A 22-year-old female presented with 5 months of nasal blockage and headache. Examination found proptosis of the eyes, swelling of the right cheek, and polyps obstructing the nasal cavity. Imaging showed haziness of the sinuses and obliteration of the nasal cavity. She underwent surgery including polypectomy and Caldwell Luc procedure on the right side to address suspected fungal sinusitis with polyps.
this is a case study on tonsillitis , this details about the diagnosis, management, treatment, patient counselling & pharmacist interventions , regarding medication etc , and also describes in detail about all aspects of tonsillitis .
please comment if you read this
thank u
this is a case study on tonsillitis , this details about the diagnosis, management, treatment, patient counselling & pharmacist interventions , regarding medication etc , and also describes in detail about all aspects of tonsillitis .
please comment if you read this
thank u
Proper Case Presentation for Dengue Fever, Prevention, Treatment and everything else. Prepared by Dr Zain Khan, Doctor at Liaquat College of Medicine and Dentistry
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
Case presentation on bronchial asthma, respiratory disorder, Introduction-Definition-History collection-Physical examination-lab diagnosis- nursing diagnosis of asthma, treatment of asthma
Proper Case Presentation for Dengue Fever, Prevention, Treatment and everything else. Prepared by Dr Zain Khan, Doctor at Liaquat College of Medicine and Dentistry
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
Case presentation on bronchial asthma, respiratory disorder, Introduction-Definition-History collection-Physical examination-lab diagnosis- nursing diagnosis of asthma, treatment of asthma
Get Rid of Your Traditional Acute Pain Service and Broaden Your Vision!Edward R. Mariano, MD
Our biggest challenge (and also opportunity) is to demonstrate our value as anesthesiologists and pain medicine specialists in the evolving healthcare landscape. Going forward, physician anesthesiologists need to take on leadership roles in coordinating patient care, including by not limited to pain medicine, by collaborating with primary care, surgery, nursing, physical therapy, pharmacy, social work, and other hospital-based services.
Prof. Mridul Panditrao's Peri-operative Management of Jehovah's Witness Patient Prof. Mridul Panditrao
A case report of Emergency Peri-operative Mnagement of a Jehovah's Witness patient.
Because of their peculear religious belief, these patients do not accept Blood and It's products. This can pose serious problems to the Anesthesiologist.
Drs. Milam and Thomas's CMC X-Ray Mastery Project: February CasesSean M. Fox
Drs. Claire Milam and Alyssa Thomas are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides on:
• Mycoplasma pneumonia
• Thoracic aortic aneurysm
• Hydropneumothorax
• Sternal fracture
• Foreign body
• Iatrogenic pneumothorax
• Pulmonary contusion
• Type A aortic dissection
• Cardiomegaly
• PCP pneumonia
• Pneumothorax
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. July 27, 2014 2
MaxillaryMaxillary
SinusitisSinusitis
Dr. ZahoorDr. Zahoor
House Surgeon,House Surgeon,
E.N.T DepartmentE.N.T Department
Capital HospitalCapital Hospital
Case Presentation
3. July 27, 2014 3
CASE NO:CASE NO: 11
Acute on Chronic Maxillary SinusitisAcute on Chronic Maxillary Sinusitis
4. July 27, 2014 4
PERSONAL DATAPERSONAL DATA
NameName :: Mehboob HussainMehboob Hussain
F/OF/O :: CDA Employee.CDA Employee.
AgeAge :: 66 Years male66 Years male
BedBed :: OSW 22/2OSW 22/2
D.O.AD.O.A :: 9.6.20039.6.2003
D.O.DD.O.D :: 18.6.200318.6.2003
5. July 27, 2014 5
HISTORYHISTORY
MAIN COMPLAINTS:MAIN COMPLAINTS:
Pain over cheeks and forehead – 1 yearPain over cheeks and forehead – 1 year
HISTORY OF PRESENTINGHISTORY OF PRESENTING
ILLNESS:ILLNESS:
Pain:Pain: According to the patient, he was alright aAccording to the patient, he was alright a
year back when he started developing pain overyear back when he started developing pain over
the cheeks and forehead, which developedthe cheeks and forehead, which developed
gradually and slowly so much so that he startedgradually and slowly so much so that he started
to have severe pain on bowing his head downto have severe pain on bowing his head down
for sajda during prayers. He got some medicalfor sajda during prayers. He got some medical
treatment off and on with little improvement.treatment off and on with little improvement.
Now he has severe pain over the cheeks for lastNow he has severe pain over the cheeks for last
15 days for which he agreed to get admitted at15 days for which he agreed to get admitted at
capital hospital.capital hospital.
