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International Journal of Otorhinolaryngology and Head and Neck Surgery
Number of Followers: 1  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2454-5929 - ISSN (Online) 2454-5937
Published by Medip Academy Homepage  [12 journals]
  • Second look, in primary site recurrence or second primary for T1 and T2
           glottic cancer treated by CO2 laser

    • Authors: Kuauhyama Luna-Ortiz, Veronica Villavicencio-Valencia, Zelik Luna-Peteuil, Diana Villavicencio-Valencia, Doria Y. Garcia-Ortega, Philippe Pasche
      Pages: 1 - 7
      Abstract: Background: Aim was to analyze the impact of second-look surgery in the surveillance of T1 and T2 glottic cancer treated with CO2 laser. Methods: Retrospective review of 98 patients treated between February 2005 and December 2022. Results: Among 98 patients with early glottic cancer (T1/T2), 56 (57%) with suspected recurrence underwent a second-look surgery. Of all patients, 38 (38.77%) recurred 6 months after initial resection, 17 of which (45%) had a lesion in a different site from the primary. Of these 38 patients, 22 (58%) underwent laser surgery once, 12 (32%) underwent laser surgery twice, and 4 (10%) underwent laser surgery on three occasions during follow-up. The 5-year disease-free survival, 5-year survival, and larynx preservation rates were, respectively, 54%, 82%, and 90.8%. Conclusions: Transoral resection is currently the first treatment option for early-stage glottic carcinoma because diagnosis and prompt treatment can be provided on an outpatient basis at the same time.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240050
      Issue No: Vol. 10, No. 1 (2024)
       
  • Malignant external otitis: about 50 cases at Fann hospital center

    • Authors: Mame Sanou Diouf, Mouhamed Barry, Moustapha Ndiaye, Abdourahmane Tall, Ciré Ndiaye, Malick Ndiaye, Fallou Niang, Cheikh Diène Niang, Faty Fall
      Pages: 8 - 11
      Abstract: Background: Malignant external otitis (MEO) is an osteitis of the skull base, originating in the external auditory canal. It is most common in elderly and diabetic patients. Early management prevents complications. The objective of the study is to provide an epidemiological, clinical, paraclinical, therapeutic and evolutionary profile. Methods: From January 2010 to January 2021, we carried out a retrospective study in the ENT department of Fann hospital, selecting the patients hospitalized and suffering from malignant external otitis Results: Fifty patients were included in this study. The mean age was 65, with a sex ratio (M/F) of 1.5. Forty-six patients were diabetic; 2 patients had leukemia and 2 had no previous history. The average length of hospital stay was 3 months. The reasons for consultation were otalgia, otorrhea and deafness in 96%, 80% and 32% respectively. Examination revealed otorrhea in 58%, peripheral facial paralysis in 54% and a polyp in 80%. Ear swab analysis isolated Pseudomonas aeruginosa in 28%. CT scan showed ear cavity filling in 40 cases and bone lysis in 26. Antibiotic treatment was based on ciprofloxacin or ofloxacin in 44% of cases, and the combination of ceftriaxone-ciprofloxacin or ofloxacin in 44%. The average duration of treatment was 3 months. There were 12% recurrences and 2 cases of death after an average follow-up of 10 months. Conclusions: MEO is a rare pathology that occurs more frequently in elderly subjects with immunodepressive backgrounds. Antibiotic therapy has proved effective in treating this condition.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240051
      Issue No: Vol. 10, No. 1 (2024)
       
  • Outcome of anti-tubercular therapy on rifampicin sensitive non-HIV
           patients with tubercular cervical lymphadenopathy in Bangladesh

    • Authors: Mahmud Asif Rifat, M. Salahuddin Al Azad, M. Anwarul Haque, M. Asaduzzaman Liton, Nahiduzzaman
      Pages: 12 - 17
      Abstract: Background: Tuberculosis (TB) remains a significant public health concern, particularly in developing countries like Bangladesh. The study aims to evaluate the outcomes of a six-month anti-tubercular therapy in rifampicin (RIF)-sensitive, non-HIV patients with tubercular cervical lymphadenopathy (TCL), and to challenge the conventional wisdom of extended treatment durations. Methods: This retrospective observational study was conducted at Dhaka medical college, Dhaka, Bangladesh, from July 2019 to July 2023. A total of 189 patients diagnosed with TCL were included, adhering to specific inclusion and exclusion criteria. Various socio-demographic characteristics, clinical presentations, and treatment outcomes were analyzed. Results: The majority of the participants were aged 15-30 (71.43%) and were female (68.25%). Fever was the most common clinical presentation, affecting 66.67% of the participants. After six months of therapy, 33.86% showed a complete response, and various clinical presentations were observed, with neck pain being the most common (11.64%). Among the 64 with complete response after 6 months, only 7.81% showed relapse at follow-up. Conclusions: Our study suggests that a six-month treatment regimen can yield significant responses in TB patients. It challenges the prevailing notion that extended treatment durations are universally necessary. Treatment plans should be individualized, taking into account the clinical conditions of each patient, and should be advised by a clinician or a respected doctor.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240052
      Issue No: Vol. 10, No. 1 (2024)
       
  • Correlation of serum thyroid stimulating hormone level to predict benign
           or malignant nature of thyroid swelling

