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Different blood components are associated with various types of adverse transfusion reactions and are linked to several factors including the number, rate and volume of transfusions. The given study was conducted to study the relationship between various transfusion reactions and its causative factors. This study was a prospective study of eighteen months on all patients who were recipient of a blood transfusion and blood components including various adverse reactions and events related to transfusion. These were correlated with tests for compatibility including general blood picture ,tests for haemolysis ,hematuria and haemoglobinuria, Coombs Test (Direct and Indirect), culture along with relevant clinical details of the patient. Out of a total of 31451 units of blood issued, 47 adverse transfusion reactions were noted with a maximum number in the age group of > 18 years (87.3%) with M: F being 1.6: 1 .0.24% of adverse transfusion reactions were by Packed red blood cell (PRBCs) transfusion and mostly were immediate transfusion with a mean volume of 100 ml and mean time of 20 minutes. Febrile Non Hemolytic Transfusion Reaction (FNHTR) was the commonest Adverse Transfusion Reaction (ATR)(0.128%) with 2 cases positive for Direct Coombs Test. A thorough serological and immunological examination and the addition of methods like buffy coat reduction and leucocyte filtration help in reducing the incidences of hemolytic transfusion reactions and transmitted infections and establishing a hemovigilance system help in the attainment of the goal of safe transfusion.

The life cycle of a virus involves interacting with the host cell, entry, hijacking host machinery for viral replication, evading the host's immune system, and releasing mature virions. However, viruses, being small in size, can only harbor a genome large enough to code for the minimal number of proteins required for the replication and maturation of the virions. As a result, many viral proteins are multifunctional machines that do not directly obey the classic structure-function paradigm. Often, such multifunctionality is rooted in intrinsic disorder that allows viral proteins to interact with various cellular factors and remain functional in the hostile environment of different cellular compartments.This report covers the classification of flaviviruses, their proteome organization, and the prevalence of intrinsic disorder in the proteomes of different flaviviruses. Further, we have summarized the speculations made about the apparent roles of intrinsic disorder in the observed multifunctionality of flaviviral proteins.Small sizes of viral genomes impose multifunctionality on their proteins, which is dependent on the excessive usage of intrinsic disorder. In fact, intrinsic disorder serves as a universal functional tool, weapon, and armor of viruses and clearly plays an important role in their functionality and evolution.

In recent years, a technology for restaurants has emerged. Each company is currently changing its operations to satisfy the needs of its customers due to technological improvements. Businesses that regularly upgrade to meet changing customer expectations will thrive in the long run. In addition to embracing new technology, the restaurant industry now provides online meal delivery services to better serve its customers. The origins of the online food industry can be traced back to 1994, when the first online food order was a pizza from Pizza Hut. This study is a subjective investigation into use pattern, user well disposed, enjoyed and detested highlights of food delivery applications, and the convictions related with them. It was essential to explore the impact of social effect on the preference to utilize food delivery applications considering the dispersion of development.

Introduction: Intraoperative squash technique provides rapid and reliable diagnosis which is helpful to monitor or modify the treatment approach. We carried out the present study to compare the accuracy of squash preparation with histopathological diagnosis and also to study the role of GFAP immunostaining in gliomas. Material and Methods: Clinicoradiologically diagnosed 127 cases of gliomas were subjected to both squash smear cytology and histopathological examination; also to GFAP staining using monoclonal antibody (EP672Y clone). Taking histopathology as gold standard, diagnostic accuracy and statistical values were calculated. Immunohistochemical analysis was compared with final diagnosis. Results: Overall diagnostic accuracy of squash cytology was observed as 95.2% (sensitivity=99.1%, PPV= 99.1%). All low grade astrocytomas and ependymoma showed strong diffuse positivity while high grade astrocytomas were focally reactive. Negative immunoexpression was seen in case of oligodendroglioma and pituitary adenoma. Conclusion: Squash cytology is of great value in rapid intraoperative consultation of gliomas. GFAP can be used as an adjunctive tool to verify the astroglial differentiation especially in diagnostically difficult cases. Keywords: diagnostic accuracy, GFAP, Gliomas, Squash.