6. July 27, 2014 6
PAST HISTORY-PAST HISTORY- Patient has past historyPatient has past history
of maxillary sinus wash but details are notof maxillary sinus wash but details are not
available.available.
FAMILY HISTORY-FAMILY HISTORY- Not significant.Not significant.
PERSONAL HISTORY-PERSONAL HISTORY- Smoker (1Smoker (1
pack per day f or last 20 years)pack per day f or last 20 years) withwith
normal bowel habits.normal bowel habits.
……HISTORYHISTORY
Contd.
7. July 27, 2014 7
DRUG HISTORY-DRUG HISTORY- Had been taking antibiotics forHad been taking antibiotics for
sinusitis off and on. No history of any drug allergy.sinusitis off and on. No history of any drug allergy.
SOCIOECONOMIC HISTORY-SOCIOECONOMIC HISTORY- Belongs to lowerBelongs to lower
middle class.middle class.
……HISTORYHISTORY
8. July 27, 2014 8
GENERAL PHYSICALGENERAL PHYSICAL
EXAMINATIONEXAMINATION
A old man sitting anxiously in bed, well orientedA old man sitting anxiously in bed, well oriented
to time, place and person.to time, place and person.
AnaemiaAnaemia
JaundiceJaundice
ClubbingClubbing AbsentAbsent
CyanosisCyanosis
Palpable NodesPalpable Nodes
Contd.
9. July 27, 2014 9
Temp:Temp: AfebrileAfebrile
Pulse:Pulse: 80 beats per min. Regular,80 beats per min. Regular,
BP:BP: 140/90 mm Hg.140/90 mm Hg.
……GENERAL PHYSICALGENERAL PHYSICAL
EXAMINATIONEXAMINATION
10. July 27, 2014 10
SYSTEMICSYSTEMIC
EXAMINATIONEXAMINATION
Resp. System:Resp. System:
CVS:CVS: NADNAD
CNS:CNS:
GIT:GIT:..
11. July 27, 2014 11
E.N.T EXAMINATIONE.N.T EXAMINATION
NASAL EXAMINATIONNASAL EXAMINATION
Inspection:Inspection:
Anterior Rhinoscopy: Swollen inferior Turbinates with some mucopusAnterior Rhinoscopy: Swollen inferior Turbinates with some mucopus
along the nasal floor.along the nasal floor.
Posterior Rhinoscopy: NADPosterior Rhinoscopy: NAD
PalpationPalpation: Tenderness over cheeks: Tenderness over cheeks
EXAMINATION OF THROATEXAMINATION OF THROAT
Poor oral hygienePoor oral hygiene
GingivitisGingivitis
12. July 27, 2014 12
EXAMINATION OF EARSEXAMINATION OF EARS
Inspection:Inspection: Surrounding area, pinnae, EAM, EAC,Surrounding area, pinnae, EAM, EAC,
T.M normal.T.M normal.
Palpation:Palpation: NADNAD
Hearing Test:Hearing Test: Hears forced wisper at ear levelHears forced wisper at ear level
Tunning Fork Tests:Tunning Fork Tests:
Rinne’sRinne’s :: Positive on both sidesPositive on both sides
WeberWeber :: CentralCentral
ABCABC :: Reduced by 5 seconds both sides.Reduced by 5 seconds both sides.
Contd.
……E.N.T EXAMINATIONE.N.T EXAMINATION
13. July 27, 2014 13
PROVISIONAL DIAGNOSISPROVISIONAL DIAGNOSIS
Acute on Chronic Maxillary SinusitisAcute on Chronic Maxillary Sinusitis
With Gingivitis & Mild SNHLWith Gingivitis & Mild SNHL
14. July 27, 2014 14
INVESTIGATIONSINVESTIGATIONS
CP:CP: Within normal limits.Within normal limits.
ESR:ESR: 05 mm within 1st hr.05 mm within 1st hr.
Renal Profile:Renal Profile: Within Normal LimitsWithin Normal Limits
Blood Sugar (Random):Blood Sugar (Random): 90 mg/dl90 mg/dl
Contd.
15. July 27, 2014 15
……INVESTIGATIONSINVESTIGATIONS
X-Ray PNS (OMX-Ray PNS (OM
View):View):
Rt. Max. Sinus is Hazy, Lt.Rt. Max. Sinus is Hazy, Lt.
hazy but less compared to Rt.hazy but less compared to Rt.
Both Middle and inf. turbinatesBoth Middle and inf. turbinates
Swollen with obliteration ofSwollen with obliteration of
both nasal spaces.both nasal spaces.
X-Ray chest :X-Ray chest :
NormalNormal..
