 95% CI, 1.12–1.21), and preterm delivery (aRR, 1.14; 95% CI, 1.05–1.23) compared with nongestational carrier cycles. When using donor oocytes, multiple birth rates were higher among gestational carrier compared with nongestational carrier cycles (aRR, 1.13; 95% CI, 1.08–1.19). Conclusion(s) Use of gestational carriers increased during 1999–2013. Gestational carrier cycles had higher rates of ART success than nongestational carrier cycles, but multiple birth and preterm delivery rates were also higher. These risks may be mitigated by transferring fewer embryos given the higher success rates among gestational carrier cycles.

Tuberculosis (TB) of the skeletal system constitutes only 1–3% of extrapulmonary TB and usually involves the thoracic spine. These patients usually present with malaise, weight loss, night sweats, muscle spasms, paraspinal swellings or neurological deficits. We report a case of tuberculosis of the spine, which had an unusual presentation only as a painless neck swelling, without any neurological complications. The patient did not respond well to antitubercular therapy (ATT), necessitating thoracotomy and drainage of pus. Then his ATT was continued for 1 year and is asymptomatic during 1 year of follow up thereafter.

Background and Purpose— Both application of neurotrophic factors like brain-derived neurotrophic factor (BDNF) and constraint-induced movement therapy like forced arm use have been shown to potentially improve outcome after stroke. The aim of the present study was to check whether postischemic long-term outcome correlates to specific modifications in the abundance of various neurotransmitter receptors. Methods— Adult male Wistar rats were subjected to photothrombotic ischemia and assigned to various treatment groups (n=5 each) with end points at 3 and 6 weeks: (1) ischemic control (saline); (2) BDNF (ischemia, 20 μg BDNF); (3) forced arm use (ischemia, saline, and ipsilateral plaster cast for 5 or 14 days for the 3- and 6-week groups, respectively); and (4) combined treatment (combi; ischemia, 20 μg BDNF, forced arm use). Animals received intravenous bolus infusions of saline or BDNF 1 hour 3 and 5 days after ischemia, respectively. A group of sham rats (n=2) served as a control. A battery of behavioral tests was performed before and up to 6 weeks after ischemia. Quantitative in vitro receptor autoradiography was performed on 12-μm-thick cryostat sections using [ 3 H]MK-801, [ 3 H]AMPA, and [ 3 H]muscimol for labeling of NMDA, AMPA, and GABA A receptors, respectively. Results— Best functional outcome was seen after BDNF treatment, whereas vice versa rats with forced arm use did worse in behavioral performance. Improved behavioral outcome was associated with increased perilesional binding densities of NMDA and AMPA receptors 3 weeks after stroke. Conclusions— Our findings suggest that transient enhanced neurotransmission as reflected by increased ligand binding of NMDA and AMPA receptors may participate in successful postlesional reorganization processes.

Objective To assess treatment and pregnancy/infant-associated medical costs and birth outcomes for assisted reproductive technology (ART) cycles in a subset of patients using elective double embryo (ET) and to project the difference in costs and outcomes had the cycles instead been sequential single ETs (fresh followed by frozen if the fresh ET did not result in live birth). Design Retrospective cohort study using 2012 and 2013 data from the National ART Surveillance System. Setting Infertility treatment centers. Patient(s) Fresh, autologous double ETs performed in 2012 among ART patients younger than 35 years of age with no prior ART use who cryopreserved at least one embryo. Intervention(s) Sequential single and double ETs. Main Outcome Measure(s) Actual live birth rates and estimated ART treatment and pregnancy/infant-associated medical costs for double ET cycles started in 2012 and projected ART treatment and pregnancy/infant-associated medical costs if the double ET cycles had been performed as sequential single ETs. Result(s) The estimated total ART treatment and pregnancy/infant-associated medical costs were $580.9 million for 10,001 double ETs started in 2012. If performed as sequential single ETs, estimated costs would have decreased by $195.0 million to $386.0 million, and live birth rates would have increased from 57.7%–68.0%. Conclusion(s) Sequential single ETs, when clinically appropriate, can reduce total ART treatment and pregnancy/infant-associated medical costs by reducing multiple births without lowering live birth rates.