Tuberculous infection of the oral cavity is an exceedingly rare clinical entity and it generally occurs secondary to pulmonary tuberculosis, with the gingival involvement as its only primary finding. Due to its rarity and atypical presentation this condition often gets misdiagnosed. We report here a case of secondary oral tuberculosis in a 44 year old male patient who presented with gingival involvement. The diagnosis was based on sputum examination, radiology of chest, montaux test and histopathology. Early diagnosis and prompt treatment is important for management of this clinical condition.

Background: Lung biopsy is crucial in histopathological subtyping and classification. However, making an accurate diagnosis in small biopsies can be challenging. This study was aimed to distinguish and classify lung tumors employing immunohistochemical markers TTF-1(thyroid transcription factor 1), Cytokeratin 5/6, Cytokeratin 20, AE1/3. Subsequently, prognostic value of different histological types of lung tumours was established employing Ki-67. Material & Methods A total of 52 clinically diagnosed cases of lung carcinoma over a period of two years were included in our study. Of these 2 cases were excluded from the study as they showed granulomas on histopathology. All the cases after being diagnosed on H&E were subjected to Immunohistochemistry (IHC). Statistical Analysis: The statistical analysis was done using SPSS for Windows 15.0 program. Specificity, sensitivity, positive predictive value, negative predictive value of all these IHC markers was statistically evaluated. Results Of 29 cases diagnosed as Squamous cell carcinoma (SCC) on H&E, 26 were CK5/6 positive on IHC. Of 4 cases diagnosed as Primary Adenocarcinoma (ADC) on H&E, 3 were TTF-1 positive. Four cases of poorly differentiated carcinoma diagnosed on H&E, 1 case was diagnosed as SCC and 2 cases as Metastatic ADC on IHC. Ki-67 was high in 82.8% cases of SCC and in 50% cases of ADC. The sensitivity and specificity of CK5/6 and TTF-1 was 100%, 57.1% and 100%, 96.7% respectively. Conclusion: Employing IHC markers either singly or in a panel is a useful adjunct to morphological features and clinical parameter in the diagnosis and management of lung tumour.

Extramedullary disease in AML-M0 is a rare occurrence. It is even rarer to encounter breathlessness as primary presenting complaint secondary to a leukemic pleural effusion. Leukemic pleural effusion occurs rarely in acute myeloid leukemia (AML) with minimal differentiation. Patients with AML usually present with weakness, hemorrhage, and recurrent infections. The highest incidence of extramedullary leukemic manifestation is seen in monocytic AML. Here, we report the case of an 18-year-old male who presented withbreathlessness and vocal cord palsy. Examination and investigation established diagnosis of an acute myeloid leukemia M0 with leukemic pleural effusion.

Background: Urothelial carcinoma is common urinary malignancy responsible for a significant proportion of cancer morbidity and mortality. We carried out the present study to demonstrate the clinicohistopathological features and to correlate the p53 and Ki-67 immunoexpression with grade and stage of bladder carcinomas. Materials and Methods: We investigated 110 cases of bladder tumor. Grading and staging were done according to the WHO-2004 and American Joint Committee on Cancer-TNM staging recommendations. Immunohistochemical staining for p53 and Ki-67 was performed in all the cases, categorized as high and low expression taking 20% positivity as cutoff value. Statistical analysis was done using McNemar's Chi-square test and Fisher's exact test. Results: There were 61 cases of high grade and 49 cases of low grade exhibiting urothelial carcinoma as the most common variant (97.3%). Muscle invasive carcinomas (pT2) noted in 29 cases whereas 23 and 58 cases revealed stage pTa and pT1, respectively. Evaluation of p53 and Ki-67 immunoexpression showed a significant association with histological grade and stage individually and also in combination (P < 0.05). Conclusion: Our results corroborate with the opinion that combined use of p53 and Ki-67 immunomarkers may provide additional prognostic information along with histological grading and staging in bladder carcinomas.