Contd.
16. July 27, 2014 16
TREATMENTTREATMENT
MEDICAL TREAMENTMEDICAL TREAMENT
Inj. Ampicillin 500 mg I/V TDSInj. Ampicillin 500 mg I/V TDS
Xynosine nasal spray tdsXynosine nasal spray tds
Steam inhalations tds.Steam inhalations tds.
Tab. Flagyl 400mg tds.Tab. Flagyl 400mg tds.
Gargalene dil. mouth wash.Gargalene dil. mouth wash.
Drugs Advised by Medical Department.Drugs Advised by Medical Department.
Tab. Lexillium 3 mg 1 x HSTab. Lexillium 3 mg 1 x HS
Tab. Capace 25 ½ X BDTab. Capace 25 ½ X BD
17. July 27, 2014 17
Patient was much relieved of his symptomsPatient was much relieved of his symptoms
at the time of discharge and a check X-Rayat the time of discharge and a check X-Ray
revealed improvementrevealed improvement
RESULTS & FOLLOW UPRESULTS & FOLLOW UP
19. July 27, 2014 19
Fungal Sinusitis with PolypiFungal Sinusitis with Polypi
20. July 27, 2014 20
PERSONAL DATAPERSONAL DATA
NameName :: DoniaDonia
D/OD/O :: Muhammad Farid - CDA Employee.Muhammad Farid - CDA Employee.
AgeAge :: 22 Years, Female22 Years, Female
BedBed :: F.10, E.N.T Dept. Capital HospitalF.10, E.N.T Dept. Capital Hospital
D.O.AD.O.A :: 05.05.200305.05.2003
D.O.DD.O.D :: 30.05.200330.05.2003
21. July 27, 2014 21
HISTORYHISTORY
MAIN COMPLAINTS:MAIN COMPLAINTS:
Nasal BlockageNasal Blockage -- 5 months5 months
HeadacheHeadache -- 5 months5 months
HISTORY OF PRESENTING ILLNESS:HISTORY OF PRESENTING ILLNESS:
Nasal Obstruction:Nasal Obstruction: According to the patient she was alrightAccording to the patient she was alright
5 months back when she slowly developed difficulty5 months back when she slowly developed difficulty
breathing through nose, so much so that now she canbreathing through nose, so much so that now she can
hardly breath and has to keep her mouth open duringhardly breath and has to keep her mouth open during
night. She said that this nasal obstruction is also associatednight. She said that this nasal obstruction is also associated
with some facial disfiguration especially prominence ofwith some facial disfiguration especially prominence of
eye balls.eye balls.
Headache:Headache: Nasal obstruction was also accompanied byNasal obstruction was also accompanied by
headache on the forehead, which is mild in intensity.headache on the forehead, which is mild in intensity.
22. July 27, 2014 22
PAST HISTORY-PAST HISTORY-
FAMILY HISTORY-FAMILY HISTORY-
PERSONAL HISTORY-PERSONAL HISTORY-
……HISTORYHISTORY
Contd.
Nothing significantNothing significant..
23. July 27, 2014 23
DRUG HISTORY-DRUG HISTORY- Had been taking antibiotics and otherHad been taking antibiotics and other
drugs as prescribed by different G.P’s. No history of any drugdrugs as prescribed by different G.P’s. No history of any drug
allergy.allergy.
SOCIOECONOMIC HISTORY-SOCIOECONOMIC HISTORY- Belongs to lowerBelongs to lower
middle class.middle class.
……HISTORYHISTORY
24. July 27, 2014 24
GENERAL PHYSICALGENERAL PHYSICAL
EXAMINATIONEXAMINATION
A young girl sitting anxiously in bed, with proptosed eyesA young girl sitting anxiously in bed, with proptosed eyes
and well oriented to time, place and person.and well oriented to time, place and person.
AnaemiaAnaemia
JaundiceJaundice
ClubbingClubbing AbsentAbsent
CyanosisCyanosis
Palpable NodesPalpable Nodes
Contd.
25. July 27, 2014 25
Temp:Temp: AfebrileAfebrile
Pulse:Pulse: 86 beats per min. Regular,86 beats per min. Regular,
BP:1BP:1 130/70 mm Hg.130/70 mm Hg.
……GENERAL PHYSICALGENERAL PHYSICAL
EXAMINATIONEXAMINATION
26. July 27, 2014 26
SYSTEMICSYSTEMIC
EXAMINATIONEXAMINATION
Resp. System:Resp. System:
CVS:CVS: N0RMALN0RMAL
CNS:CNS:
GIT:GIT:..