Pediatric vasculitides are multisystem diseases that can be diagnostic challenges because of variable clinical manifestations. The clinical manifestation is determined by the size of the affected vessels, organs involved, extent of vascular injury, and underlying pathologic characteristics. Henoch-Schönlein purpura and Kawasaki disease are the two most common subtypes of pediatric vasculitis. Diagnosis of pediatric vasculitis can be difficult, and the outcome can be serious or fatal in the absence of timely intervention. Imaging plays a central role in establishing the diagnosis of vasculitis involving large- and medium-sized vessels, visualizing its vascular and extravascular manifestations, and monitoring the disease course and response to treatment. Although imaging cannot depict the vessel changes of small-vessel vasculitis directly, it can be used to detect tissue damage resulting from vessel inflammation. This article discusses the classification and clinical features of the major pediatric vasculitides. The imaging approach to and nonneurologic findings of major pediatric vasculitis subtypes are reviewed for the pediatric body imager.

Purpose To investigate the cases of foreign body in the aerodigestive tract and to elucidate the characteristic problems in India. Design and setting Three hundred patients presenting with a history of either aspirating or swallowing a foreign body were analyzed in a tertiary care center. Data were collected by retrospective chart review and statistically analyzed. Results Of the 300 patients studied, 90% (270 cases) did have a retained foreign body, with 233 (86.2%) cases found in the pharyngoesophagus and 37 (13.7%) cases in the tracheobronchial tree. With foreign bodies in the tracheobronchial passages, the most common sign and symptom were rhonchi (50%) and dyspnea (67%), respectively; in pharyngoesophagus, the most common symptom and sign were dysphagia (64%) and odynophagia (45%), respectively. The most common foreign body found was fish bone in 39% (106 cases) and the most common site of lodgment was the cervical esophagus 50.5% (136 cases). Rigid endoscopy with forceps removal under general anesthesia was the main treatment modality. Thirty-three (12.2%) cases had complications secondary to retained foreign body. Conclusion Foreign bodies in the aerodigestive tract continue to be a common problem affecting adults and children alike. Rigid endoscopies with forceps removal under general anesthesia are the preferred management modality. From their experience, the authors recommend that no foreign body in the upper aerodigestive tract should be left alone with the hope that it will come out spontaneously. Delay in diagnosis and management can lead to life-threatening complications.

Purpose AIDS is a fatal illness, which breaks down the body's immunity and leaves the victim vulnerable to life-threatening opportunistic infections, neurological disorders, or unusual malignancies. About 80% of patients with HIV infections present with otolaryngological symptoms. Often, the otolaryngologist is the primary physician who diagnoses the HIV infection. He should be aware and vigilant for its symptoms and unusual presentations. The aim of our study was to determine the incidence of otolaryngological manifestations, the clinical presentations, relevant diagnostic tools, management, and survival rates. Materials and methods We studied 968 patients who were diagnosed to have HIV infection at Kasturba Medical College, Mangalore, India, from January 1996 to December 2004. The incidence of otolaryngological manifestations was noted. Patients with opportunistic infections were treated by specific and symptomatic measures. Of 968 patients studied, 419 were followed up for a 5-year period. Results In our study, otolaryngological findings were noted in 79% of individuals. Oropharyngeal findings, which were the commonest, were seen in 59%, followed by cervical lymphadenopathy in 42% of patients. Oral candidiasis was the commonest oropharyngeal finding, seen in 39% of patients. Among nasal complaints, rhinosinusitis was the commonest, found in 17% of patients. Otological manifestations were seen in 20%, of which chronic suppurative otitis media was the commonest, seen in 13% of patients. Routine investigations were found to suffice for diagnosis. Of 419 patients who were followed up, the 5-year survival rate was 73%. Conclusion With the increase in the number of AIDS cases, it is important for otolaryngologists to be aware of otolaryngological manifestations. Early diagnosis and timely intervention along with appropriate antiretroviral therapy improve survival rates.