Background: Coronavirus disease of 2019 (COVID-19) has made an imperishable haunting mark worldwide, and has changed in many aspects the way medicine had been practiced till now. This study is intended to highlight the approach that was followed in the department of ear, nose, and throat (ENT) learning from the existing available guidelines to provide safe routine and emergency ENT care to all the patients irrespective of the COVID status. Objectives of the study were to highlight the changes, challenges, triage and safety recommendations associated with patient management during the ongoing pandemic.Methods: This study conducted between 25th March 2020 to 15th September 2020 constitutes of following points covering various aspects of patient management such as education about personal protective equipment, the 3-station triage system starting from the patient’s entry in the hospital, general working and precautions at the ENT outpatient department (OPD) registration counter, medical consultation with otorhinolaryngologist in OPD or in ER, general precautions in endoscopy room/voice lab, and operation theatre, patient transport, and postoperative care. Results: A total of 8930 patients were seen from 25th March 2020 to 15th September 2020. 7885 patients were seen in ENT outpatient department, 561 in emergency room, and 484 patients were seen as referrals sent from other departments. 297 patients were advised admission for various surgical procedures whereas 22 patients were admitted for conservative management.Conclusions: Through this study, we suggest a paradigm consisting of safety and triage recommendations to be followed while dealing with patients in a way to minimise the cross transmission of virus.

Background: To highlight the changes, challenges, and safety recommendations associated with surgical management of a patient which were practiced effectively at our institute during the pandemic and share our experience.Methods: This retrospective observational descriptive study conducted between 25th March 2020 and 31st October 2020 constitutes of following points covering various aspects of surgical management of patient such as- general precautions followed by otrorhinolaryngologist while doing OPD surgical procedures, while doing endoscopy, in every major operative elective or emergency surgical procedure. This study also mentions focussed considerations for specialised surgical procedures like otology surgeries, endoscopic sinus and skull base surgeries, airway surgeries, tracheostomy, head and neck carcinoma etc. Results: Of the 342 cases operated between 25th March 2020 and 31st October 2020 during this pandemic, 69 nasal surgeries, 83 ear surgeries, 37 throat surgeries, 37 head and neck surgeries, 26 oesophagoscopies, 17 bronchoscopies, 63 tracheostomies, and 10 cases of maxillofacial trauma were performed. 983 patients were taken up for endoscopic examination of the mucosa of the head and neck in OPD as an office-based procedure.Conclusions: Through this study, we suggest a safety and recommendations procedural framework to be followed while managing surgical patients in a way to minimise the cross transmission of virus.

Background: The main objective of the study was to assess the anatomical and functional results of cartilage tympanoplasty using full thickness cartilage graft (with or without perichondrium) reinforced with fascia in high risk situations.Methods: This prospective non-controlled, non-randomized study included 124 cases of chronic otitis media who underwent cartilage (reinforcement) tympanoplasty (underlay) and ossicular reconstruction with or without mastoidectomy in following seven groups: revision cases, atelectatic cases, subtotal perforation (dry), larger anterior perforations (dry), tympanosclerosis, cholesteatomatous ear, and wet (discharging) ears . Graft success was accepted labelled as an intact graft at the end of six month postoperatively. At the same time, hearing results were also assessed by comparing pre- and post-operative pure tone average air-bone gap (PTA-ABG) of each group using Student “t” test and pResults: Anatomical success rate in this series was 94.36%. The overall mean pre- and post- operative pure tone average air-bone gap (PTA-ABG) were 31.33±10.41 dB and 19.55±12.04 dB, respectively and the difference was statistically significant (pConclusions: This study discusses the results of cartilage tympanoplasty in specifically indicated seven situation and reveals good anatomic results in each group (minimum success rate was 86.66% in wet ears) and statistically significant differences in mean pre- and post op PTA-ABG in groups except cholesteatoma and wet ear group.

Background: Tuberculous otitis media (TOM), a rare cause of chronic otitis media, is easily confused with nonspecific chronic otitis media owing to its unexpectedly changing and variable presentation, low suspicion and low prevalence which causes difficulty in its early diagnosis. The purpose of this study was to analyze its changing clinical pattern and to formulate an acceptable management protocol.Methods: This retrospective observational, descriptive study included 457 cases of Chronic otitis media who were operated between January 2017 to July 2020 in a tertiary care center. Histo-pathological examination of tissue from the middle ear and mastoid were sent and positive results were corroborated retrospectively to the clinical findings.Results: Diagnosis of TOM was established post-operatively in five cases (1.09%) with a positive histopathology report in four out of five cases and by polymerase chain reaction (PCR) in one case. Three cases (60%) presented with facial palsy and one with profound hearing loss (20%). All cases received 6 months course of anti-tubercular therapy postoperatively and were in regular follow up.Conclusions: Tuberculosis of the middle ear can present unexpectedly either as a complication or completely as a non-specific chronic otitis media. The extent of pathological findings might not be in commensuration with the clinical features. In operated chronic otitis media cases, specimen for histopathological examination must be sent in all cases and further specific microbiological investigations may as well be advised accordingly.