    • Authors: Sabi Rana, Meera Bista, Akriti Shrestha, Property Bhandari, Sagar Devkota, Sujan Pradhan, Saurav Sharma
      Pages: 18 - 23
      Abstract: Background: Thyroid enlargement is a common clinical problem encountered in ENT practice, thyroid cancer, by contrast is less common. Several imaging modalities, FNAB and biomarkers are available but a simple clinical or biochemical diagnostic criterion is still lacking. Serum TSH is a well- established growth factor for thyroid nodules and thus can be used as a simple and reliable test to predict the risk of having a thyroid malignancy in a patient with thyroid swelling. Objectives were to correlate serum TSH level with benign or malignant nature of thyroid swelling and to evaluate the use of TSH level in predicting thyroid malignancy. Methods: This was a prospective observational study conducted over a period of one year at department of otorhinolaryngology and head and neck surgery of a tertiary care center in Nepal involving a total of 61 patients with thyroid swelling who underwent thyroid surgery. Pre-operative serum TSH level was measured and correlated with final HPE diagnosis. Results: The study included 61 patients of which 30 (49.2%) were malignant on histopathology report. The mean TSH level for benign cases was 1.97 mIU/l±0.99 and that for malignant cases was 3.85 mIU/l±1.20 (p=0.000), thus showing higher level of mean serum TSH in malignant group and also more in differentiated thyroid cancer. Conclusions: Patients with higher range of TSH levels were more likely to have thyroid malignancy as compared to lower range even within normal value. Hence, serum TSH level can be a reliable marker to predict malignancy in thyroid swelling.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240053
      Issue No: Vol. 10, No. 1 (2024)
       
  • Effect of hearing loss on P300 measures

    • Authors: Archisman Shubhadarshan, Uneza Gaiwale
      Pages: 24 - 28
      Abstract: Background: P300 is among the first auditory responses in a collection of event-related or endogenous evoked responses. Hearing loss has drastically reduced cognitive abilities in individual adults. P300 is used as an electrophysiological tool to assess cognitive functions. This study was framed to compare the effect of hearing loss in P300 amplitude and latencies in Indian population. As no such study was carried out in Indian population, this study will be helpful in evaluating the correlation between hearing loss and cognitive function. Methods: We recruited a total of 60 participants out of which 30 were in group 1 having normal hearing and other 30 were included in group 2 having hearing loss. P300 was obtained using a Neurosoft instrument using tone burst stimuli The acquisition of tonal stimuli was carried out in a sound-treated room. Results: The t test value (t=4.75, p<0.001) for P300 amplitude indicates that the difference between the mean among normal hearing and hearing-impaired adult was statistically significant. But the p=0.68 for P300 latency which indicates that the difference between the two groups is not statistically significant, which accepts hypothesis that There would not exist any relationship of P300 latency in normal hearing- and hearing-impaired adults. Pearson's correlation was found that hearing loss and amplitude of P300 has a strong negative correlation and latency of P300 has a poor positive correlation with hearing loss. Conclusions: Hearing loss affects the P300 measures. Due to hearing loss cognitive decline occurs which results in reduced amplitude and prolonged latency in P300.
      PubDate: 2024-01-10
      DOI: 10.18203/issn.2454-5929.ijohns20240013
      Issue No: Vol. 10, No. 1 (2024)
       
  • Modified radical mastoidectomy in chronic otitis media: year outcome
           post-surgery

    • Authors: Vaibhav J. Lahane, Swati Mishra, Devanshi Modi, Sagar Jani
      Pages: 29 - 34
      Abstract: Background: Cholesteatoma is defined as erosive process, eroding ossicular chain, scutum, otic-capsule, fallopian canal and tegmun. Surgical management of cholesteatoma includes mastoidectomy. The aim of the study was to focuss on MRM: indications and outcomes of procedure. Methods: This study aims at knowing the indications and outcome of MRM after 1 year in terms of success rate, efficacy and patient’s satisfaction. It involves study over 42 patients who underwent surgery and were followed over a period of one year post surgery. Results: After 1 year of MRM 64.27% showed hearing improvement, 95.2% had dry and settled cavity, and there was no post-operative facial palsy, and SNHL. Conclusions: MRM is a procedure of choice for COM with extensive disease of mastoid. A meticulous and skilled MRM gives a well fashioned mastoid cavity with minimum or no recurrence/post-operative complications with a satisfactory hearing outcome.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240054
      Issue No: Vol. 10, No. 1 (2024)
       
  • Utility of Lugol’s iodine in assessing the margin status of early stage
           oral cavity cancer-could it be a simple and effective way to achieve R0
           resection'

    • Authors: Subbiah Shanmugam, Sathiyaseelan Balakrishnan
      Pages: 35 - 39
      Abstract: Background: It is often challenging to distinguish between dysplastic and normal mucosa during surgery. Use of staining agents that will identify abnormal mucosa may improve results. Because Lugol's iodine is readily available, simple to use, and cost-effective, it was chosen as the preferred staining agent. To determine the effectiveness of Lugol’s iodine application in achieving R0 resection in early-stage oral cavity malignancy and thereby leading to better outcomes after treatment. Methods: In this study we included 49 patients and randomized them into two arms. One arm we did wide excision for early-stage oral cavity cancers guided by subjective assessment of margins by surgeons and in another arm, we used Lugol’s iodine to define the margin. We analysed the margin status and thereby the need for the adjuvant therapy between these two groups. Results: In those 49 patients, two of them had microscopically positive margin. One belonged to Lugol’s iodine arm and other belonged to control arm. 17 patients had close margin at mucosal site (less than 5 mm) out of which 11 belonged to control arm and 5 belonged to Lugol’s iodine arm. Conclusions: Lugol’s iodine may be a simple and reliable method in achieving better resection margins and R0 resections for early-stage oral cavity cancer. By using this simple and cost-effective method we may reduce the possibility of ending up with positive or close margins and thereby avoiding the need of chemotherapy and radiation as adjuvant therapy in those patients.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240055
      Issue No: Vol. 10, No. 1 (2024)
       
  • Rhino-orbital mucormycosis during COVID-19 pandemic: our clinical
           experience

