1. The document discusses several disorders of the nasal cavity including foreign bodies, rhinoliths, nasal myiasis, nasal synaechia, choanal atresia, and CSF rhinorrhoea.
2. Foreign bodies are commonly seen in children and can be organic or inorganic materials that enter the nose. Rhinoliths form around a nucleus like a blood clot and grow large within the nasal cavity.
3. Nasal myiasis involves maggot infestation in the nose from fly eggs, which can cause extensive tissue destruction if untreated.
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Inflammation of the mucosa of sinuses associated with inflammation of the nasal mucosa is called rhinosinusitis (RS).
CLASSIFICATION:
• Acute RS: Symptoms lasting for less than 4 weeks with complete resolution.
• Subacute RS: Duration 4-12 weeks.
• Chronic RS: Duration ~ 12 weeks.
• Recurrent RS: Four or more episodes of RS per year; each lasting for 7-10 days or more with complete resolution in between the episodes.
• Nasal obstruction.
• Nasal discharge/congestion, anterior, or posterior in the form of postnasal drip.
• Facial pain or pressure.
• Alteration in the sense of smell, hyposmia or anosmia.
• Other symptoms include cough, fever, halitosis, fatigue, dental pain, pharyngitis, headache or ear fullness.
Tooth extraction is a common practice for the oral surgeons. As a post extraction complication, formation of a communication between oral cavity & maxillary sinus through the socket of alveolar bone during extraction of maxillary premolars & molars, which is known as oroantral fistula is also a common phenomenon. If it can’t be early diagnosed & treated, chronic sinusitis of maxillary sinus may occur which is a very painful condition of cranium.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. FOREIGN BODIES :
Aetiolgy :
• Mostly seen in children
• Organic or inorganic
• Pieces of paper, chalk, button, pebbles and seeds.
• Pledgets of cotton or swabs may be accidentally left in the nose.
Clinical features :
• May present immediately if the history of foreign body is known.
• If a child presents with unilateral, foul-smelling nasal discharge,
foreign body must be excluded.
• Occasionally, a radiograph of the nose to confirm and localise a
foreign body if it is radio-opaque.
3. Treatment :
• Pieces of paper or cotton swabs can be easily removed with a pair
of forceps.
• Rounded foreign bodies can be removed by passing a blunt hook
past the foreign body and gently dragging it forward along the
floor.
• In babies and uncooperative children, general anaesthesia with
cuffed endotracheal tube is used. Patient is placed in Rose’s
position, a pack is inserted into the nasopharynx and the foreign
body retrieved with a forceps or a hook.
Complications : A foreign body left in the nose may result in :
i) Nasal infection and sinusitis
ii) Rhinolith formation
iii) Inhalation into, the tracheobronchial tree
4. RHINOLITH :
Aetiology :
• Stone formation in the nasal cavity.
• A rhinolith usually forms around the nucleus of a small
exogenous foreign body, blood clot or inspissated secretion by
slow deposition of calcium and magnesium salts.
• It grows into a large irregular mass.
• May cause pressure necrosis of the septum and/or lateral wall of
nose.
5. Clinical features :
• More common in adults
• Unilateral nasal obstruction and foul-smelling discharge, blood-
stained.
• Frank epistaxis and neuralgic pain from ulceration of the
surrounding mucosa.
On examination
• A grey brown or greenish black mass with irregular surface and
stony hard feel in the nasal cavity.
Treatment :
• Removed under general anaesthesia.
• Some particularly hard and irregular ones, require lateral
rhinotomy.
6. NASAL MYIASIS (MAGGOTS IN NOSE) :
• Maggots are larval forms of flies.
• Infest nose, nasopharynx and paranasal sinuses causing
extensive destruction.
• Flies, of the genus chrysomia, attracted by the foul smelling
discharge emanating from cases of atrophic rhinitis, syphilis,
leprosy or infected wounds and lay eggs.
• Within 24 hours hatch into larvae.
Clinical features :
• First 3 or 4 days maggots produce intense irritation, sneezing
lacrimation and headache.
• Thin blood-stained discharge.
• Eyelids and lips become puffy.
7.
8. • On the 3rd or 4th day maggots crawl out of the nose. Patient has
foul smell surrounding him.
• Cause extensive destruction to nose, sinuses, soft tissue of face,
palate and the eyeball.
• Death from meningitis.
Treatment :
• Visible maggots should be picked up with forceps.
• Instillation of chloroform water.