Zintl compounds are potential candidates for efficient thermoelectric materials, because typically they are small band gap semiconductors. In addition, such compounds allow fine tuning of the carrier concentration by chemical doping for the optimization of thermoelectric performance. Herein, such tunability is demonstrated in Mg3Sb2-based Zintl compounds via Zn(2+) doping at the Mg(2+) site of the anionic framework (Mg2Sb2)(2-), in the series Mg3-xZnxSb2 (0 ≤ x ≤ 0.1). The materials have been successfully synthesized using the spark plasma sintering (SPS) technique. X-ray diffraction (XRD) analysis confirms a single solid solution phase of Mg3-xZnxSb2 (0 ≤ x ≤ 0.1). The thermoelectric properties are characterized by the Seebeck coefficient, electrical conductivity, and thermal conductivity measurements from 323 K to 773 K. Isoelectronic Zn substitution at the Mg site presents the controlled variation in the carrier concentration for optimizing the high power factor and reduced thermal conductivity. These results lead to a substantial increase in ZT of 0.37 at 773 K for a composition with x = 0.10 which is ∼42% higher than undoped Mg3Sb2. The electronic transport data for the Mg3-xZnxSb2 (0 ≤ x ≤ 0.1) compound are analyzed using a single parabolic band model predicting that Mg2.9Zn0.1Sb2 exhibits a near-optimal carrier concentration for high ZT. The electronic structure of transport properties of these disordered Mg3-xZnxSb2 (0 ≤ x ≤ 0.1) is also studied using density functional theory and the results obtained are in good agreement with experimental results. The low cost, lightness and non-toxicity of the constituent elements make these materials ideal for mid-temperature thermoelectric applications.

Aim Palpable masses in the head and neck region can arise from various structures, such as lymph node, thyroid gland, major and minor salivary glands, soft tissues, blood vessels, and neural structures. Fine needle aspiration cytology (FNAC) is a simple, quick, inexpensive first-line method to evaluate such swellings and thus confirm the diagnosis. This study correlates aspiration cytology as an indispensable tool in diagnosing various head and neck swellings and their prevalence with respect to age, sex, site of origin, and nature of those masses. Materials and methods This study was done from January 2007 to December 2013 in the Department of Otorhinolaryngology and Department of Pathology. All the patients presenting with various head and neck swellings underwent FNAC, and the results were correlated with anatomical sites and frequency of occurrence and categorized into various clinicopathological groups. Results This study included 1,272 cases who were evaluated by FNAC for head and neck swellings. In this study, 32 patients presented with frank abscesses, 36 cases with submandibular region swellings, seven cases with submental swellings, 70 cases with various swellings in the neck and postauricular area, 47 cases with various facial and scalp swellings, two cases from oral cavity, 74 cases with parotid masses, 680 cases with lymphadenopathy, and 324 cases with thyroid lesions. Conclusion Fine needle aspiration cytology is a useful, reliable, cost-effective, and valuable diagnostic tool for the initial evaluation and diagnostic categorization of all superficial and deep-seated lesions in the head and neck region as it is a fairly sensitive and specific procedure in addition to being simple, rapid, accurate, and without any significant complications and above all without affecting the underlying tissue morphology altogether How to cite this article Pandey AK, Bhardwaj A, Maithani T, Kishore S, Singh VP. Distributive Analysis of Head and Neck Swellings with Their Cytopathological Correlation. Int J Otorhinolaryngol Clin 2016;8(3):89-96.