    • Authors: Prakash N. S., Arfan Nasser, Prathvi P. Nayak, Ima Chandra, Mathew Thomas Manampuram, Mayur S. Warad, S. K. Ranjani, Sushmita Sulhyan
      Pages: 40 - 44
      Abstract: Background: The ongoing COVID-19 pandemic declared by the WHO was compounded by the sudden and unexpected increase of Rhino-orbital mucormycosis infections during the year 2021. Mucormycosis a life-threatening infection, with added COVID-19 infection further increases the morbidity and mortality of the disease. Our aim is to shed some light on possible risk factors, treatment options and outcomes when these diseases occur together. Methods: 22 cases diagnosed with rhino-orbital mucormycosis with history of COVID-19 infection were selected. Cases underwent surgical and medical management. Patients were followed up for 3 months and were continued on medical treatment and regular post-operative DNE, CECT PNS and brain and relapses were treated accordingly. Results: Of these 22 patients, 15 were males and 7 were females ranging between 31-60 years. 15 (68.18%) had history of DM, 16 (72.72%) gave history of oxygen therapy and 18 (81.82%) had history of high dose steroid therapy. 15 (68.18%), 4 (18.18%) and 3 (13.64%) respectively underwent Endoscopic debridement, Total maxillectomy and Medial maxillectomy. There were 3 cases of relapse which were managed with additional full course treatment with Intravenous Liposomal Amphotericin B. Conclusion: COIVD-19 and uncontrolled DM to both be probable pre-disposing factors for developing Mucormycosis. Oxygen therapy & high dose of steroids used in the treatment of COIVD-19 may increase incidences of mucormycosis. Early treatment with surgery is necessary to reduce the need for more radical procedures and improving the recovery.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240056
      Issue No: Vol. 10, No. 1 (2024)
       
  • Are we ushering into the pre-antibiotic era: alarming trends of antibiotic
           resistance in chronic otitis media in a tertiary care hospital in Delhi,
           India

    • Authors: Nitish Aggarwal, Deepika Sethi, Akshay Tamrakar, Ashwani Sethi
      Pages: 45 - 49
      Abstract: Background: Chronic otitis media is an infection of the middle ear cleft for at least 12 weeks or more. It has a high prevalence rate in India pertaining to factors like malnutrition, overcrowding and poor hygiene. Thanks to greats like Paul Ehrlich and Alexander Fleming, Antimicrobials are a powerful and readily available form of treatment for this disease. Methods: In this study we re-evaluated the changing trends in bacteriological profile of COM and the antibiotic sensitivity pattern to most of the currently available antibiotics in a tertiary care hospital in India. Results: Most common pathogens found in our study were Pseudomonas aeruginosa, Staphylococcus aureus, Proteus mirabilis, Proteus vulgaris, Enterococcus, Escherichia coli and Morganella morganii. A declining pattern in the sensitivity towards commonly used antibiotics with an alarming increase in MRSA was observed. Conclusions: The trends observed in our study warrant an urgent need for antibiotic policies, judicious use of antibiotics and vigilance in our hospitals.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240057
      Issue No: Vol. 10, No. 1 (2024)
       
  • The study of management of cerebrospinal fluid rhinorrhea at tertiary care
           center

    • Authors: Rinkal H. Chaudhari, Kaivan K. Shah, Keval Trivedi, Shailee Mehta
      Pages: 50 - 53
      Abstract: Background: CSF Rhinorrhea is clinically emergency condition in Otorhinolaryngology. Patients were presented with unilateral watery nasal discharge. In the evolving world, CSF leak repair done via endoscopic method. Recurrence is very less with endoscopic repair method of CSF leak. Methods: We took complete history, complete Ear, Nose, Throat and Head and Neck examination, Endoscopic examination of nasal cavity followed by Radiological test in the form of MR Cisternography. Depending upon the site of leak, CSF leak repair done via endoscopic method of overlay and underlay and with the help of fascia, fat, surgical, flap, fibrin glue and cartilage. Results: Total 30 cases analysed where 63.33% & 26.67% patients have defect at cribriform plate & fovea ethmoidal is respectively. 63.33% patients are male, almost all patients are adults. 73.33% are spontaneous & rest are traumatic, 43.33% have circular defect, 36.67% have horizontal defect, 53.33% are treated with fat, surgical, fascia, fibrin glue, 40% are treated with above-mentioned things with flap, 6.67% patients are treated with above-mentioned things with cartilage. Conclusions: Most of CSF leak are spontaneous in nature, most of patients had defect in cribriform plate that too in anterior portion of the plate, almost all patients were adults, more females had defect than males, circular defects are slightly more common than horizontal ones, and most of the patients didn’t need flap or cartilage during surgery.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240058
      Issue No: Vol. 10, No. 1 (2024)
       
  • A study on hearing screening using oto-acoustic emissions in newborns
           delivered by normal vaginal delivery and lower segment caesarean section

    • Authors: Swathi Appathurai, Ashwin Ashok Jaiswal, Subodh Kumar Saha, Arun Kumar Dora, Prachi Mene
      Pages: 54 - 61
      Abstract: Background: Hearing is one of the most complex systems of the human body and is a skill involved in the human social evolution. It has been estimated that around 900 million people by the end of 2050, will probably suffer from hearing loss. Our study aims to find out the correlation between the mode of delivery and the effect it has on newborn hearing screening. Methods: The Prospective study on 136 Newborn babies who were delivered in JLN Hospital & Research Centre, Bhilai, Chhattisgarh during October 2020 to August 2021. After obtaining detailed history all newborns underwent TEOAE screening and the data were then compared with the available literature. Results: We observed normal vaginal delivery newborns have passed the test by 97.91% and 89.58% when compared to LSCS delivered infants 97.15% and 86.36% in screening and diagnostic frequency respectively. COVID-19 infection was seen in 2.94% of pregnant mothers in the 3rd trimester. There were no babies who required BERA in our study Conclusions: Normal vaginally delivered newborns have higher pass rate in TEOAE test when compared with LSCS delivered babies. Covid-19 infection in antenatal mother can influence the outcome in 1st TEOAE tests. The pass rate in TEOAE hearing test in the screening frequency is found to be greater when compared with diagnostic frequencies. In a developing country like India, Universal hearing screening programs needs to be reached out to the most remote parts of the country, in order to identify at risk infants for hearing loss.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240059
      Issue No: Vol. 10, No. 1 (2024)
       
  • A clinicopathological study of various aetiologies of headache in
           otorhinolaryngology

