A Review on Deviated Nasal Septum: Classification, Clinical Features and Management

The nasal septum separates the right and left part of the nasal cavity and columellar septum, membranous septum and septum proper are the parts of it. Deviation of nasal septum is a common case of nasal obstruction presented in a clinic. A lot of classifications have been developed to help ease the study of deviated nasal septum but none of them is used as a standard. Some of the classifications include the one given by Vidigal, Guyuron, Cerek, Mladina and Cottle’s. Apart from nasal obstruction other common clinical features involving deviated nasal septum are sinusitis especially in horizontal deviation type V. Pressure on lateral wall by spurs can also cause pressure headache. Due to increased air flow in the nasal cavity, dryness occurs causing epistaxis. Obstruction of nasal cavity causes mouth breathing in return either exaggerating or leading to obstructive sleep apnoea. Septal deviation also effects the choroidal thickness and choroidal blood supply. Histopathologically, lymphocytic infiltration and squamous metaplasia occurs in septal mucosa. These changes occur mostly due to change in the aerodynamic flow. There is decreased cilia movement and inferior turbinate hypertrophy. Thickness of inferior turbinate gains importance while septoplasty as, if thickened a lot, the inferior turbinate demands excision. The deviated nasal septum is associated with sinusitis, chronic suppurative otitis media and Eustachian tube dysfunction. Management involves sub mucus resection or septoplasty. Out of the two, septoplasty is preferred as it is a conservative surgery. Only symptomatic and cosmetically grossly disfigured cases require a surgical treatment while the asymptomatic cases are generally not indicated for surgery. This study tries to review the Classification, Clinical Features and Management of Deviated Nasal Septum.

Neurological manifestation of Vitamin D deficiency

Idiopathic intracranial hypertension, also known as pseudotumor cerebri, is a disorder with raised intracranial pressure, headache, papilledema, visual disturbances with a normal cerebrospinal fluid examination, and normal neuroimaging. It is rare in the pediatric population and may occur as a manifestation of underlying disorders. Vitamin D deficiency is a common deficiency in the pediatric age group. However, neurological manifestations are rare. Here, we present the case of a 5-year-old male child who presented with headache, vomiting, and hypertension; however, the neurological examination was normal but the neuroimaging was suggestive of pseudotumor cerebri. Appropriate investigations were done. The most likely cause of pseudotumor cerebri in this patient was the deficiency of Vitamin D. We have reported this case as pseudotumor cerebri is a rare neurological manifestation of Vitamin D deficiency.

New onset headache caused by histiocytic sarcoma of the spinal cord and leptomeninges: a case report

BackgroundHeadache due to raised intracranial pressure is rarely caused by spinal lesions. We describe a patient with primary histiocytic sarcoma who presented with a new onset headache with features of raised intracranial pressure and subtle signs of cauda equina syndrome due to predominant lower spinal cord infiltration and minimal intracranial involvement.CaseA previously well 54-year-old man presented with a 2-month history of new onset headache with features of raised intracranial pressure. Progression of lower limb weakness was delayed and mild with diagnostic delay resulting from the primary presentation with headache leading to an initial focus on cerebral pathology. Subsequent investigations revealed a previously unreported presentation of primary histiocytic sarcoma infiltrating the cauda equina causing raised intracranial pressure headache.ConclusionThis case highlights the importance of a broad search in the investigation of new onset raised intracranial pressure headache, including imaging of the lower spinal cord. Primary histiocytic sarcoma should be considered in the differential diagnosis of this rare syndrome.

PROBLEMS OF MEDICINES STORAGE IN HOME FIRST AID KITS OF GERIATRIC PATIENTS

The polymorbidity of geriatric patients and the associated polypharmacy necessitate “first-aid kits”, which raises the problem of uncontrolled storage of medicines. Aim: to analyze the home kits of elderly patients in terms of composition and storage. Methods. The author’s questionnaire containing 11 questions was compiled. A survey was conducted on 106 patients older than 65 years; the questionnaire was filled by respondents with a help of researchers during personal visit with an examination of “first-aid kits”. Results. First-aid kits contained on average 16 types of drugs; Over-the-counter (OTC) drugs prevailed (76.50%) in solid dosage forms, mainly non-steroidal anti-inflammatory drugs, analgesics and antispasmodics, antihypertensive drugs, etc. Elderly patients most often used home medicine kits in responsible self-medication with high blood pressure, headache, and cardiac disorders, joint pain, digestive disorders. Expired medicines found in 30.2% of respondents accounted for 7.20% of the total number of medicines in first-aid kits, of which 83.44% were OTC drugs and 16.56% were prescription drugs. 58.57% of disposable syringes were expired. Violation of storage conditions was found in first-aid kits in 32.08% of respondents in 4.82% of drugs, of which 78.87% in non- prescription drugs. Conclusion. Violations of the shelf life and storage conditions of medicines and syringes in home first-aid kits were revealed. It is necessary to improve the skills of pharmacy employees in relation to pharmaceutical counseling of geriatric patients to ensure proper practice of storing and disposing of medicines. It is recommended to reduce the number of tablets and capsules of OTC drugs in the package. It is advisable to apply warning labels on the packaging of disposable syringes «before use, check the integrity of the package» and «after the expiration date, use is not allowed». Increasing the knowledge of geriatric patients about the proper practice of storing home first aid kits will help to improve the effectiveness and safety of pharmacotherapy.

