Obstructive sleep apnea (OSA) is a multi-level airway disease, and the specific site of obstruction may influence associated conditions such as eustachian tube dysfunction (ETD) and gastroesophageal reflux disease (GERD). This study aimed to explore the relationship between OSA, ETD, acid reflux, and the anatomical site of obstruction. Methods: Participants were assessed using validated questionnaires for OSA, ETD, and reflux symptoms. The site of upper airway collapse was determined objectively using apneagraphy or sleep MRI. Acid reflux symptoms were evaluated using a standardized reflux symptom questionnaire, and 24-hour pH monitoring was done when indicated. ETD was assessed both subjectively and objectively through the Toynbee maneuver. Results: Sixty-three individuals completed the evaluation. The mean age was 40.4 years, and the mean BMI was 28.1 kg/m2. Retroglossal obstruction was observed in 76.1% (48/63), while 23.9% (15/63) had retropalatal obstruction. ETD was diagnosed in 53% of participants, and GERD in 38% by objective testing. A statistically significant association was found between retroglossal collapse and complete ETD (p=0.02). However, no significant link was noted between the obstruction site and laryngopharyngeal reflux or partial ETD. Additionally, salivary pepsin levels showed no correlation with reflux (p=0.412). Conclusions: OSA is frequently accompanied by ETD and GERD. Notably, retroglossal obstruction appears to be significantly associated with complete ETD, suggesting a potential site-specific impact. These findings underscore the importance of anatomical localization in understanding OSA-related comorbidities and warrant further investigation in larger multicenter studies.

Obstructive sleep apnea (OSA) is a multi-level airway disease, and the specific site of obstruction may influence associated conditions such as eustachian tube dysfunction (ETD) and gastroesophageal reflux disease (GERD). This study aimed to explore the relationship between OSA, ETD, acid reflux, and the anatomical site of obstruction. Methods: Participants were assessed using validated questionnaires for OSA, ETD, and reflux symptoms. The site of upper airway collapse was determined objectively using apneagraphy or sleep MRI. Acid reflux symptoms were evaluated using a standardized reflux symptom questionnaire, and 24-hour pH monitoring was done when indicated. ETD was assessed both subjectively and objectively through the Toynbee maneuver. Results: Sixty-three individuals completed the evaluation. The mean age was 40.4 years, and the mean BMI was 28.1 kg/m2. Retroglossal obstruction was observed in 76.1% (48/63), while 23.9% (15/63) had retropalatal obstruction. ETD was diagnosed in 53% of participants, and GERD in 38% by objective testing. A statistically significant association was found between retroglossal collapse and complete ETD (p=0.02). However, no significant link was noted between the obstruction site and laryngopharyngeal reflux or partial ETD. Additionally, salivary pepsin levels showed no correlation with reflux (p=0.412). Conclusions: OSA is frequently accompanied by ETD and GERD. Notably, retroglossal obstruction appears to be significantly associated with complete ETD, suggesting a potential site-specific impact. These findings underscore the importance of anatomical localization in understanding OSA-related comorbidities and warrant further investigation in larger multicenter studies.

Obstructive sleep apnea (OSA) is a multi-level airway disease, and the specific site of obstruction may influence associated conditions such as eustachian tube dysfunction (ETD) and gastroesophageal reflux disease (GERD). This study aimed to explore the relationship between OSA, ETD, acid reflux, and the anatomical site of obstruction. Methods: Participants were assessed using validated questionnaires for OSA, ETD, and reflux symptoms. The site of upper airway collapse was determined objectively using apneagraphy or sleep MRI. Acid reflux symptoms were evaluated using a standardized reflux symptom questionnaire, and 24-hour pH monitoring was done when indicated. ETD was assessed both subjectively and objectively through the Toynbee maneuver. Results: Sixty-three individuals completed the evaluation. The mean age was 40.4 years, and the mean BMI was 28.1 kg/m2. Retroglossal obstruction was observed in 76.1% (48/63), while 23.9% (15/63) had retropalatal obstruction. ETD was diagnosed in 53% of participants, and GERD in 38% by objective testing. A statistically significant association was found between retroglossal collapse and complete ETD (p=0.02). However, no significant link was noted between the obstruction site and laryngopharyngeal reflux or partial ETD. Additionally, salivary pepsin levels showed no correlation with reflux (p=0.412). Conclusions: OSA is frequently accompanied by ETD and GERD. Notably, retroglossal obstruction appears to be significantly associated with complete ETD, suggesting a potential site-specific impact. These findings underscore the importance of anatomical localization in understanding OSA-related comorbidities and warrant further investigation in larger multicenter studies.