    • Authors: Anjali Krishna B., Anirudh Shukla, Kavita Sachdeva, Rashi Goyal, Jagmohan Singh Dhakar
      Pages: 62 - 66
      Abstract: Background: Headache is one of the most common complaints with which a patient presents to an outpatient clinic. Because of the wide range of clinical presentations and etiologies, evaluation of headache is often a challenging problem for the clinician. In our study, we are finding out the possible aetiologies of headache in patients attending the otorhinolaryngology department. Methods: The patients underwent history taking and ENT examination involving hematological, radiological investigations and all data were recorded by in Microsoft excel Sheet and analyzed with the help of SPSS 20 software for windows. Results: The 128 (35.9%) patients had otomastoiditis, 120 (33.6%) patients had nasal mass, 33 (9.2%) patients had sinusitis, 29 (8.1%) patients had laryngeal cancer, 14 (3.9%) patients had tongue cancer, 2 (0.6%) patients had parapharyngeal mass and 31 (8.7%) patients had normal findings. Conclusions: Most common pathologies associated with headache in ENT are otitis externa followed by sympatomatic deviated nasal septum.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240060
      Issue No: Vol. 10, No. 1 (2024)
       
  • Risk of hearing loss in non-operated ear due to mastoid drilling

    • Authors: Neetu Agrawal, Kavita Sachdeva
      Pages: 67 - 73
      Abstract: Background: The study purpose is to evaluate the effect of drill-generated high intensity noise on hearing sensitivity in contralateral ear. Methods: Sixty patients who underwent mastoidectomy were studied to see the effect of mastoid drilling on hearing sensitivity in normal ear using pure tone audiometry (PTA) and distortion product otoacoustic emission (OAE) values recorded preoperatively and postoperatively. Results: For PTA, there is no significant hearing loss for 0.25 kHz and 0.50 kHz for all PODs. For 1 kHz, 2 kHz and average PTA there is significant temporary hearing loss from POD 1 to POD 7 which normalizes around POD 30. However, there is significant temporary threshold shift for 4 kHz and 8 kHz from POD 1 to POD 5 and the hearing sensitivity improves to preoperative levels at POD 7. For OAE, 1 kHz, 4 kHz and average OAE there is significant temporary hearing loss from POD 1 to POD 7 which normalizes around POD 30. However, there is significant temporary threshold shift for 2 kHz and 6 kHz from POD 1 to POD 5 and hearing sensitivity improves to preoperative levels at POD 7. There is a significant correlation between drilling duration and PTA averages and OAE averages. Conclusions: Sensorineural hearing loss is more prevalent following modified radical and radical mastoidectomy as compared to canal wall up mastoidectomy. The factors influencing postoperative contralateral ear sensorineural hearing loss are type and size of burr and the duration of burr use.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240061
      Issue No: Vol. 10, No. 1 (2024)
       
  • Epidemiological study on the association between tobacco chewing and
           cigarette smoking in head and neck cancer patients, India

    • Authors: Vijay Pratap Singh, Chandan Kumar Singh, Akash Kumar Singh, Sumantra Sircar, Vishal Mohan Singh, Arun Kumar Jha, Amit Kumar, Priyadarshi Ranjan
      Pages: 74 - 78
      Abstract: Background: Tobacco consumption, including smoking and chewing, is a significant risk factor for head and neck cancer in India. This study aims to examine the correlation between tobacco use and the causation of cancer among oral cancer patients. Methods: We used the hospital-based cancer registry database at Savera cancer and multispeciality hospital in Patna. This is a retrospective analysis of head and neck cancer patients. The study was conducted from January 2019 to December 2022, involving patients aged 18-75 years. Histopathology Confirmed cases (n=691) of head and neck cancer were categorized into four groups: Only smoking tobacco (N=286), Only chewing tobacco (N=243), Smoking and chewing tobacco (N=139) and non-smoking and non-chewing (N=23), and examined. Results: Among the random cases examined (n=691), the distribution was as follows: only smoking tobacco - 286 (41.4.0%), only chewing tobacco 243 (35.2%), Smoking and Chewing Tobacco 139 (20.1%), and non-smoking and non-chewing tobacco 23 (3.3%). Statistical analysis revealed a significant (p<0.005) association between tobacco consumption and oral cancer incidence. Conclusions: Long-term exposure to chewing/non-chewing tobacco appears to play an important role in the development of head and neck cancer. There is an urgent need for preventive measures, including targeted interventions and public health campaigns, to mitigate the burden of cancer associated with it.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240062
      Issue No: Vol. 10, No. 1 (2024)
       
  • Evaluation 172 patients of submandibular gland swelling with a case of
           adenocarcinoma, not otherwise specified: a needle in a haystack

    • Authors: Navneet Agarwal, Paridhi Ahuja, Sukriti Agarwal, Ayushi Dhawal
      Pages: 79 - 83
      Abstract: Background: Aim of the study was to assess the patients of submandibular gland pathology and to describe a case of adenocarcinoma, not otherwise specified (ANOS) of the submandibular gland in terms of clinical presentation, diagnosis, line of management and prognosis. Methods: The study was conducted as a retrospective review of all the patients who underwent submandibular gland excision in the last 6 years at the department of otorhinolaryngology, M.D.M. hospital, Dr. S.N. Medical college, Jodhpur. The records were assessed and statistically evaluated. Results: Out of 172 cases of submandibular gland excision, only 1 case of ANOS was seen. The rest included 134 cases were of chronic non-inflammatory process, 24 cases of sialolithiasis, 10 cases of metastasis from oral cavity cancer and 3 cases of primary squamous cell carcinoma. Fine needle aspiration cytology (FNAC) was not diagnostic in ANOS. Excision of the gland with primary closure was done. Adjuvant radiotherapy was given. Conclusions: ANOS has a rare occurrence in submandibular gland swelling and it is also very tricky to diagnose it. The nature of this malignancy is invasive and nodal metastasis is present. Surgical excision and post-op evaluation can be life-saving.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240063
      Issue No: Vol. 10, No. 1 (2024)
       
  • Clinical-epidemiological profile of vestibular migraine patients: Indian
           scenario