27. July 27, 2014 27
E.N.T EXAMINATIONE.N.T EXAMINATION
NASALNASAL
EXAMINATIONEXAMINATION
Inspection:Inspection:
Proptosis more on right side.Proptosis more on right side.
TelecanthusTelecanthus
Swelling over the right cheekSwelling over the right cheek
Anterior Rhinoscopy: BilateralAnterior Rhinoscopy: Bilateral
polypoidal mass with somepolypoidal mass with some
cheesy material & mucopus.cheesy material & mucopus.
PalpationPalpation: Firm swelling over: Firm swelling over
right cheek which was tender.right cheek which was tender.
28. July 27, 2014 28
EXAMINATION OF THROATEXAMINATION OF THROAT
NADNAD
EXAMINATION OF EARSEXAMINATION OF EARS
NADNAD
Contd.
……E.N.T EXAMINATIONE.N.T EXAMINATION
29. July 27, 2014 29
C.N I - XIIC.N I - XII Intact.Intact.
EXAMINATION OF CRANIALEXAMINATION OF CRANIAL
NERVESNERVES
30. July 27, 2014 30
INVESTIGATIONSINVESTIGATIONS
CP:CP:
TLC:TLC: 9.0 Thsd/Cu mm9.0 Thsd/Cu mm
DLC:DLC: N-69%N-69%
L-29%L-29%
M-01%M-01%
E-01%E-01%
ESR:ESR: 38 mm within 1st hr.38 mm within 1st hr.
B.T:B.T: 2 min 30 sec.2 min 30 sec.
C.T:C.T: 5 min 50 sec.5 min 50 sec.
Renal Profile:Renal Profile:
Urea: 29 mg/dlUrea: 29 mg/dl
Creatinine: 0.8 mg/dlCreatinine: 0.8 mg/dl
LFT’s:LFT’s: NormalNormal Contd.
31. July 27, 2014 31
……INVESTIGATIONSINVESTIGATIONS
X-Ray PNS (OMX-Ray PNS (OM
View):View):
Hazy maxillary and ethmoidHazy maxillary and ethmoid
sinusessinuses
Also nasal cavity appearsAlso nasal cavity appears
obliterated.obliterated.
X-Ray chest :X-Ray chest :
NormalNormal..
Contd.
32. July 27, 2014 32
……INVESTIGATIONSINVESTIGATIONS
C-T Scan (Nose andC-T Scan (Nose and
PNS)PNS)
Obliteration of the nasal cavity, Rt.Obliteration of the nasal cavity, Rt.
Maxillary sinus, ethmoids with littleMaxillary sinus, ethmoids with little
extension into anterior cranial fossa.extension into anterior cranial fossa.
Lt. maxillary sinus is minimallyLt. maxillary sinus is minimally
affected.Destruction of Rt. Medialaffected.Destruction of Rt. Medial
orbital wall is also noted with littleorbital wall is also noted with little
extension into orbit.extension into orbit.
Likely lesion could be NasalLikely lesion could be Nasal
polyposis, fungus. Howeverpolyposis, fungus. However
malignancy cannot be excluded.malignancy cannot be excluded.
Contd.
Coronal Views
34. July 27, 2014 34
PROVISIONAL DIAGNOSISPROVISIONAL DIAGNOSIS
Fungal Sinusistis with polypiFungal Sinusistis with polypi
35. July 27, 2014 35
SURGICAL TREATMENTSURGICAL TREATMENT
After thorough preoperative preparation on 17.5.2003After thorough preoperative preparation on 17.5.2003
at 10.00 a.m following surgical procedure wasat 10.00 a.m following surgical procedure was
performed under general G/A with oro-trachialperformed under general G/A with oro-trachial
intubation through oral cavity and throat packing.intubation through oral cavity and throat packing.
1.1. Bilateral polypectomyBilateral polypectomy
2.2. Cald well Luc’s operation on right side includingCald well Luc’s operation on right side including
transantral ethmoidectomy and antrostomy.transantral ethmoidectomy and antrostomy.
3.3. Left sided transnasal ethmoidectomy.Left sided transnasal ethmoidectomy.
BIPP & clotrim imprenated packing done in antrumBIPP & clotrim imprenated packing done in antrum
and nasal cavity.and nasal cavity.
TREATMENTTREATMENT
38. July 27, 2014 38
FOLLOW UPFOLLOW UP
Nasal pack removed on 2nd
post
operative day.
Antral pack (BIPP) removed
over 1 week.
Follow up on 15th
post operative
day showed normal nasal patency
and markedly reduced disfiguration
Monthly followup till Dec. was
satisfactory, however was advised
to repeat scan.