Terminal branching of internal laryngeal nerve: a cadaveric study

Background: Innervation of larynx is much more complicated than previously been thought. Laryngopharynx is the common gateway for many specialists like oral surgeons, ENT surgeons, anaesthetists, UGI endoscopists and bronchoscopists. The sub-mucosal neural network can be anaesthetised by topical application or injection of local anaesthetics. In this study destination of the internal laryngeal nerve and its penetration into the intrinsic muscles of larynx are analysed.Methods: A total of 40 en bloc cadaveric specimens were investigated in the department of anatomy, Madras Medical College, Chennai and from Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Kanchipuram. Conventional anatomy dissection method was used in the identification of internal laryngeal branch of superior laryngeal nerve and its branches.Results: Irrespective of the number of divisions at the point of entry into thyrohyoid membrane, 4 branches were constantly traceable. The branches were traced by 2 approaches- (A) those supplying the mucus membrane- (i) to the junction of aryepiglottic fold and lateral border of epiglottis; (ii) to the posterior surface of interarytenoideus; (iii) to the posterior surface of posterior arytenoideus; and (iv) descending to apex of the pyriform fossa behind cricothyroid junction; (B) penetration into intrinsic muscles- (i) a branch terminated after entering interaryteoideus; and (ii) another terminated after entering the posterior cricoarytenoideus muscle.Conclusions: The knowledge of variation into branches and area of supply of internal laryngeal nerve is essential for anatomists and clinicians. It is not a nerve to be neglected as the knowledge of its branches is very much essential for the surgeons operating in this area of air and food passage.

COMPARISON OF HUMANPAPILLOMAVIRUS MESSANGER(E6)RNA EXPRESSION AND DNA AS BIOMARKER IN SCREENING OF VIAVILI POSITIVE CASES IN TERTIARY CARE

Cervical cancer is second most frequent cancer of women in the world. HPV infection is now a well established cause of cervical cancer . Currently used screening programmes are detecting cases in which only 15-20 percent of women found to have an abnormality signicant enough to need treatment, other 80-85 percent were probably false alarms. The oncogenic process in cervical cancer is initiated and mediated by upregulation of E6/E7 mRNA proteins and their over expression. So HPV E6 mRNA detection as a triage test could actually detect a neoplastic transformation and may help to reduce the false alarms. To compare the expression of HPV E6 mRN AIMS AND OBJECTIVES : A verses the HPV DNA as a biomarker in the screening of cervical cancer .Biopsy is used as gold standard for screening. This a prospective MATERIALSAND METHODS: study conducted in Institute of Social Obstetrics and Govt. Kasturba Gandhi hospital, Madras medical college, 41 cases positive for VIA/VILI in colposcopy were selected and subjected to conventional cytology and cervical biopsy ,part of biopsy was collected in RNA later solution and were typed for HPV DNA 16& 18,HPV E6mRNA Expression.the results of above test are compared with histopathology as gold standard. RESULTS: The specicity of E6 mRNA was 100% for both high grade and low grade lesions.But the sensitivity was less than HPV DNA and cytology for both low and high grade lesions.With increasing severity of lesion expression of E6 mRNA was found to increase. Low positivity CONCLUSION: rate and the high specicity makes E6 mRNA better biomarker in a screening of cervical cancer.

ROLE OF STRESS ECHOCARDIOGRAPHY IN THE FUNCTIONAL ASSESSEMENT OF PROSTHETIC MITRAL VALVE

Objective: To assess the resting echo profile of patients with prosthetic mitral valve and monitor the function of the prosthetic valves by doing stress echocardiography by treadmill exercise and dobutamine infusion. Methods: An open-labeled prospective randomized comparative study was conducted in 30 patients at Madras Medical College and Hospital, Chennai- 600 003, Tamil Nadu. Patients, who have been done mitral valve replacement, were selected randomly to undergo the stress echocardiography. 14 male and 16 female patients were included and evaluated on the basis of Echocardiographic examination, Exercise studies, Dobutamine stress echocardiography & Estimation of LV outflow. Results: Upon comparison, the patient's heart rate were increased from rest to exercise by a mean of 24 ±12.5 beats per minute. The paired t-test showed a significant correlation with an increase in the dobutamine group (P <0.001). With respect to peak gradients, it was increased between the two stress protocols was statistically significant (P <0.001). The mean gradient obtained at rest and with exercise and dobutamine stress also showed a similar pattern of increase as seen in the peak gradient. Moreover, the net difference in the Pulmonary artery pressure achieved with both stress protocols was 5.563±4.6mmHg more in the exercise protocol which was statistically significant (P <0.001). Conclusion: The study reveals Dobutamine produces a greater augmentation in the effective mitral orifice area when compared to exercise. Similarly, the exercise protocol produces a much higher increase in the pressure gradients when compared with dobutamine.

