Bangalore Baptist Hospital

Thornwaldt cyst is an uncommon developmental midline cystic lesion arising from the pharyngeal bursa. It is most frequently detected in younger patients incidentally during imaging or diagnostic nasal endoscopy (DNE), and may later in the course of the disease present with symptoms secondary to nasal obstruction. A 75-year-old male presented with symptoms of progressive persistent nasal obstruction since three years, that worsened over past four months. DNE and Contrast enhanced computed tomography (CECT) showed a large midline nasopharyngeal cystic mass fully occupying the choana, measuring ~3×2 cm. Patient underwent transnasal endoscopic coblation-assisted excision of cyst where cheesy material and thick mucoid cyst content was identified. Histopathology showed Cyst wall lined by respiratory epithelium with reactive lymphoid cells. Follow up at 1 week and 2 months showed good postoperative healing of nasopharynx with no evidence of recurrence. Although rarely seen at this age, Thornwaldt cyst can be considered as a potential diagnosis in elderly patients presenting with nasopharyngeal mass- like lesion. In our experience with this case transnasal endoscopic coblation- assisted excision is an effective method for removal of nasopharyngeal cyst like lesions by providing adequate visualisation and access, with coblation wand acting as a single tool for excision, content aspiration and hemostasis.

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia seen in clinical practice. AF prevalence increases with age and is often linked to underlying conditions such as hypertension, heart failure and valvular disease.2D echocardiography (2D Echo) offers insights into atrial size, ventricular function, and structural abnormalities such as valvular disease and left heart dimensions. Aim: To analyze the echocardiographic assessment of left atrial dimensions and left ventricular filling pressure in patients diagnosed with atrial fibrillation. Materials And Methods: This is a descriptive observational study to analyze echocardiographic assessment of left atrial dimensions and left ventricular filling pressure in patients diagnosed with atrial fibrillation. The study was conducted in a tertiary care centre from June 2024 to December 2024. Over 7 months, 102 patients diagnosed with AF were analyzed. Results: The majority of patients diagnosed with AF were in the 61-80 age group, comprising 59 individuals (57.84%). Common observations include concentric left ventricular hypertrophy (LVH) and hypertension, which were observed in 43 and 76 patients respectively. Left atrial (LA) dimensions revealed an average size of 4.71 ± 0.15 cm in males and 4.36 ± 0.11 cm in females. Out of 102 patients, 70 (68%) patients were categorized as having moderate LAVI (left atrial volume index) and LA enlargement which included 28 males and 42 females. LAVI measured 45.035±1.45 cm in males and 43.42±0.91 cm in females. Filling pressure during atrial fibrillation measured by E/e' was found to be 13.84 ± 2.35cm in males and 13.78 ± 2.28 cm in females. Additionally, PAH pressure was 45.8± 11.27 mmHg in males and 53.28± 15.20 mmHg in females. Among heart diseases, CAD was the most prevalent affecting 42 patients (41%). Conclusion: The 2D echocardiographic evaluation of atrial fibrillation (AF) patients is critical for therapeutic decision-making and prognosis. This study aimed to collect information on left atrial (LA) enlargement, left atrial volume index (LAVI), concentric left ventricular hypertrophy (LVH), pulmonary artery pressures and LV filling pressure in AF patients. Our study revealed AF patients had higher LA volume, LVH, higher PAH, and increased filling pressure consistent with existing literature.

Benign paroxysmal positional vertigo (BPPV) is the most common cause for vertigo. It is diagnosed by the characteristic nystagmus induced by provocative positional tests. During these positional tests the patient experiences spinning vertigo and neurovegetative symptoms such as nausea and vomiting. This can cause severe discomfort to the patient during treatment and in some cases reduced compliance. Minimal stimulation strategy reduced the episodes of induced vertigo, nausea and vomiting thereby making the treatment maneuvers more tolerable. This study aims to evaluate the utility of minimum stimulus strategy for managing BPPV in a resource limited center. The present study also evaluated the utility of 3rd step vertigo as an alternative marker for recovery nystagmus in predicting the efficacy of Epley's maneuver in treating posterior canal BPPV. All patients diagnosed with canalolithiasis of posterior semicircular canal (pc-BPPV), horizontal semicircular canal (hc-BPPV), anterior semicircular canal (ac-BPPV) and multiple semicircular canal (mc-BPPV) were included in the study. The side on which the maximum symptoms were experienced was asked to the patients and noted. The first positional test done in all patients was the Dix-Hallpike maneuver and minimum stimulation strategy was used for treating BPPV. Appropriate canalolith repositioning maneuvers (CRM) were used to treat BPPV. Positional maneuvers were repeated after the CRM in the same sitting and the treatment was considered successful if nystagmus had disappeared on repeat positional tests. The presence of 3rd step vertigo during Epley's maneuver was documented. A total of 71 patients were enrolled in the study. Patients correctly identified the side of BPPV in 76.31% of cases. 3rd step vertigo was able to predict a successful Epley's maneuver in pc-BPPV with a sensitivity and specificity of 41.67% and 60% respectively. Incidence of 3rd step vertigo was seen in 41.37% of patients with pc-BPPV and in 90.9% of patients with mc-BPPV. Minimal stimulation strategy is useful in reducing the discomfort experienced by the patients with BPPV during treatment and thereby improve the compliance to treatment maneuvers. Patients were able to identify the correct side of BPPV in 76.31% of cases. Third step vertigo could predict successful Epley's reposition maneuver with a sensitivity of 41.67% and specificity of 60% in our cohort. However, more studies with larger sample size are required to ascertain its role as an alternative marker for 'recovery nystagmus'.

Dapagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor used in the treatment of type 2 diabetes mellitus. SGLT2 inhibitors are known to cause diabetic ketoacidosis (DKA) with normal to mild increases in blood glucose levels. Euglycemic DKA develops in patients with pre-existing risk factors such as major surgery, missed insulin dosage, dehydration, and other acute medical illnesses. We describe a 54-year-old female diabetic patient who developed severe DKA in the post-operative period with normal blood glucose levels presenting as acute abdomen. She was successfully managed with DKA protocol and was discharged from the hospital.

Background In obstetrics, accurately determining gestational age (GA) is a critical aspect of managing pregnancy and evaluating fetal growth and development. Intrauterine growth restriction (IUGR) is characterized by the failure of the fetus to reach its potential growth. Early detection of IUGR is crucial for optimal obstetric care to reduce fetal complications and neonatal morbidity and mortality. The purpose of the current research is to determine the role of transcerebellar diameter (TCD) and the TCD/abdominal circumference (AC) ratio in assessing fetal growth and diagnosing IUGR. Methods In the sample, there were 600 expectant mothers with GA exceeding 28 weeks. We measured TCD and AC and then calculated the TCD/AC ratio. We used IBM SPSS Statistics for Windows, V. 22.0 (IBM Corp., Armonk, NY), for statistical analysis. The data was subjected to statistical tests, including Pearson's correlation coefficient, coefficient of determination, and tests of validity. Results The current research demonstrates a strong linear correlation between TCD and GA. Additionally, there was no notable disparity in TCD measurements between normal and IUGR fetuses with the same GA. There was an insignificant relationship between the TCD/AC ratio and GA, with a constant TCD/AC ratio in the third trimester of pregnancy in normal fetuses. The mean TCD/AC ratio was 14.72±0.89 (mean±standard deviation), and a cut-off value of 16.5 was determined to diagnose IUGR. Conclusion TCD can serve as a reliable measure for GA estimation during the third trimester in pregnant women with uncertain last menstrual period (LMP) or no dating scan and IUGR fetuses. In diagnosing IUGR, the TCD/AC ratio has demonstrated greater sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The TCD/AC ratio is a GA-independent measure that can be used to diagnose IUGR.

A 16-year-old male patient, apparently healthy, presented with bilateral lower limb swelling, facial puffiness, cough, and fever with breathlessness of 1-week duration. On physical examination, he was conscious, oriented, tachypnoeic, and tachycardic, with bilateral pitting pedal edema, axillary lymphadenopathy, and hepatosplenomegaly. On auscultation, air entry was grossly reduced on the left side of the chest. Point of care ultrasound revealed a left massive pleural effusion with underlying collapse 1-3,5

Acitretin is a synthetic, second-generation retinoid mainly used for the treatment of Darier's disease (DD), which impacts biological processes by binding to a nuclear receptor from the corticosteroid/thyroid receptor superfamily, thereby altering gene expression. Our report outlines the case of a 41-year-old male patient who has received a clinical diagnosis of DD and does not exhibit any other coexisting comorbidities, who developed hypothyroidism posttreatment with acitretin, an unusual and rare side effect of the drug. His baseline routine investigations fell within normal limits before the initiation of acitretin. Acitretin-induced hypothyroidism was treated with thyroxine. Although a good therapeutic response was seen with acitretin, it could not be continued due to the development of side effects and was continued on topical therapy. This case emphasizes the likelihood of adverse effects linked to therapeutic levels of acitretin in patients without any prior history and signifies the critical importance of consistent blood monitoring throughout drug therapy.

ABSTRACT Background: An increase in colorectal cancer incidence has been reported in India, often presenting in advanced stages and resulting in poor survival. However, the genomic and therapeutic landscape is not well understood. Objective: The primary objective of the study was to understand the mutational profile of metastatic colorectal cancer in the Southeast Asian cohort, and the secondary objective was to define the proportion of patients with therapeutically significant variants. Materials and Methods: This retrospective study was conducted between January 2021 and September 2023, at 4baseCare Onco Solutions Pvt. Ltd., Bengaluru, Karnataka, India. Comprehensive genomic profiling (CGP) and biomarker testing for MSI, TMB, and PD-L1 was carried out in 477 metastatic advanced (Stage III/IV) colorectal cancer patients, for the current retrospective-observational study. Results: With CGP, we identified drivers/clinically actionable variants in 78.6% of the cohort (375 patients). Although 30.8% of our cohort (147 patients) was eligible to available targeted therapy, 29.5% (141 patients) were found to harbor variants imparting therapeutic resistance. The combined mutation frequency of APC, TP53, and KRAS was >50%, while KRAS constituted >90% of all RAS mutations. The mismatch repair (MMR) genes including MLH1, MLH3, MSH3, and POLE were exclusively found in colon cancers. Genomic alterations in several genes of prognostic/therapeutic significance were seen (mutations in PIK3CA, SMAD4, BRAF, and amplifications in KRAS, EGFR, and ERBB2). Of those tested, 15.8% (41 patients) of the cohort had high tumor mutation burden (TMB-H), 14% had high microsatellite instability (MSI-H) (46 patients), and 26.8% were programmed death-ligand 1 (PD-L1) positive (30 patients). Conclusion: Our study shows that CGP is an advantageous option for identifying subsets of patients eligible for various targeted therapies, thus, improving patient outcomes.