A lingual thyroid is a mass of ectopic thyroid tissue located in the midline of the base of the tongue. Its estimated prevalence ranges from 1 in 3,000 to 1 in 10,000 population. We report the interesting case of a 28-year-old woman who presented with a primary papillary carcinoma in a lingual thyroid and a histologically normal thyroid gland. To the best of our knowledge, this case probably represents only the second reported case of a follicular variant of a papillary carcinoma arising in a lingual thyroid.

Ectopic thyroid is an uncommon embryological aberration of the thyroid descent. Subhyoid median ectopic thyroid gland is a result of incomplete descent of the thyroid anlage and is characterized by a cosmetically unacceptable ovoid mass of thyroid tissue in the midline overlying the thyroid cartilage and thyrohyoid membrane. A normally placed thyroid gland is not detectable and in most cases all functioning thyroid tissue is located within the mass. Usually it is mistaken for a thyroglossal cyst and excised. Severe myxedema follows removal. Many cases have been reported in the literature, none of which was recognized prior to operation. All patients were operated upon for removal of a thyroglossal duct cyst. The diagnosis was missed at operation and in these cases severe myxedema was universal. The cause of the myxedema was not always immediately recognized. Therefore, many diagnostic tests including thyroid function test, ultrasound of the neck and thyroid scanning had been recommended in the preoperative evaluation of a thyroglossal cyst. Here, we present a case of ectopic thyroid mass which was the only thyroid tissue present in the neck. So division and repositioning of the thyroid mass thereby redefining the anatomy was done with good cosmetic result.How to cite this articleNaik KM. Redefining Anatomy in a Case of Midline Subhyoid Ectopic Thyroid. Int J Head and Neck Surg 2012;3(3):179-181.

Background: It is common in medical practice to see patients having persistent pain and radiculopathy even after undergoing discectomy surgery. Inflammatory cytokines, such as interleukins are produced at the site of disc herniation and are now considered responsible for the pain perceived by the patient. This study has used high sensitive C-reactive protein (HSCRP) assay for predicting inflammation around the nerve roots on very same principle, which has used HSCRP for predicting coronary artery diseases in current clinical practice. Thus, purpose of this study is to test whether HSCRP can stand as an objective tool to predict postoperative recovery in patients undergoing lumbar discectomy. That is, to study association between preoperative HSCRP blood level and postoperative recovery with the help of modified Oswestry Back Disability Score. Materials and Methods: A study group consisting of 50 cases of established lumbar disc disease and control group of 50 normal subjects, matched with the study group. Both the study and control groups were subjected to detailed evaluation with the help of modified Oswestry Low Back Pain Scale both pre and postoperatively at 3 months, 6 months and 1-year. The preoperative blood samples were analyzed to assess the HSCRP concentration. All the cases underwent surgery over a period of 1-year by the same surgeon. Results: The level of HSCRP in the study group was between 0.050- and 0.710 mg/dL and in the control group, 0.005-0.020 mg/dL. There was highly significant positive correlation between preoperative HSCRP level and postoperative score at P < 0.005. Cases with HSCRP level in the range of 0.1820 ± 0.079 mg/dL, showed better recovery (score improved > 10 points), while those with HSCRP level in the range of 0.470 ± 0.163 mg/dL, showed poor recovery (score improved < 10 points). Conclusion: HSCRP will serve as a good supplementary prognostic marker for operative decision making in borderline and troublesome cases of lumbar disc disease.

