A Lingual thyroid is relatively rare. Of all ectopic thyroids 90 % are found to be Lingual thyroids. We report a case of 32 year old female who presented to us with history of mass on back of the tongue with history of dysphagia.The clinical, biochemical and radioisotope scanning confirms the diagnosis of lingual thyroid with hypothyroidism. Patient was treated with levothyroxine. After treatment, Lingual thyroid reduced in size and patient improved symptomatically.

Background and ObjectivesAuditory brainstem response (ABR) is a noninvasive measurement of a stimulus-locked, synchronous electrical event. ABR provides information concerning the functional integrity of brainstem nuclei. Age is a key factor in the interpretation of ABR peak latency among different age groups. Progressively with time it follows a "maturation pattern" during which latencies decrease. Wave V is very prominent and reliable for detection of threshold in children. The present study was performed to see the effect of age related auditory maturation on ABR wave V latency in children.Subjects and MethodsThe study involved 80 subjects ranging in age from birth to 12 years. The subjects were divided equally into eight age groups. ABR were elicited by an acoustic click stimuli, brainstem responses collected through electrode and recorded at the same time. Latency of wave V was acknowledged.ResultsWave V latency decreased rapidly in early childhood, became slower after 3 years of age and completely matured by 12 years of age. There was no significant difference in latency of wave V between the ears with age.ConclusionsThere is a distinct maturation pattern of wave V latency in ABR for both ears. ABR is a reliable test to assess the functional maturation of wave V in children.

Background Hyderabad, Pakistan, was the first city to witness an outbreak of extensively drug resistant (XDR) typhoid fever. The outbreak strain is resistant to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, fluoroquinolones, and third-generation cephalosporin, thus greatly limiting treatment options. However, despite over 5000 documented cases, information on mortality and morbidity has been limited. Objective To address the existing knowledge gap, this study aimed to assess the morbidity and mortality associated with XDR and non-XDR Salmonella serovar Typhi infections in Pakistan. Methods We reviewed the medical records of culture-confirmed typhoid cases in 5 hospitals in Hyderabad from October 1, 2016, to September 30, 2018. We recorded data on age, gender, onset of fever, physical examination, serological and microbiological test results, treatment before and during hospitalization, duration of hospitalization, complications, and deaths. Results A total of 1452 culture-confirmed typhoid cases, including 947 (66%) XDR typhoid cases and 505 (34%) non-XDR typhoid cases, were identified. Overall, ≥1 complications were reported in 360 (38%) patients with XDR typhoid and 89 (18%) patients with non-XDR typhoid (P<.001). Ileal perforation was the most commonly reported complication in both patients with XDR typhoid (n=210, 23%) and patients with non-XDR typhoid (n=71, 14%) (P<.001). Overall, mortality was documented among 17 (1.8%) patients with XDR S Typhi infections and 3 (0.6%) patients with non-XDR S Typhi infections (P=.06). Conclusions As this first XDR typhoid outbreak continues to spread, the increased duration of illness before hospitalization and increased rate of complications have important implications for clinical care and medical costs and heighten the importance of prevention and control measures.

Objective:The objective of this study was to determine patterns and frequency of antimicrobial drug use among hospitalized patients with community-acquired pneumonia (CAP).Methodology:A retrospective 5 years (April 2007–March 2012) detailed medical record review of patients diagnosed with CAP and discharged to home from Non-Intensive Care Unit respiratory medicine wards of two public hospitals in Delhi.Results:A total of 261 medical records were analyzed. Over the 5 years, 82.0% (2007–08), 78.6% (2008–09), 59.5% (2009–10), 64.7% (2010–11), and 67.8% (2011–12) patients were prescribed two antimicrobials. In the last two study years, the proportion of patients receiving three antimicrobials increased (from 2.0% to 26.5% and 28.8%), while the proportion receiving monotherapy decreased (from 16.0% to 8.8% and 3.4%). In accordance with guidelines, beta-lactams and macrolides were the two most frequently prescribed antimicrobials (34.1%). However, newer generation beta-lactams were prescribed. A total of 37 patients were prescribed beta-lactam-tazobactam combination preparations. Overall, beta-lactams constituted more than 40% of prescriptions while macrolides were the second most prescribed class. Cephalosporin prescriptions significantly increased (P < 0.01) and penicillin prescriptions significantly decreased over study periods. The prescription of fluoroquinolones also decreased (21.5–6.0%, P < 0.01) and aminoglycoside prescription ranged from 9.7% to 16.4%, over 5 years. Reasons for prescribing three antimicrobials, use of aminoglycosides, or higher-end/reserve antibiotics were not mentioned in the medical records. There were no hospital-specific guidelines for doctors to follow in the treatment of CAP.Conclusions:These findings suggest the need for implementing antimicrobial treatment guidelines. Adequate documentation and monitoring of antibiotic use for feedback are also lacking. An antimicrobial stewardship program may offer the most comprehensive solution for appropriate use of antimicrobials.