    • Authors: Divya Joy, Ayushi Agarwal, Rohit K., Sumit Singh, Vikas Kakkar, Akriti Sharma, Khushboo Arora, Anusha Stani
      Pages: 84 - 89
      Abstract: Background: The main objective of this study was to observe the Indian clinical scenario and analyse the clinical and epidemiological profile of patients with vestibular migraine. Methods: This is a retrospective observational descriptive study. The outpatient records of the vertigo clinic at Department of Otorhinolaryngology of SGT medical college, Budhera, Gurgaon, Haryana was assessed from April 2023 to July 2023. Patients who were diagnosed with vestibular migraine based on ICD classification as follows was included in the study. Results: Study population predominantly comprised of 77% (17) females and 23% (5) of males. Almost 80% of the study population belonged to age group 31-40 years. Each episode of vertigo lasts for seconds in 50% of the patients and minutes in 45% of the patients. All patients had episodic vertigo.59% of patients described the vertigo as rotatory,18 % of the study population reported imbalance,18 % described swaying and 5% reported blackouts. Most of the examination was normal except 5 out of 22 patients reported giddiness on testing vertical saccades. Conclusions: Vestibular migraine is an underdiagnosed condition in India, there’s not much research and awareness, hence this study aims to overcome these limitations. Most of the patients were middle aged women. The physical and audiological examination of most patients were normal but showing abnormalities on testing saccades.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240064
      Issue No: Vol. 10, No. 1 (2024)
       
  • Assessing intraoperative and postoperative complications associated with
           tonsillectomy in children: institutional study

    • Authors: Himani Sharma, Kaveri Birla, Srijan Bareja, Rohit Saxena, Pooja Bhati
      Pages: 90 - 93
      Abstract: Background: Tonsillectomy, a common procedure in children aged 2 to 18, aims to improve their well-being and minimize tonsil-related complications. Comprehensive risk assessment pre and post-surgery is crucial. This study analyzed numerous pediatric tonsillectomy cases to enhance our understanding of its safety and identify associated risk factors. Methods: A 24-month retrospective cohort study focused on 100 children (aged 2-18) who underwent unilateral or bilateral tonsillectomy at Sharda Hospital's ENT Department. Factors like age, gender, and complications during and up to 7 days post-surgery were analyzed. Results: Gender and age were assessed for their correlation with complications in tonsillectomy patients. No significant correlation was found between gender and intraoperative or postoperative complications (p-values: 0.679584 and 0.822866). The low phi coefficient (1.501E-22) supports this, aligning with the infrequent occurrence of intraoperative complications. Age also showed no significant association with complications (p=0.77216). Postoperatively, 49.11% experienced no issues within 7 days, while common problems included pain/discomfort (31.25%), nausea/vomiting (9.82%), and secondary hemorrhage (5.36%). Conclusions: This 24-month study on 100 pediatric tonsillectomy cases revealed no significant correlation between gender/age and complications. Postoperatively, the most prevalent issues included pain/discomfort, nausea/vomiting, and secondary hemorrhage, affecting nearly half of the patients.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240065
      Issue No: Vol. 10, No. 1 (2024)
       
  • Comparison between upfront surgery vs salvage surgery following definitive
           chemoradiation in the treatment of potentially curable locally advanced
           oral cavity cancer: a retrospective study

    • Authors: Subbiah Shanmugam, Aravind Shivakumar
      Pages: 94 - 99
      Abstract: Background: We conducted a study to compare the outcomes of upfront surgery and salvage surgery following definitive chemoradiation in locally advanced oral cavity squamous cell carcinoma. This study aims to compare the short-term outcomes (postoperative morbidity, recurrence) & long-term outcomes (overall survival, disease-free survival) between upfront surgery and salvage surgery following definitive chemoradiation in locally advanced oral cavity squamous cell carcinoma. Methods: A total of sixty patients with locally advanced oral cavity squamous cell carcinoma (T4a, N1-N2b) were retrospectively analyzed between January 2021 and August 2023. Thirty patients underwent upfront surgery followed by adjuvant radiation (group 1) while another thirty patients underwent salvage surgery following definitive chemoradiation (group 2) (radiation dose- 66-70 Gy) Results: Morbidity was found to be significantly higher in the salvage surgery group (group 2) when compared to the upfront surgery group (group 1) with a p value of 0.003. There was no statistical significance between the two groups in terms of disease-free survival and overall survival. Conclusions: This retrospective study shows that there are no significant differences in overall survival and disease-free survival amongst patients of locally advanced oral cavity squamous cell carcinoma treated with upfront surgery and salvage surgery following definitive chemoradiation. Morbidity is significantly higher in the salvage surgery group.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240066
      Issue No: Vol. 10, No. 1 (2024)
       
  • Tuberculous otomastoiditis: analysis of otological tuberculosis with
           intact tympanic membrane

    • Authors: Nandini Gupta, Divyanshu Sharma, Darshan Parikh
      Pages: 100 - 103
      Abstract: In recent years extra pulmonary tuberculosis has more frequently been associated with mastoiditis in patients with immunodeficiency state. Although tuberculosis of the mastoid or otomastoiditis is a very rare complication of tuberculosis today, when occurs it may cause significant morbidity. Complications such as facial paralysis and permanent hearing loss may develop. Our purpose was to evaluate the differential findings of tuberculous otomastoiditis and evaluation of outcomes in patients undergoing surgery along with anti-tubercular therapy rather than patients receiving only anti-tubercular therapy. We reviewed 12 cases of TOM, all of which had been confirmed on sputum and pathological examination following middle ear mucosal biopsy. Neuroradiologists analyzed the typical findings of HRCT temporal bone. Tympanomastoid ear surgery was planned according to the extent of the disease involved. The soft tissue attenuation in the entire middle ear cavity and extension to the external auditory canal (EAC) or mucosal thickening of the bony EAC, erosion of the ossicles and scutum was clinically significant. Patients who underwent tympanomastoid surgery showed better prognosis than the patients receiving anti tubercular drugs alone. Patients with extra-pulmonary tuberculosis, especially otomastoiditis should get operated to remove the disease along with anti-tubercular treatment to prevent complications.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240067
      Issue No: Vol. 10, No. 1 (2024)
       