Mass of the vulva include both benign and malignant lesions. Benign mass lesions of the vulva include tumors, hamartomas, cysts, infectious disorders, and non-neoplastic epithelial disorders. Some are rare mass lesions. Here, we presented three rare mass lesions of the vulva. The first case presented with the complaint of vulvar lesion since childhood, while the two cases presented in reproductive age and perimenopausal age. All three cases presented as mass lesions in the vulva with pain or uneasiness during work. In all these cases, excision was done. On histopathological examination, the lesions have different diagnoses which are common in other parts of the body, but rarely present at the vulva. A definitive diagnosis of a vulvar mass lesion is difficult to make, especially in the case of rare mass lesion. Histopathology is the principal tool of diagnosis.
Lymphangioma ; Fibroadenoma

Introduction: Despite recent advances, management of distal tibial fractures is challenging, with high rate of complications. Fibula pro tibia plating technique fixes fibula and tibia together, via laterally placed fibular plate without disturbing the tibial soft tissue sleeve. We contemplated this pilot study to assess effectiveness of fibula pro tibia plating in management of distal tibia fibula fractures. Materials and methods: A total of 30 patients with distal tibia fibula fractures with fracture line extending within 5cm from tibial plafond were managed with fibula pro tibia plating, with or without minimal articular fixation. Outcome evaluation was done by union, union time, alignment and functional outcome as assessed by AOFAS score. Results: Mean age in the series was 39.4 years with male to female ratio of 3:2. Mean duration of surgery, blood loss and C arm exposure were 79 minutes (range 52 to 98min), 80ml (range 62 to 102ml) and 48 shoots (range 36 to 81 shoots), respectively. All fractures united in mean union time of 10.2 weeks (range 9 to 14 weeks) with acceptable alignment in all the patients except one. Mean AOFAS score was 86.3 (range 70 to 93) with 29 patients having good to excellent outcome. One patient had varus malunion and in one case infection was seen. Conclusion: Fibula pro tibia plating can be successfully used to manage complex distal tibia fractures which leaves the soft tissue and periosteal sleeve undisturbed, thus avoiding wound related problems and leading to early union.

Purpose::Dental and orofacial trauma among the adult population constitutes a major public health problem. The impact is not just physical but also psychological. To analyse the impacts of dental and orofacial trauma on oral health-related quality of life (OHRQoL) in adults and determine whether the 2 variables are closely interlinked.Methods::This is a systematic review. The terms "dental trauma", "orofacial trauma", "oral health", "oral health related impact life", "OHRQoL", "positive and negative affect scale", "quality of life", "facial injuries", "adults", and "young adults" were researched in the databases of PubMed, ScienceDirect, Scopus and Google Scholar for associated studies up to December 30, 2022. A comprehensive search was designed and the articles were independently screened for eligibility by 2 reviewers. The included studies’ author, year of publication, the country where the study was conducted, population demographics (number and age), an instrument used for assessing OHRQoL and the relevant result were recorded and compared. The quality of the evidence was assessed using Joanna Briggs Institute checklist for observational studies.Results::Out of 482 unique records, 3 articles were included for data extraction. Observational studies were included. Two studies did not mention confounding factors. Different scales were used for dental and orofacial trauma and OHRQoL. OHRQoL has a directly proportional relationship with orofacial trauma. Adolescents with orofacial trauma have a significant impact on this value with a prevalence of 88.4%.Conclusion::The highest impact on OHRQoL was seen immediately after the diagnosis of an orofacial trauma. The impact increases with the severity of the trauma. Therefore, to promote overall dental and general health, health education initiatives should include information on the causes, prevention, and requirement for prompt responses by the populace in seeking dental intervention.

Purpose: Postoperative nausea and vomiting (PONV) is a prevalent and distressing complication, especially in laparoscopic surgeries. This review compares the efficacy and safety of palonosetron and ondansetron in preventing PONV after laparoscopic surgery. Methods: A systematic review was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library to identify comparative studies that reported the efficacy (nausea and vomiting) at three postoperative time points T1 (0–2 hours), T2 (2–6 hours), T3 (6–24 hours) and safety (incidence of adverse effects). Meta-analysis of relative risk was performed using a random effect model and subgroup analysis based on factors such as antiemetic dose and timing of administration, type of surgery, and anesthetic agents. Results: Twenty-one randomized controlled trials were published between 2011 and 2022, involving 2,043 participants. Nineteen trials were included in the meta-analysis (efficacy, 17;safety, 11). The pooled risk ratio revealed that patients receiving palonosetron demonstrated significantly less likelihood of developing nausea and vomiting at various postoperative time points. Subgroup analysis indicated significantly less PONV when palonosetron was administered before intubation and in combination with isoflurane anesthesia. Headache, dizziness, constipation, and drowsiness were the most commonly reported. The safety profiles of palonosetron and ondansetron were comparable. Conclusion Palonosetron exhibits superior efficacy within the first 24 hours postoperatively and requires less rescue antiemetic intervention compared to ondansetron in laparoscopic surgery patients. Both demonstrate nearly comparable safety profiles. Future trials focusing on cardiac safety (QT interval) and cost consideration are needed.

