WHAT ARE THYROGLOSSAL CYSTS

Thyroglossal cysts are fibrous cysts that forms due to a persistent thyroglossal duct. The thyroid gland usually develops in the oropharynx and then it descends to its final position through tongue, hyoid bone and neck muscles making a thyroglossal duct which usually closes before birth. If it remains open it is called persistent thyroglossal duct which can lead to a thyroglosssal cyst formation.

Symptoms:

Usually patients present with palpable lump in the midline of neck between thyroid and hyoid bone which moves swallowing and upward with protrusion of neck. Usually the patients are asymptomatic but a few of them might complain of dysphagia i.e. difficulty in swallowing or he can present with difficulty in breathing. Sometimes cysts can get infected.

Treatment:

Surgical removal is the mainstay. Sistrunk operation is performed in which hyoid bone is also removed to ensure the complete thyroglossal tract removal to prevent recurrence.

TUNING FORK TESTS

These tests are use for assessment of hearing in an individual, hearing loss. We can also differentiate between conductive hearing loss and sensory hearing loss using these tests.

Hearing Pathway: The sound first reaches the tympanic membrane via external auditory canal then via auditory ossicles (Malleus, Incus, Stapes) reaches the cochlea from where VIIIth nerve takes the impulse and take to brain in the temporal lobe. The pathway till cochlea is the conductive pathway.

So now for the test we need tuning fork, 512hz frequency is ideal as lesser frequencies produce more vibration on the bone and the tone of higher frequencies decay faster.

Air Conduction: It the conduction via normal pathway as described above. It is usually better than bone conduction.

Bone Conduction: When we put the base of tuning fork on the mastoid, or middle of forehead the sound waves travel directly via cranial bones to the cochlea bypassing the normal pathway. This is called bone conduction.

Below is a video showing how to do a Rinne Test.

Now there are usually three tests that we use in Tuning Fork Test

1. Rinne Test: It is done using a 512hz tuning fork. 1st we check the bone conduction by ringing the tuning fork and then placing the base of the tuning for on mastoid process. Ask the patient whether he can hear a sound or not and if he can hear the sound then ask him to raise his hand or simply tell you when the ringing stops. Note that time. Then again hit the tuning fork and place it near his ears and repeat the same procedure.

• Rinnes test is positive in normal people as Air Conduction > Bone conduction. 
• Rinnes Test is negetive In conductive hearing loss the BC>AC as there is problem in conductive pathway leading to decreased conduction but when we bypass the pathway via bone conduction the soun is percieved normally as cochlea is healthy. 
• Rinnes is positive in sensory neural hearing loss i.e. AC>BC but the duration of the ringing is reduced for both AC and BC, as cochleae is damaged so there is no bypass pathway left to carry sound energy to brain.

   2.   Webers Test: It is done by placing the tuning fork in the middle of the forehead of the patient. Then ask the patient on which side he can hear the sond better. In conductive hearing loss the sound lateralises to bad ear while in sensory neaural hearing loss sound goes to better ear

WHAT IS PARONYCHIA

Paronychia is a bacterial or fungal infection of hand where nail meets the skin. It could start suddenly called acute paronychia or it gradually called chronic paronychia.. It is usually common in diabetics. Acute paronychia usually occurs in bacterial infection whereas fungal infection causes chronic paronychia.

Symptoms: Usually the first symptom is painful, red swelling around the nail, often at the cuticle or at the site of hangnail or other injuries. Pus filled blisters can also be found specially in bacterial infection.

Treatment: Paronychia can effectively be treated with antibiotics like cephalexin or dicloxacillin. Topical antibiotics can also be used. When there is pus in loculi we need to drain it. Sometimes partial nail is also removed.

                    Fungal infection tends to heal slowly taking a period of around 4-6 weeks.

Prevention: 

• Care for nail and and skin around the nail properly.
• Do not bite or pich the nai
• Protect nails from damage
• Bring your manicure tools.
• Avoid gatting damage to flaps.

DIABETES COMPLICATIONS: THE DIABETIC FOOT

The diabetic foot occurs due to decreased blood supply to lower limbs due to accelerated arterial hardening also called atherosclerosis, nerve damage which leads to decreased sensation in foot, tight fitting shoes etc. Since there is poor blood and nerve supply, even a small trauma or infection can cause a very serious damage which can lead to even amputation of limbs. Below is a video of diabetic foot in an uncontrolled diabetic patient.

Treatment includes antibiotics, daily dressing of the wound with vitE, trental ointments (which increase blood flow in lower limbs) can be used. 

Surgical management includes debridement of the infected area and then dressing and antibiotics. If that doesnt help then amputation is the last resort.

DIABETES MELLITUS

Diabetes mellitus is a group of metabolic disease in which patient cant utilize glucose present in the body either due to decreased insulin or due to insulin resistance in body. There are basically two types of diabetes:

• Diabetes Mellitus Type I: It occurs due to destruction of insulin producing cells ( beta-cells) in the islet of Langerhans of pancreas. This occurs due to some autoimmune disorders, pancreatitis, infections. Destruction of beta-cells leads to decreased production of insulin. Insulin is required by muscle cells to draw the sugar in blood into themselves. But in absence of insulin they cant do it and sugar remains circulating in blood leading to a rise in blood sugar level i.e. Diabetes.

• Diabetes Mellitus Type II: This type usually occurs in obese people in whom resistance to insulin developes. So there is insulin but muscle cant use them for glucose uptake as insulin cant attach to its receptors because the receptors becomes defective. Pancreas tries to overcome to this situation by producing increased amount of insulin, which leads to increased weight in turn. But after some period of time the pancreas gets exhausted of overwork and the insulin levels start to decline.

Symptoms: The patient usually feels lethargic, due to decreased amount of glucose in muscle. Thirst, Polyuria occur when kidneys no longer can retain the sugar lost in urine leading to increased osmotic outflow. Increased appetite is also a symptom.

Usually in type I diabetes the symptoms lead to diagnosis at once but there is no hidden disease while in type II patient develops symptoms very late and is diagnosed late or accidentally during regular check up.

Treatment:

Type I can be treated by using insulin, combination of insulins.

Type II: Here diet and lifestyle modification along with oral hypogycemics like metformin is prescribed. Exercise usually helps to decrease the insulin resistance. But after a few years when beta cell get exhausted of producing excess insulin, recombinant  insulin injections are required.