OUR INSTIUTIONAL EXPERIENCE IN VISCERAL ARTERY ANEURYSMS

Objectives: To evaluate the incidence, management, and outcome of visceral artery aneurysms (VAA) over the 5. years in our institution, a tertiary care centre, Madras Medical College. Methods 14 patients with 19 VAA were analysed according to location, diameter, aneurysm type, aetiology, rupture, management, and outcome. Results: VAA were localised at the splenic artery, coeliac trunk, renal artery, hepatic artery, superior mesenteric artery, and other locations. The aetiology was mostly degenerative, connective tissue disease. The rate of rupture was higher in pseudo-aneurysms than true aneurysms (66% vs 5%). 18 VAA were treated by intervention {coil embolisation} (n=3) or surgery (n=9) or hybrid [n=1] and one patient was managed conservatively. Three cases with ruptured VAA were treated on an emergency basis. The largest aneurysm was about 16cm and smallest one was about 1mm . After interventional treatment, the 30-day mortality was 21.4 % in ruptured VAA compared to no mortality in non-ruptured cases. Follow-up included USG and/or CT after a mean period of 7 months. The current status of the patient was obtained by a structured telephone survey. Conclusions: There is increase incidence of Celiac and SMA aneurysms. Aneurysm size seems to be a reliable predictor for rupture. Young patient need vasculitic workup for further management.

Prevalence of Physical comorbidities among Long-Term Psychiatric Inpatients: A Single Centre Study from South India

Background: Physical comorbidities are the most common causes of early mortality among patients with mental disorders. Prevention and early treatment of physical comorbidities would lead to better outcomes. Hence, the aim to the study was to estimate the prevalence of physical health disorders present as comorbidities among long-term stay psychiatric inpatients and to compare the difference in the physical comorbidities among male and female patients. Materials and Methods: The study was conducted at Institute of Mental Health, Madras Medical College, Chennai. It was a descriptive study combining data from clinical files and nursing records related to the physical health of the long-term inpatients. The clinical records of long-term inpatients, defined as the duration of stay in the care facility for more than 5 continuous years between 1stJanuary and 30thJune, 2019 were assessed. Results: The estimated prevalence was74.2% (95% CI: 69.5-78.6) for at least one physical disorder comorbidity and 38.8% (95% CI: 33.8-43.9) had more than one physical comorbidities. Female in-patients have 2.7 times higher risk than males to have diabetes mellitus, hypertension and thyroid disorders. They also have 0.92 times higher risk than males to have anaemia. Conclusion: There is a high prevalence of physical comorbidities among long term psychiatric inpatients. Systems for the early detection and better clinical management of these physical comorbidities are essential in any long-term psychiatric facility.

Prevalence of Physical comorbidities among Long-Term Psychiatric Inpatients: A Single Centre Study from South India

Background: Physical comorbidities are the most common causes of early mortality among patients with mental disorders. Prevention and early treatment of physical comorbidities would lead to better outcomes. Hence, the aim to the study was to estimate the prevalence of physical health disorders present as comorbidities among long-term stay psychiatric inpatients and to compare the difference in the physical comorbidities among male and female patients. Materials and Methods: The study was conducted at Institute of Mental Health, Madras Medical College, Chennai. It was a descriptive study combining data from clinical files and nursing records related to the physical health of the long-term inpatients. The clinical records of long-term inpatients, defined as the duration of stay in the care facility for more than 5 continuous years between 1stJanuary and 30thJune, 2019 were assessed. Results: The estimated prevalence was74.2% (95% CI: 69.5-78.6) for at least one physical disorder comorbidity and 38.8% (95% CI: 33.8-43.9) had more than one physical comorbidities. Female in-patients have 2.7 times higher risk than males to have diabetes mellitus, hypertension and thyroid disorders. They also have 0.92 times higher risk than males to have anaemia. Conclusion: There is a high prevalence of physical comorbidities among long term psychiatric inpatients. Systems for the early detection and better clinical management of these physical comorbidities are essential in any long-term psychiatric facility.