To review morphometry, morphology, branching patterns and anomalies of middle cerebral artery (MCA). The databases of PubMed, Google Scholar and Scopus were searched with different keywords. The review comprised of 45 studies.Meta-analysis was done for dimensions of MCA, shapes, patterns and MCA anomalies. Newcastle-Ottawa Scale was used for assessment of literature. Statistical analysis was done using R software using meta package. Thirteen research were combined to determine the proportion of MCA length and pooled proportion was 16.53 cm (15.33 to 17.72 cm); I2 =98%; P-value<0.01.Nine studies were combined to determine proportion of MCA diameter and pooled proportion was 2.85 cm (2.52 to 3.17 cm); I2 =100%; P-value<0.05. M1 segment mean length is more on left side as compared to right side. Mean length in males (16.57±1.40 cm) is more than females (15.9±1.32 cm). Mean diameter of M1 segment is similar on both sides. Mean diameter in males (3.20±0.09 cm) is higher than females (3.14±0.18 cm). Different branching patterns observed were single trunk, early bifurcation, bifurcation, trifurcation, quadrifurcation and multiple trunks. The most typical MCA branching pattern is bifurcation. The shapes of MCA like straight shaped, U shaped, C shaped, inverted U shaped and S-shaped of M1 segment have been described. Straight MCA is the most common shape. The MCA measurements and branching pattern will assist surgeons in limiting errors in the treatment of cerebral aneurysms and infarcts and providing the best possible result for the patients. An understanding of MCA shape will aid surgeons and physicians in effective endovascular recanalization.

Background: There is a shortage of data on brain tumor patients admitted in to intensive care unit (ICU) from developing countries. We aimed to assess the clinical course and 30-day mortality with factors affecting the mortality of brain tumor patients who were admitted to medical ICU. Methods: This study was a single-centre retrospective observational cohort study and was conducted in a medical ICU of a tertiary care center in India. We included 42 patients admitted in to the medical oncology ICU over 3 years. Data regarding demographics, baseline characteristics, clinical and laboratory data, need for organ support, and 30-day mortality were collected. Factors associated with increased mortality in these patients were determined. Results: Overall 30-day mortality was 30.95%. The most common indication for ICU admission was altered sensorium (57.1%) followed by sepsis (23.8%). Age [odds ratio, OR: 0.843 (95% confidence interval, CI: 0.721–0.986)], and need for invasive mechanical ventilator (IMV) support [OR: 484.62 (95% CI: 2.707–8676.02)] or vasopressor support [OR: 523.83 (95% CI: 2.12– 3,023.13)] were directly associated with 30-day mortality. Severity indices such as Sequential Organ Failure Assessment (SOFA) score, SAPS II (Simplified Acute Physiology Score II), and Acute physiology and chronic health evaluation II (APACHE II), APACHE III and APACHE IV scores were higher in non-survivors than survivors. Conclusion Advancing age and need for IMV or vasopressor support may be associated with worse prognosis in brain tumor patients admitted in to ICU. A scoring system could be used along with clinical judgement to triage brain tumor patients for ICU admission.

To review morphometry, morphology, branching patterns and anomalies of middle cerebral artery (MCA). The databases of PubMed, Google Scholar and Scopus were searched with different keywords. The review comprised of 45 studies.Meta-analysis was done for dimensions of MCA, shapes, patterns and MCA anomalies. Newcastle-Ottawa Scale was used for assessment of literature. Statistical analysis was done using R software using meta package. Thirteen research were combined to determine the proportion of MCA length and pooled proportion was 16.53 cm (15.33 to 17.72 cm); I2 =98%; P-value<0.01.Nine studies were combined to determine proportion of MCA diameter and pooled proportion was 2.85 cm (2.52 to 3.17 cm); I2 =100%; P-value<0.05. M1 segment mean length is more on left side as compared to right side. Mean length in males (16.57±1.40 cm) is more than females (15.9±1.32 cm). Mean diameter of M1 segment is similar on both sides. Mean diameter in males (3.20±0.09 cm) is higher than females (3.14±0.18 cm). Different branching patterns observed were single trunk, early bifurcation, bifurcation, trifurcation, quadrifurcation and multiple trunks. The most typical MCA branching pattern is bifurcation. The shapes of MCA like straight shaped, U shaped, C shaped, inverted U shaped and S-shaped of M1 segment have been described. Straight MCA is the most common shape. The MCA measurements and branching pattern will assist surgeons in limiting errors in the treatment of cerebral aneurysms and infarcts and providing the best possible result for the patients. An understanding of MCA shape will aid surgeons and physicians in effective endovascular recanalization.