  • TIRADS and BETHESDA correlation to histopathological results of thyroid
           nodules: a case series at Dr. Sardjito General Hospital, Yogyakarta

    • Authors: Sri Wulan Dhari, Sagung Rai Indrasari, Camelia Herdini, Danu Yudistira, Yulialdi Bimanto
      Pages: 104 - 109
      Abstract: Early diagnosis of thyroid nodules is necessary to identify malignancy before surgery. Fine needle aspiration (FNA) and ultrasonography (USG) are supporting examinations for diagnosing thyroid tumors. There have been several previous studies related to the sensitivity of each investigation compared to postoperative biopsy findings. Both have different diagnostic values, and it is hoped that if these two diagnostic methods are applied before surgery, they will have a higher sensitivity value in determining the type of thyroid nodule compared to a single examination. A single-center retrospective case series study. Socio-demographic and clinical data were obtained from hospital records. This study included six thyroid nodule cases, consisting of three (50%) women and three (50%) men. Patients had the appearance and clinical symptoms of swelling in the neck (100%), of which 50% had symptoms of difficulty swallowing and 16% had symptoms of shortness of breath. Three (50%) patients underwent isthmolobectomy, and 3 (50%) patients underwent total thyroidectomy. Three (50%) patients suspected of approaching malignancy based on TIRADS and BETHESDA underwent total thyroidectomy with postoperative histopathological results of non-malignancy. Three (50%) patients with suspected benign nodules based on TIRADS and BETHESDA underwent isthmolobectomy, with postoperative histopathological results indicating non-malignancy. The concordance of the results of the ultrasound examination (TIRADS) and histopathology of thyroid nodules before surgery (BETHESDA) compared with the results of the postoperative histopathological examination was 50%.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240068
      Issue No: Vol. 10, No. 1 (2024)
       
  • Incidence of tick as foreign body in ear in Western Pahang and case series

    • Authors: Ahmad Zamir Asyraf Rosli, Nur Farahin Rosdi, Najihah Hanim Asmi, Norkahfi Razali
      Pages: 110 - 112
      Abstract: We report the incidence of tick as a manifestation of foreign body in the ear in our centre and how climate change is a contributing factor in the increasing amount of tick densities. The removal of tick can be difficult in centres with limited equipment and expertise. The commonest presentations may include ear pain or ear bleeding. However, in certain occasions, patient may come with its complications, such as otitis externa, otitis media, and rarely, isolated facial nerve palsy. Further discussion includes a case series and the complications and management of the foreign body manifestation.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240069
      Issue No: Vol. 10, No. 1 (2024)
       
  • Late endoscopic removal of a bullet in the orbital apex

    • Authors: Yan Yu Chai, Sharifah Intan Safuraa, Yogesvaran Kanapaty, Mohamad Doi
      Pages: 113 - 116
      Abstract: We report a case of gunshot injury causing bullet embedded in the left orbital apex via entry point at left eyebrow with immediate left visual impairment. The exact location of bullet was identified using computerized tomography scan and the bullet was removed via endoscopic approach. The case showed the management of bullet removal with endoscopic guidance to minimise the injury to adjacent structure and for better cosmetic outcome without any external incision to the face. In the current case report the bullet was removed via endoscopic approach. Endoscopic removal of bullet in the orbital apex causes less local damage, less bleeding risk , better wound healing, and better cosmetic outcomes.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240070
      Issue No: Vol. 10, No. 1 (2024)
       
  • Rare case of mastoid osteoma: a case report

    • Authors: Udhaya S. Sankarapandian
      Pages: 121 - 123
      Abstract: Osteoma of the temporal bone is a very rare slow growing benign tumour of bone. They commonly arise from skull. Temporal bone osteomas are commonly present without symptoms, but may cause bony deformity, pain, and hearing loss depending upon the site. Osteomas may arise from external ear canals, but very rarely from mastoid bone. Aetiology is unknown and many theories are postulated like congenital, traumatic and infectious. Here, we are presenting a case of 30 years old lady, presenting with progressively enlarging hard lump behind right ear for 3 years. It was diagnosed as osteoma and confirmed by computed tomography (CT) scan. Complete excision is done until normal mastoid cortex/air cells are exposed.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240071
      Issue No: Vol. 10, No. 1 (2024)
       
  • A rare case report of dual swellings in the head and neck region in a male
           diagnosed as a right infra-auricular keratin cyst with right
           supraclavicular lipoma

    • Authors: Varunkumar J., Priyanka Kumar Arora
      Pages: 124 - 127
      Abstract: Benign neck swellings are commonly seen in adults as congenital swelling or acquired. But this case report documents the first case of two benign swellings on the same side of the neck in a male especially supraclavicular lipoma with no symptoms other than swelling. A 42-year-old male patient presented to our ENT out-patient department with one painless swelling below the right ear and another on the right side of the neck since the age of 23 years with no other specific complaints. The patient was planned for the fine needle aspiration and imaging studies which showed branchial cyst and lipoma respectively. Post-operative specimen showed a keratin cyst of the right infra-auricular area swelling and lipoma of the right Supraclavicular area swelling and the patient was followed up for 2 years with no recurrence. Our case of dual swellings with different etiopathogenesis on the same side in the head and neck region is being reported for the first time in the literature. This case report aids surgeons to plan for the complete excision with minimal complications as the swelling is close to the great vessels.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240072
      Issue No: Vol. 10, No. 1 (2024)
       
  • An unusual foreign body nose: a case report

    • Authors: Amruta V. Hippalgaonkar, Amod D. Pendharkar
      Pages: 128 - 130
      Abstract: Nasal foreign bodies constitute an emergency and are more common in children with insertion generally via anterior nares. Case presentation: We present a case of 57-year-old-man with unusual entry site foreign body nose after external trauma to face, confirmed by 3D computed tomography and extracted through nasal route without any complication. Thus, nasal foreign bodies, a frequent accident in medical practice, usually harmless, but if neglected may cause complications hence prompt extraction is important.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240073
      Issue No: Vol. 10, No. 1 (2024)
       