Clinico-epidemiological study of mask induced acne due to increased mask use among health care workers during COVID pandemic in a tertiary care institute

<p><strong>Background:</strong> Acne vulgaris is a self-limiting, multifactorial disorder affecting the sebaceous glands and pilosebaceous follicles. Regular wearing of mask during this COVID-19 pandemic has resulted in increased incidence of acne flare. The objective is to study the incidence and the clinic-epidemiological factors associated with mask induced acne.</p><p><strong>Methods:</strong> This is a cross sectional web-based survey conducted at Madras medical college and Rajiv Gandhi government general hospital during August 2020. The clinic-epidemiological details were collected from the 215 post-graduates of Madras medical college and Rajiv Gandhi government general hospital in a pre-set questionnaire.</p><p><strong>Results:</strong> Among 215 study participants, 134 (62.3%) reported mask induced acne. Female gender has a statistically significant association. Itching was the most common complaint. Cheeks, chin and bridge of the nose were the common site of lesions. Comedone and papules were the common presenting lesions. Premenstrual flare and psychological stress had a statistically significant association.</p><p dir="ltr"><strong>Conclusion:</strong> Mask induced acne has various factors like micro-climate theory, hydration of keratin, mechanical occlusion of pilosebaceous unit pores, seborrhoea, ambient high humidity due to sweating involved in its pathogenesis. Although wearing a mask is extremely important to our fight against COVID-19, the general public should be aware of proper and rational mask wearing.</p>

ROLE OF SURFACE BRACHYTHERAPY IN PREVENTING RECURRENCE IN RECURRENT EAR KELOID AFTER EXCISION-SINGLE INSTITUTION PROSPECTIVE STUDY

Background Adjuvant radiation therapy is a recognised option for the treatment of keloid scars. It was first described by Sequeira in 19091 and is currently considered the most efficacious modality according to the international advisory panel on scar management. The reported therapeutic response rates are generally in the range of 67–98%. Following surgical excision of a scar, active blood borne repopulation of fibroblasts occurs; postoperative radiation treatment is thought to prevent recurrence by inducing fibroblastic apoptosis as well as imparting toxicity to endothelial cells. Aim of the study. 1. To confirm post-operative HDR brachytherapy reduce the recurrence in recurrent keloid. Materials and Methods All recurrent ear keloids operated at department of plastic surgery, madras medical college were included in the study and brachycatheter inserted during excision and HDR radiotherapy was given early postoperative period. The further fractions are given such that there is 6 hr gap between two fractions. The treatment is given as 3 gy in 4#, 4 gy in 3#,6 gy in 2 #,12gy in 1#. Total dose was 12 gy. Period of study :3 years (2017-2020), conducted in MMC, Chennai. Primary end point was recurrence. All cases were analysed using standard statistical methods. Results Total no cases included were 15. Recurrence found in 1 cases(6%). Recurrence rate was significantly reduced following post excision HDR brachytherapy(P=0.0002). Complications encountered are wound dehiscence, hyper/hypopigmentation and thinning of cartilage. Conclusion. Hereby concluded that recurrence in ear keloids after recurrent ear keloid excision was potentially prevented by HDR surface brachytherapy. It can be useful in other locations for preventing recurrence.

CLINICOPATHOLOGICAL STUDY OF PAPILLARY CARCINOMA THYROID IN TERTIARY CARE CENTRE- THREE YEAR STUDY.

INTRODUCTION: Papillary carcinoma thyroid (PTC) is the predominant form of thyroid cancer in both adults and children [1]. The incidence of thyroid cancer is increasing [2]. Incidence of PTC is 3 times more common in female than male, but this disparity decreases with increasing patient age [1]. AIM: To analyse the clinicopathological profile of PTC in Madras Medical College located in Chennai, TamilNadu, India. MATERIALS AND METHODS: Data on age, sex, size, histological subtype, centricity of the tumor, nodal metastasis, extra thyroidal extension and associated non malignant condition of all cases of PTC diagnosed in Madras Medical College, Chennai from January 2016 to December 2018 were obtained clinicopathological documents. Histopathological slides were analysed and Immunohistochemistry was done to differentiate PTC from other non malignant lesion. The cases were divided into four catagories based on age and sex. RESULT: Totally 189 thyroid malignancies were reported of which 161 were PTC (85%). Female: male ratio was 3.5: 1. This disparity decreases after 50 years of age. In males above 50years of age had nodal metastasis (47%) and extra thyroidal extension (47%) which was high when compared with other groups. Extrathyroidal extension (50%) was found to be more frequent in cases with tumor size more than >4cm. CONCLUSION: Papillary thyroid carcinoma was common in female. Extra thyroidal extension (P =0.014996), nodal metastasis (P =0.030258) was most common in elderly male (> 50 years).