Unresolved Issues with Repeated MRI and CT Scan of the Brain in Vestibular Migraine and Recurrent Vestibulopathy: A Case Study

 

Abstract

Vertigo and vestibular disorder are on of common illness that still having multiple and unresolved issues especially in term of diagnosis and management. Limited awareness of the actual protocol for the vestibular disorder management lead to unnecessary investigation among the vertigo patients. Many clinicians in our set up focusing more on investigation such as repeated MRI and CT scan of the brain in order to rule out the cause of the problem. Due to this will lead to financial burden to patients and not an optimum management. Since after several investigation and undefined diagnosis patient will end up with the frustration and prolonged the problem without proper management. Recurrent vestibulopathy and Vestibular migraine is among the most common causes of recurrent vertigo in the general population. Despite its high prevalence and impact on healthcare management cost, it has remained an under-recognized condition and unknown pathophysiology. Recurrent vestibulopathy and vestibular migraine common illness that having unclear mode of therapy. In this case the optimum management is intensive vestibular Rehabilitation (VRT) needed and not a medication or injection that only symptomatic relieve. A 48-year-old lady, underlying migraine and hypertension was presented with spinning sensation for 1 year associated with left ear tinnitus. Improved almost 60% after intensive vestibular rehabilitation in ward for 4 days using BAL EX Quick balance module. Optimum and end solution able to achieve using proper diagnosis and management.

Keywords: Migraine; recurrent vestibulopathy; vestibular rehabilitation

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Health vs Environment with a Focus on Otolaryngology: A Sociological Appraisal

 

Abstract

Sociologically speaking, environment, especially the built environment has highly affected the human health in particular in urban areas where population is more concentrated, merged with industries and the pollution diluted. The current urban life is exposed to many disorders and health issues. Under such circumstances, the developed countries have access to better means of treatment especially otolaryngological facilities, whereas the developing countries are generally in short of the necessary medical means. What the developing countries need to do is to invest more on their educational atmosphere, wide-spreading education in all corners of their countries regardless of race, gender, creed and color. That would be a good column for the next healthy generations. Environmental health includes neighborhood spaces, schools, and the places where we live. Based on environmental sociological perspectives, qualitative differences between different environments should be reduced to a minimum. However, population density and extensive and continuous migration have caused different geographical environments to have different environmental health. Environmental diseases largely reflect racial and class status such as habitat and climate which are interrelated, and also affect human health.

Keywords: Environmental effects; air pollution; urban environment; environmental justice; healthy generations

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Negative Pathology Report Following Salivary Gland Surgery for Suspected Primary Tumor– What Went Wrong?

 

Abstract

Objective: For patients undergoing an oncologic surgery, postoperative pathological diagnosis negative for a tumor is a confusing outcome. Additionally, it may carry clinical and medicolegal consequences. The study defines the causes of such discrepancies in order to prevent such instances in the future.

Methods: A retrospective cohort study of patients who had undergone resection of a major salivary gland for a suspected or diagnosed primary tumor but had no tumor on surgical pathology.

Results: Eight patients (2.5%) had negative pathology. Causes for negative pathology were A) Surgical pathology error (n=3) B) Surgical management error (n=1) C) Surgery for definite diagnosis (n=2) D) Unexplained (n=2).

Conclusions: Negative pathology in salivary gland surgery is not rare. Negative pathology should raise the suspicions of both the surgeon and the pathologist. An immediate multidisciplinary review of all data will find the cause in most cases Keywords: Negative pathology; no tumor on pathology; salivary gland tumor; parotid gland tumor

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Changes in Allergy Pattern in Covid Pandemic

 

Introduction

In accordance to the above statement, both- the basic problem and the solution to this problem have been mentioned & that is- ‘stay home, stay safe and follow the Covid protocols’. In the last 2 years, the world has witnessed this century’s one of the most dreadful and contagious viral infection- Covid 19.

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Orbital Ameloblastic Carcinoma – Unusual Presentation in A Non-Odontogenic Location

 

Abstract

Ameloblastic carcinoma has been described as an ameloblastoma in which there is histological evidence of carcinoma in a primary or recurrent ameloblastoma. The frequency of the lesion is estimated to be less than 1% of all ameloblastomas occurring in the mandible and maxilla.1 We present a case of a 30-year-old woman who presented with painless swelling of left upper face and recurrent upper respiratory tract infections. She was evaluated with CECT, MRI and PET-CT which showed 3.6 x 3.5 x 3.3 cm mass arising from the inferomedial wall of left orbit with sunburst periosteal reaction and cloudy osteoid matrix which was thought to be an osteosarcoma. She underwent a transorbital and trans nasal endoscopic wide local excision of the lesion which was then diagnosed as ameloblastic carcinoma on histopathology. Imaging features and pathological findings of the tumor along with novel treatment strategies and differential diagnosis are discussed in this case report.

Keywords: MRI; orbital tumor; ameloblastic carcinoma; osteosarcoma; CECT; PET

Abbreviations: 18F-FDG-PET: 18F-fluorodeoxyglucose–Positron Emission Tomography; CECT: Contrast Enhanced Computed Tomography; FLAIR: Fluid Attenuated Inversion Recovery; MRI: Magnetic Resonance Imaging; WHO: World Health Organization

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Meniere’s Disease: Its Possible Cause

 

Short Communication

There is a disease identified in the 19th Century that causes hearing loss beginning at age 30 -60. Not only is it associated with sensorineural hearing loss, but also dizziness and ringing in the ears. I propose that the cause of Meniere’s Disease is the result of a misalignment of the head relative to the spine.

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Novel Personalized Biologic Driven Strategies in Head and Neck Cancers – Empirical Cancer Care Leaping Towards Precision Care

 

Abstract

Precision medicine is the targeted therapy with personalized approach to cancer treatment, ultimately Resulting in more precise targeting of tumor cells and spares the normal tissues and with minimal toxicities. The currently practised precision/targeted approaches in head and neck cancer are either based on the patient-specific or tumor-specific characteristics which includes the underlying etiology, tumor microenvironment or the genomics. The concept of precision medicine in oncology is focused on identifying therapies that are based on the genetic characterization of a patient’s tumor, thereby tailoring the cancer treatment to a specific gene mutation in an individual patient’s cancer. Though radiation oncology with the recent advancements with image guidance and functional imaging provides a more individualized treatment, it can be further optimized by the incorporation of novel biologic driven strategies, by consolidating the data obtained from genomics and radio genomics. This upgrades the treatment options with de-intensification or intensification based on the patient and tumor characteristics and etiology. This is currently achieved by various immunotherapeutic agents already in practice with monoclonal antibodies and signal transduction inhibitors and can be further expanded by identification of neoantigens for cancer vaccines and checkpoint inhibitor gene panels, with predictive and prognostic objective in addition to therapeutic benefits.

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