  • Intraoperative incidental finding of maxillary hypoplasia: a rare case
           report

    • Authors: Sama Rizvi, Riya Thakral, Stuti Shukla, Saurabh Singh
      Pages: 131 - 133
      Abstract: Hypoplastic and aplastic paranasal sinuses are rare conditions which can lead to obstruction of mucociliary clearance. most of these patients are asymptomatic, however these conditions may lead to chronic headaches and nasal obstruction which can be misleading towards the diagnosis of chronic rhinosinusitis. it has been reported in literature that conventional radiography could not differentiate between inflammatory pathologies, neoplasm, and hypoplasia of the sinus. Computed tomography and cone beam computed tomography are the modalities of choice to differentiate these conditions, wherein cone beam CT is found to be more accurate for diagnosis of hypoplasia. In the present study, we report an incidental intraoperative finding of hypoplastic left sided maxillary sinus of a 17-year-old male patient who had clinical features of chronic rhinosinusitis.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240074
      Issue No: Vol. 10, No. 1 (2024)
       
  • IgG4 related disease masquerading as a sinonasal mass: a case report and
           review of literature

    • Authors: Meenu Krishnan, Vijay Rangachari, Sanjeev Katti, Yathish G. Channabasappa, Susmita H. Rakshit
      Pages: 134 - 137
      Abstract: IgG4-related disease (IgG4-RD) is a relatively new autoimmune fibroinflammatory disease. Most seen to affect the pancreas and biliary tract, IgG4-RD of the nose and paranasal sinuses is very rare. Known to have tumour-like clinical presentations, they can present with varying levels of dysfunction of the organs they affect. In the paranasal sinuses, it can present with nasal block, discharge, bleeds, and sometimes, with symptoms that arise as a consequence of bony erosions and subsequent extension of the disease. We present a case of a 52-year-old lady, who presented with a painful swelling over the malar region with discoloration of the overlying skin. Radiological evaluation helps to check for bony erosions and soft tissue infiltration. Histopathology with immunohistochemistry helps to confirm the diagnosis of IgG4-RD. Most patients benefit from a long course of oral steroids and regular follow-ups, that help to prevent recurrence and ensure a good quality of life for the patient.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240075
      Issue No: Vol. 10, No. 1 (2024)
       
  • A looped nasogastric tube impacted in nasal cavity: a case report

    • Authors: Abhishek D. Khond, Elton C. Mendonca, Bhavini Verma, Ganesh D. Borewad
      Pages: 138 - 141
      Abstract: Use of nasogastric tubes is a common practice in modern medicine. However, their use entails various complications. At the same time these tubes need regular care and maintenance. Negligence regarding the same can add to the list possible complications. We report a case of an uncared and ignored nasogastric tube in a 22-year-old female which developed a loop and later got impacted in her nasal cavity during tube removal. The patient was referred to the on-call emergency otorhinolaryngology team who attended the patient immediately and assessed this rare complication. Routine tube removal could not be achieved. The tube was then promptly removed by endoscopic guidance under general anaesthesia. The nasal cavity had minimum bleed under endoscopic guidance and removal under vision was achieved. Such cases of nasogastric tube complications underline the importance of tube care as well as the precautions to be taken during their insertion and removal.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240076
      Issue No: Vol. 10, No. 1 (2024)
       
  • Ceruminous adenoma: an unusual mass in external auditory canal: a case
           report

    • Authors: Manali Bhat, H. Vijayendra, Vinay Kumar Vijayendra, Nilesh Mahajan
      Pages: 142 - 145
      Abstract: Most masses in the external auditory canal (EAC) are either polyps or granulations secondary to an underlying inflammatory process. Less common swellings are exostosis and osteomas, a tumour being quite rare. A middle-aged female presented with a mass in the ear which mimicked a meningoencephalocele. However, further study revealed it to be a benign neoplasm of the ceruminous gland of the EAC-a ceruminous adenoma. The tumour was successfully excised with no recurrence on follow-up. A clinician must keep in mind the differential diagnosis of a mass in the EAC. A thorough examination and radiological investigations help aid in the diagnosis.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240077
      Issue No: Vol. 10, No. 1 (2024)
       
  • Management of a recurrent third branchial arch fistula using combined
           endoscopic and open approach

    • Authors: Meenu Krishnan, Anitha Kumari, Ramani C. V.
      Pages: 146 - 148
      Abstract: Branchial cleft anomalies are rare, congenital lesions, that occur due to the maldevelopment of the branchial apparatus, during fetal maturation. Anomalies of the third and fourth arch contribute to a very small proportion of these. Most cases are detected in childhood, either as a cyst, sinus or fistula in the neck. Some of the common treatment approaches to third branchial cleft fistulas include endoscopic cauterization, open cervical fistulectomy and, in cases of recurrence, selective neck dissection. Here, we present a case of recurrent branchial fistula of the third arch, wherein we used a combined cervical and intraoral approach, conserving the thyroid cartilage, to achieve a complete excision of the fistula tract.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240078
      Issue No: Vol. 10, No. 1 (2024)
       
  • A rare case of unilateral lymphoid papillary hyperplasia of tonsil in a
           nine-year-old girl

    • Authors: Ekta Narang, Aarshi Gupta, Arti Khatri, Neha Jain, Sonali Tyagi, Dimple Chaudhary
      Pages: 149 - 151
      Abstract: We report a rare case of lymphoid papillary hyperplasia of palatine tonsil in a 9-year-old girl. It is a rare benign pathology characterised by papillomatous appearance of palatine tonsil with reactive lymphoid hyperplasia. Early recognition of this lesion is important because in spite of clinical feature being suggestive of malignant tumour, it is a benign tumour-like proliferation, that can easily be cured by tonsillectomy.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240079
      Issue No: Vol. 10, No. 1 (2024)
       