Clinical characterization of delayed alcohol-induced headache

ObjectiveTo evaluate the International Classification of Headache Disorders (ICHD) criteria and to characterize the clinical phenotype of delayed alcohol-induced headache (DAIH).MethodsWe conducted a cross-sectional study of university students who voluntarily consumed alcohol and experienced headache. Participants completed a survey that included demographic and clinical data. We analyzed the phenotype of the headache, validated ICHD phenotype criteria for DAIH, and analyzed whether participants fulfilled criteria for low-CSF-pressure headache or migraine.ResultsA total of 1,108 participants were included (58% female, mean age 23 years, 41% with headache history). Mean alcohol intake was 158 g; spirits were consumed by 60% of the participants; beer was consumed by 41%; and wine was consumed by 18%. The ICHD criteria for DAIH were met in 95% of the participants. Headache duration (mean, 6.7 hours) correlated with total grams of alcohol consumed (r = 0.62, p = 0.03). Pain was bilateral in 85% of patients with predominantly frontal topography (43%). Pain quality was mainly pressing (60%) or pulsatile (39%) and was aggravated by physical activity in 83% of participants. ICHD low-CSF pressure-headache criteria were fulfilled in 58% of patients, and migraine criteria were fulfilled by 36%.ConclusionsDAIH is a moderate-intensity headache, is typically bilateral, and presents with frontal predominance and a pressing quality. The phenotype of DAIH combines features of both migraine and low-CSF-pressure headaches.

Evaluation and Modeling of Traffic Noise in Berhampur City, India

Traffic noise in urban areas is increasing day by day, owing to addition in the number of vehicles on road in developing and developed countries. The increase of noise level reduces the wellbeing of the exposed people. Exposure to high noise results in development of ill health including annoyance, high blood pressure, headache and other physiological and psychological problems. Noise not only affects the human life but also affects animals and birds in the ecosystem. In this experimental study, the evaluation of traffic noise in Berhampur city has been done. Eleven important locations covering the whole city were considered for traffic noise evaluation. Other than the evaluation of traffic noise, the well-known traffic noise prediction models have been tested here. It has been found that, in this situation, such established models do not function well and have a low coefficient of correlation value. A new befitting model has been formulated using multiple regression analysis to predict the traffic noise level and later on, it is also tested as well as validated at different locations.

Imaging of the Spontaneous Low Cerebrospinal Fluid Pressure Headache: A Review

Spontaneous intracranial hypotension (SIH) is a significant cause of chronic, postural headaches. Spontaneous intracranial hypotension is generally believed to be associated with cerebrospinal fluid (CSF) leaks, and these leaks can be posttraumatic, iatrogenic, or idiopathic in origin. An integral part of the management of patients with this condition consists of localizing and stopping the leaks. Radiologists play a central role in the workup of this condition detecting leaks using computed tomography, magnetic resonance imaging, or nuclear imaging. In this article, we briefly review SIH and the various imaging modalities, which can be used to identify and localize a spontaneous CSF leak.

Hydrocephalus

Hydrocephalus specifies a disorder of cerebrospinal fluid (CSF) physiology resulting in abnormal expansion of the cerebral ventricles, associated with increased intracranial pressure in certain subtypes. An equilibrium between CSF production and CSF reabsorption maintains mean CSF pressure at 5–25 cm of water in normal adults. In patients with communicating and noncommunicating forms of hydrocephalus, the buildup of extra CSF fluid within the ventricles may cause increased intracranial pressure. Idiopathic normal pressure hydrocephalus (iNPH) causing ventriculomegaly without intracranial hypertension is a related and under-reported condition. The epidemiology of hydrocephalus is greatly disputed. Due to etiological heterogeneity, lack of a conclusive definition, and regional treatment variations, the true incidence of hydrocephalus is not known in adults or children. Clinical features, especially in children, commonly include a classical complex of elevated intracranial pressure, headache, vomiting, and drowsiness. Less common clinical features may include papilledema, abducens nerve palsy, and lethargy. iNPH typically presents with some combination of gait, cognitive impairment, and urinary dysfunction. Investigation centers around radiological modalities such as computed tomography and magnetic resonance imaging scans with the addition of CSF sampling to assess mean CSF pressure and CSF drainage. Treatment of hydrocephalus is based on a number of factors, including age, etiology, severity, and supplementary testing. Treatment is usually indicated wherever hydrocephalus is considered to be progressive. Surgical intervention is central to management. This chapter discusses the classification, epidemiology, pathophysiology, diagnosis and treatment, controversies, and future research agendas for hydrocephalus—a condition with an economic burden that outweighs its resources allocation.

Effect of Intranasal Corticosteroids on Secondary Sinonasal Symptoms: A Systematic Review of Randomized Trials

Background Intranasal corticosteroid (INCS) sprays are indicated for use in the treatment of seasonal and perennial allergic rhinitis and include aqueous and nonaqueous formulations. Secondary symptoms of rhinitis include postnasal drip, facial pain/pressure, headache, cough, and ear fullness. The effectiveness of INCS on these specific symptoms, as well as the comparative effectiveness of aqueous and nonaqueous formulations, is poorly defined. Objective To evaluate the effectiveness of aqueous versus nonaqueous INCS formulations on less common sinonasal symptoms. Methods A systematic review was conducted of English-language, randomized controlled trials, with adherence to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standard. Studies that did not provide quantitative data on relief of postnasal drip, facial pain/pressure, headache, cough, and ear fullness were excluded. An itemized assessment of the risk of bias was conducted for each included study. Results Of the 118 studies identified, 9 met the criteria for qualitative analysis. An effect on postnasal drip was reported in 5 studies, facial pain/pressure in 2 studies, and cough in 2 studies. A reduction in a specific symptom was reported in about half of these studies, with heterogenous outcome measures. Only 1 study reported the effect of a nonaqueous formulation on a specific symptom. No studies reported an effect on aural fullness. Conclusions Limited data are available regarding the effectiveness of aqueous or nonaqueous INCS on secondary symptoms in adult patients with rhinitis. Further study is needed using homogenous outcome measures and direct comparison of INCS formulations.