Pleomorphic adenomas occurring in the nasal cavity are rarely encountered; nevertheless, there is abundance of minor seromucinous glands in that region. Most cases present with a painless, slowly progressing unilateral nasal obstruction, a nasal mass, and epistaxis. Herewith, we present an unusual case of pleomorphic adenoma arising from the lateral wall of the right nasal cavity in a 41-year-old male who complained of right nasal obstruction with no history of epistaxis. Rigid nasal endoscopy revealed a swelling continuous with right inferior concha. Computed tomography showed a well-defined, soft tissue mass in the right nasal cavity. The lesion was completely excised endoscopically. Histopathology confirmed a pleomorphic adenoma consisting of epithelial and mesenchymal elements. Wide exposure is crucial for complete excision with negative margins to achieve positive outcome and to prevent recurrence. How to cite this article Pandey AK, Bhardwaj A, Maithani T, Rathi S. Pleomorphic Adenoma of the Lateral Nasal Wall: An Unusual Entity. Clin Rhinol An Int J 2016;9(3):146-148.

Background To study the frequency of postoperative complications after thyroid surgery indicated for various benign and malignant lesions and to corroborate the results in relation to the extent of surgery and a clinical overview of evolution of thyroid surgery. Materials and methods An analytical study was carried out at a tertiary care center over a period of 3 years from January 2011 to December 2013. Data were collected from 80 patients who underwent thyroidectomies for various thyroid diseases at this center. Results Hemithyroidectomy, isthmusectomy, subtotal, neartotal, and total thyroidectomies were performed in 36 (45%), 6 (7.5%), 8 (10%), 10 (12.5%), and 20 (25%) cases respectively. The overall postoperative complication rate was 20%. Postoperative hypocalcemia and recurrent laryngeal nerve injury were the most common complications. Permanent hypocalcemia and permanent recurrent laryngeal nerve injury were observed in 3.75 and 2.5% of all operated cases respectively. The less common complications were wound hematoma, seroma formation, and superior laryngeal nerve injury. There was no mortality observed in our series. Conclusion The overall complication rate can be minimized by operating in a bloodless field, doing a meticulous dissection, and correctly identifying and preserving recurrent and superior laryngeal nerves along with parathyroid glands, if feasible. How to cite this article Pandey AK, Maithani T, Agrahari A, Varma A, Bansal C, Bhardwaj A, Singh VP, Rathi S. Postoperative Complications of Thyroid Surgery: A Corroborative Study with an Overview of Evolution of Thyroid Surgery. Int J Head Neck Surg 2015;6(4):149-154.

Kartagener’s syndrome is a rare congenital disorder consisting of sinusitis, bronchiectasis with situs inversus and is associated with infertility. It is the subgroup of disorder called primary ciliary dyskinesia in which well defined morphological or functional abnormalities of cilia result in sinopulmonary involvement with varying severity. Clinical manifestations involve chronic and/or recurrent respiratory infections with much heterogeneity in multisystem involvement. Early diagnosis and management of this condition help to prevent irreversible lung damage and prevent chronic lifelong sequelae.

First branchial cleft anomalies (FBCA) represent a small subset of congenital malformations in neck. Prime objective of this study is to share our experience with FBCA, emphasize its relevance in otolaryngology and deal with its pediatric perspective. Embryology, pathologic anatomy and varied spectra of clinical presentations of FBCA are discussed. Along with this we have illustrated three different cases; all of them were of pediatric age group and were misdiagnosed by their treating specialists elsewhere. In this article we have also laid special emphasis on its pediatric considerations. FBCA are mostly misdiagnosed due to their unfamiliar clinical signs and symptoms. Swellings may masquerade as other neck masses. Majority of patients give a history of previous incision and drainage. While dealing with pediatric patients the important factors to be kept in mind are the age of child, superficial course of facial nerve, any associated agenesis of parotid gland. Alteration in surgical technique may be required in children. A thorough medical examination with high index of clinical suspicion should be kept in mind while dealing with such anomalies. Owing to their complex presentation and close relation with facial nerve they are challenging lesions for surgeons.

Fibroids during pregnancy are often asymptomatic but sometimes may lead to various complications and unusual presentations. We are reporting an unusual case of cervical fibroid during pregnancy that presented as retained placenta with postpartum hemorrhage following a full term normal vaginal delivery.

Angiomyolipoma (AML) is a benign mesenchymal tumor, mostly seen in kidneys and usually in association with tuberous sclerosis. Extrarenal AML is uncommon, but sporadic cases have been reported at other sites. Here, we are presenting a case of extrarenal AML in the right lower extremity of a 70-year-old male with no evidence of tuberous sclerosis.