• A patient with maggots should be isolated with a mosquito net to
avoid contact with files.
• Instruction for nasal hygiene.
9. NASAL SYNAECHIA :
• Adhesion formation between the nasal septum and turbinates.
• Result of injury to opposing surfaces of nasal mucosa.
• Result from intranasal operations such as septal surgery,
polypectomy, removal of foreign bodies, reduction of nasal
fractures or even intra-nasal packing.
• Severe infections which cause ulcerative lesions in the nose.
• Nasal synaechia cause nasal obstruction.
• Impede drainage from the sinuses resulting in sinusitis, headache
and nasal discharge.
Treatment :
• Removal of synaechia and prevention of the opposing raw surfaces
to come into contact with each other by placing a thin silastic or a
cellophane sheet between them.
10. CHOANAL ATRESIA :
• Due to persistence of bucconasal membrane.
• Unilateral or bilateral
• Complete or incomplete.
• Bony (90%) or membranous (10%).
• Unilateral atresia more common may remain undiagnosed
until adult life.
• Bilateral atresia presents with respiratory obstruction at
birth.
12. Diagnosis :
• Mucoid discharge in the nose.
• Absence of air bubbles in the nasal discharge.
• Failure to pass a catheter from nose to pharynx.
• Putting a few drops of a dye (methylene-blue) into the nose and
seeing its passage into the pharynx.
• Installing radio-opaque dye into the nose and taking a lateral
film.
• A feeding nipple with a large hole provides a good oral airway
(McGovern’s technique).
• Definitive treatment: correction of atresia by transnasal or
13. CSF RHINORRHOEA :
Aetiology :
i) Traumatic : Head injuries, surgery of frontal, ethmoid or
sphenoid sinus or hypophysectomy. Complication of endoscopic
sinus surgery.
ii) Tumours : Tumours of the pituitary or the olfactory bulb.
iii)Congenital defects in skull.
iv) Spontaneous type.
Sites of leakage :
• CSF from anterior cranial fossa reaches the nose by way of
cribriform plate, ethmoid air cells or frontal sinus.
• CSF from middle cranial fossa reaches the nose via sphenoid
sinus.
14. Diagnosis :
• Dribbling of clear fluid from the nose on bending or straining.
• Discharge is clear and watery, appears suddenly in a gush of
drops when bending forward or straining, is uncontrollable and
cannot be sniffed back.
• No associated sneezing, nasal congestion or lacrimation.
• CSF contains glucose which can be demonstrated by oxidase-
peroxidase paper strip or bicohemical tests.
∀ β2 transferrin is specific for CSF.
15. Differences between CSF and nasal secretions
CSF fluid Nasal secretion
History Nasal or sinus surgery, Sneezing, nasal stuffiness,
head injury or itching in the nose or
intracranial tumour lacrimation.
Flow of A few drops or a stream Continuous, No effect of
discharge of fluid gushes drown bending forward or
when bending forward or straining. Can be sniffed
straining; cannot be back.
sniffed back.
Character of Thin, watery and clear Slimy (mucus) or clear
discharge (fears)
Sugar content More than 30 mg/dl Less than 10 mg/dl
Presence of Always present. It is Always absent
β2 transferrin specific for CSF
16. Localisation of CSF leak :
• Intrathecal injection of a dye (fluorescein 5%, 1 ml) or a
radioisotope and placing pledgets of cotton in the olfactory slit,
middle meatus, sphenoethmoidal recess and near the eustachian
tube and examining the pledgets for dye or radioactivity.
Olfactory slit Cribriform plate
Middle meatus Frontal or ethmoid sinuses
Sphenoethmoidal recess Sphenoid sinus
Inferior meatus near the Temporal bone
eustachian tube
• Site of leak can be determined by high resolution, thin section
coronal cuts with bone window.
17. • CT cisternogram : in this procedure, CT scan is combined with
injection of a contrast material into intrathecal space via cisterna
magna.
• MRI with T2-weighted images or MRI cisternography is more
useful.
• In traumatic CSF leak, when CSF and blood are mixed, double ring
sign (or target sign): In this sign, discharge collected on a piece of
filterpaper shows a central spot of blood while CSF spreads out
like a halo around it.
Treatment :
• Placing the patient in the semi-sitting position, avoiding blowing
of nose, sneezing and straining. Prophylactic antibiotics.
• Persistent cases of CSF rhinorrhoea are treated surgically by nasal
endoscopic or intracranial appraoch.