The diagnosis of acute right lower quadrant pain in a pediatric population is challenging. Acute appendicitis is the most common cause of an acute surgical abdomen. The common mimics of acute appendicitis are acute gastrointestinal and gynecologic diseases. This article reviews the sonographic findings of the spectrum of common acute abdominal emergencies in children with a focus on imaging clues to a specific diagnosis. This awareness can impact on diagnostic accuracy and impact patient management.

Angiolymphoid Hyperplasia with eosinophilia (ALHE), also known as epithelioid haemangioma, is an atypical vascular tumour which occurs with a predilection for the head and neck region. It is characterized by the presence of solitary or multiple lesions with varying clinical appearances, from intradermal papules to subcutaneous nodules.

Background: The aim of this study was to evaluate the various manifestations of tuberculosis in the head and neck region, incidence of the different forms and the diagnostic modalities and the treatment modalities employed. We also studied its coexistence with pulmonary tuberculosis and human immunodeficiency virus infection. Methods: Our study was a prospective study done conducted in the otolaryngology and head and neck surgery departments, Kasturba medical college and allied hospitals in Mangalore, India. The study group comprised 70 patients diagnosed with tuberculous manifestations of the head and neck region over the period of 2 years from 2011-2013. Chest radiography and sputum AFB was also done in all the patients to rule out coexisting pulmonary tuberculosis. All patients were screened for HIV. Results: Our study included 70 patients with tuberculosis of the head and neck region. The most common presentation of tuberculosis in the head and neck region was tuberculous lymphadenitis in 77% followed by deep neck space abscess 10% then laryngeal tuberculosis in 8.50%, submandibular gland tuberculosis in 3% and 1.5% diagnosed with pharyngeal tuberculosis. 12.8% of our patients had coexisting HIV infection and 33% patients had associated pulmonary tuberculosis. Conclusions: Tuberculosis of the head and neck region though not very frequent, still remains an important clinical entity which should be kept in mind especially in developing countries. Involvement of the cervical lymph nodes remains one of the commonest manifestations.

Tuberculosis of the nose is very rare. When it does occur, it almost always arises secondary to primary pulmonary tuberculosis. Nasal tuberculosis is most common in women older than 20 years. We report the case of a 16-year-old girl who presented with epistaxis, fever, submental swelling, and enlargement of multiple cervical and axillary lymph nodes. The patient was diagnosed with tuberculous granuloma of the nose and tuberculous lymphadenopathy. She was successfully treated with a 6-month regimen of standard antituberculous therapy.

Rab6 is a GTP binding protein that regulates vesicular trafficking within the Golgi and post-Golgi compartments. We overexpressed wild-type, a GTPase defective (Q71L), and a guanine nucleotide binding defective (N125I) Rab6 protein in Drosophila photoreceptors to assess the in vivo role of Rab6 in the trafficking of rhodopsin and other proteins. Expression of Drab6(Q71L) greatly reduced the steady state levels of two rhodopsins, Rh1 and Rh3, whereas Drab6(wt) and Drab6(N125I) showed weaker effects. Analysis of a strain carrying Rh1 rhodopsin under a heat shock promoter showed that Drab6(Q71L), but not Drab6(wt) or Drab6(N125I), prevents the maturation of rhodopsin beyond an immature 40 kDa form. Drab6(Q71L) is a GTPase defective mutant, indicating that anterograde transport of rhodopsin requires Rab6 GTPase function. The three Drab6 strains had no effect on the expression of several other photoreceptor proteins. The Drab6(Q71L) photoreceptors show marked histological defects at young ages and degenerate over a two week time span. These results establish that rhodopsin is transported via a Rab6 regulated pathway and that defects in trafficking pathways lead to retinal degeneration.

Sinonasal lymphomas are uncommon malignancies. They are difficult to differentiate from carcinomas, and immune-histochemistry is needed to make the diagnosis. We describe an unusual case of a T cell lymphoma that involved only the paranasal sinuses in a middle-aged man. The patient presented with a complete loss of vision in one eye and lateral rectus muscle palsy, but no nasal symptoms.