  • Tongue base schwannoma: a case report

    • Authors: Neha Anand Shendge, Biswanath Roy, Subhrojyoti Mukherjee, Alokendu Bose, Arpita Sutradhar
      Pages: 152 - 155
      Abstract: Schwannoma is a benign, slow growing tumor which is most commonly seen in the VIII cranial nerve. Schwannoma was first described by Verocay in 1910. We have reported a case of a 52 year old female who presented to the hospital with complaints of difficulty swallowing, change of voice and a growth on the posterior one third of the tongue. Biopsy was done and sent for histopathological evaluation which confirmed the diagnosis of Schwannoma. She underwent Lip Split with Mandibulotomy surgery which was done with a awake fiberoptic nasal intubation followed by general anesthesia. The tumor was excised in toto. Her postoperative period was uneventful. Mandibulotomy with lip split provides more than adequate visualization of the masses on the posterior region of the tongue, allowing better maneuvering, ease and precise results for a skilled surgeon. Transoral approach may be the most widely used technique but the decision should be based on the clinical evaluation such as the size, shape and the anatomy of the patient. Narrowing down to the technique of choice should be done after a comprehensive evaluation of that patient. A team of various specialities like Otolaryngologist, Anaesthetist and radiologist is required for optimal execution for this surgery. To enhance our understanding a literature review between 2006 and 2023 was done which included the reports on tongue base schwannoma. A large number of them underwent transoral excision of the mass with a minority choosing mandibulotomy with lip split. A limited array of literature is available for tongue base schwannoma cases.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240080
      Issue No: Vol. 10, No. 1 (2024)
       
  • An interesting case of extraluminal migrating fish bone

    • Authors: Indutai G. Rathod, Vishal H. Pawar, Sujit M. Shivasharan
      Pages: 156 - 158
      Abstract: Hypopharyngeal and oesophageal foreign bodies are usually intraluminal but sharp foreign bodies can get impacted submucosally or extraluminally due to inadvertent attempt of removal by patient. Foreign body impaction is a common condition in Asian populations, with fish bone being the most common, often migrating to the lateral neck space or related organs. This case report emphasizes the significance of proper history and awareness among clinicians about the migration of fish bones, aiming to prevent diagnosis delays and potential complications. The present case depicts an unusual presentation of fish bone in case of 71 year old male patient farmer by occupation presented with chief complains of difficulty in deglutition, right side diffuse neck swelling associated with foreign body sensation in throat. The patient underwent clinical and radiological examination, which was diagnostically confirmed that fish bone present in retropharyngeal space. In management we had done tracheotomy followed by endoscopic examination and SOS removal but foreign body not found intraluminally. Patient started on higher antibiotics to decrease septic foci. Patient improved drastically and managed the patient conservatively. To our knowledge such a case has not been reported in literature.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240081
      Issue No: Vol. 10, No. 1 (2024)
       
  • Role of magnetic resonance imaging in sinonasal pathology: a review

    • Authors: Santosh Kumar Swain, Prerna Barik, Pradosh Kumar Sarangi
      Pages: 159 - 165
      Abstract: The last several years have seen a considerable advancement in the treatment of sinonasal diseases. The advent of minimally invasive functional endoscopic sinus surgery has led to an increased understanding of the anatomy and function of the sinonasal region, making previously inaccessible areas safe to operate in. The advancement in imaging of the sinonasal tract has been associated with the evolution of endoscopic sinus surgery. The imaging of sinonasal pathology has progressed from conventional radiographs (plain films) to computed tomography (CT) and magnetic resonance imaging (MRI). Technological advancements in CT and MRI have given a precise differential diagnosis and greater detail about the anatomical extent of sinonasal pathologies. Because the high water content of the inflammatory state causes a markedly enhanced signal on T2-weighted scans, MRI can currently distinguish between retained secretions and inflammatory responses from the mass of the tumor. The invasive lesions affecting the soft tissues outside of the sinonasal region are more easily distinguished by MRI. MRI largely took the position of CT scan for malignant sinonasal lesions due to its superior capacity to distinguish between inflammation and tumor and its increased sensitivity for intracranial extension. MRI can be more useful than a CT scan in demonstrating the degree of soft tissue abnormalities and in identifying lesions that have returned after surgery.
      PubDate: 2024-01-25
      DOI: 10.18203/issn.2454-5929.ijohns20240082
      Issue No: Vol. 10, No. 1 (2024)
       
  • Nasopharyngeal Burkitt lymphoma masquerading as adenoid hypertrophy in an
           adult: a diagnostic challenge

    • Authors: Deepika Eswari D., Sunil Pai, Ajay Kumar, Ramnath Shenoy, David Rosario, Hanock Nischal, Herison J.
      Pages: 117 - 120
      Abstract: This case report presents the diagnostic challenges encountered in identifying nasopharyngeal Burkitt lymphoma (BL) in an 18- year-old male initially misdiagnosed with adenoid hypertrophy. BL, a rare and aggressive B-cell non-Hodgkin’s lymphoma (NHL), typically manifests in cervical lymphnodes or facial bones, making nasopharyngeal involvement unusual. The patient's symptoms progressed from nasal blockage to oropharyngeal dysphagia and neck swelling, prompting further investigation. Radiological assessments, including a CT scan, were inconclusive, leading to a diagnosis through excisional biopsy and immunohistochemistry, confirming BL with CD20, CD10, and Bcl-6 expression. Successful treatment involved six cycles of chemotherapy, resulting in complete remission. This case underscores the importance of considering rare malignancies in atypical presentations and highlights the role of comprehensive diagnostic approaches in achieving accurate and timely management.
      PubDate: 2023-12-30
      DOI: 10.18203/issn.2454-5929.ijohns20234163
      Issue No: Vol. 10, No. 1 (2023)
       
 
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Publisher: Medip Academy   (Total: 12 journals)   [Sort by number of followers]

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JournalTOCs
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Email: journaltocs@hw.ac.uk
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