Kikuchi's disease is an idiopathic self-limiting necrotizing lymphadenitis. Clinically, it mimics tuberculous cervical lymphadenopathy. The disease is diagnosed by histopathologic study. The only specific treatment that has been reported is empiric steroid therapy. We report a case of tuberculosis that was originally thought to be Kikuchi's disease in a 24-year-old man. When the patient's condition worsened during a course of steroid therapy, he underwent surgical exploration, which revealed the presence of tuberculous lymphadenitis. The patient was switched to antituberculosis drug therapy, and his improvement was dramatic.

This case report illustrates two unusual cases of parapharyngeal schwannomas mimicking carotid body tumors in terms of characteristic vascular displacement. Carotid body tumors classically cause splaying of internal and external carotid arteries demonstrating the Lyre sign on imaging. Also interestingly, both of these cases were seen in younger ages and include cervical sympathetic chain schwannoma and vagal schwannoma. However, these schwannomas revealed hypovascularity on imaging studies allowing differentiation from hypervascular carotid body tumors. Preoperative distinction between carotid body tumors and schwannomas is very important.

To study the presentation, etiology, microbiology and morbidity of deep neck space infections.Retrospective study Methods: 29 patients admitted in Kasturba Medical College Hospital, Mangulore, India between January 1997 and December 2002 with deep neck space infections.,were included in the study.The most common space involved was the parapharyngeul space. No specific etiology was determined in .38%; an odontogenic cause was discovered in 28% of the patients; tonsillar/pharyngeal infections in 24% of patients and foreign body impaction in 7% of cases. The main morbidity was due to mediastinitis (5 patients). I patient succumbed to the disease. Mixed flora with aerobic and anaerobic infections was identified in most of the cases.

year old male was operated upon for trauma induced L1 burst fracture with complete paraplegia. On 7 th postoperative day patient started developing rapidly evolving bilaterally symmetrical ascending areflexic motor paralysis involving shoulder accompanied by tingling dysesthesias in the upper extremities. Thereafter, he developed lower cranial nerve palsy with facial diaparesis. All relevant haematological & serological tests were not contributory to definite diagnosis and MRI-Spine did not show any abnormality. However, Electrodiagnostic study & CSF examination supported the diagnosis of Guillain-Barre Syndrome (GBS). Patient was subsequently subjected to plasmapheresis but his condition deteriorated and he succumbed to death on 15th postoperative day. This rare case reports illustrates the importance of watchful expectancy for a neurodeficit that may or may not be related to spine surgery even after critical postoperative period, so that urgent measures can be initiated at the right time in the form of supportive & curative treatment.

Hydranencephaly is an encephaloclastic central nervous system disorder characterised by severe destruction of the cerebral hemispheres with preservation of posterior fossa structures. We present MRI and neurosonography features of a unique case of hydranencephaly involving cerebellum (in the form of complete liquefaction of cerebellar hemispheres) and cerebral hemispheres with associated bilateral microphthalmia and ocular colobomas. This is an exceptional case as to the best to our knowledge. In humans, such a severe involvement of cerebellum has not been reported in cases of hydranencephaly. It is essential to distinguish hydranencephaly from gross hydrocephalus, as treatment and prognosis of the two are totally different. During differentiation, it is important to remember that severe cerebellar involvement can be seen in hydranencephaly.

Inverted papilloma is a benign tumor with malignant potential that commonly arises from the lateral wall of the nose. We present a case of inverted papilloma, in a premalignant stage, of unusual origin and with oropharyngeal extension. The patient presented with complaints of a nasal mass arising from the left nasal cavity and progressively increasing in size since 2 years. On examination a fleshy, firm, sensitive mass was noted, which was attached to the medial wall, and extending posteriorly and inferiorly into the oropharynx. Diagnostic nasal endoscopy and complete excision of the mass was performed with a stable postoperative period. Histopathology of the mass revealed an inverted nasal papilloma of the septum with carcinoma in situ.