Background: Even after achieving tremendous advances in diagnosis and treatment of rheumatoid arthritis (RA), many of the patients undergo delays in diagnosis and initiation of treatment, which leads to worsening of the condition and poor prognosis. Objective: The objective of this study was to perform a literature review to quantify the lag times in diagnosis and treatment of RA and study the reported factors associated with it. Methods: The authors searched literature published until September 2016 in electronic full-text and abstract databases and hand-searched the suitable articles. Results: The weighted average of median lag time from symptom onset to therapy was 11.79 months (12 studies, 5,512 patients, range 3.6–24.0 months). Lag1 was 3.14 months (onset of symptoms to first physician consultant; 12 studies, 6,055 patients, range 0–5.7 months); lag2 was 2.13 months (physician visit to RA specialist referral; 13 studies, 34,767 patients, range 0.5–6.6 months); lag3 was 2.91 months (consultation with rheumatologist to diagnosis; 3 studies, 563 patients, range 0–5 months), lag4 was 2.14 months (diagnosis to initiation of disease-modifying antirheumatic drug therapy; 5 studies, 30,685 patients, range 0–2.2 months). Numerous patient- and physician-related factors like gender, ethnicity, primary care physician knowledge of the condition, availability of diagnostics, and so on were responsible for the delays. Conclusion: This review estimated the delay times and identified the main factors for delay in RA patients in diagnosis and initiation of treatment. A most plausible solution to this is coordinated effort by the rheumatology and primary care physicians.

Acute respiratory infections (ARI) are a major public health problem and one of the commonest reasons for visiting primary health care centers (PHC). In developing countries, seventy-five percent of the cases are treated with antibiotics, although the majority are caused by viral infection. Our aim was to observe the pattern of physician practices with...

Giant-cell tumor of soft tissue (GCT-ST) is a rare neoplasm that was first described in 1972. Due to its histological and immune-histochemical similarities with GCT of bones, GCT-ST is thought to be its counterpart. This review article aims to recognize the characteristics of this rare tumor along with a favorable way to diagnose and treat. We reviewed 12 cases of GCT-ST in the head and neck. This tumor involves both sexes at any age. Histopathology in many cases revealed the presence of mononuclear cells and spindle cells. Immunohistochemistry was positive in many cases for CD68. Complete excision was the most accepted management technique; however, few cases reported recurrence and metastasis. Post-operative radiology is suggested to prevent local recurrence and in case of incomplete excision of the tumor.

Giant cell tumor of soft tissue is a rare benign tumor of low malignant potential. It counterparts soft tissue bone tumor. Majority of cases are in extremities and to a lesser extent in other regions but rarely in head and neck. Here we report for the first time giant cell tumor of soft tissue in the ear. A 28 years old female presented with painless right ear mass slowly progressing over 2 months associated with discharge for 2 weeks. The condition was initially diagnosed as chronic otitis media. CT scan and Excisional biopsy was done. Microscopically, examination revealed multiple tumor nodules that diffusely infiltrate the soft tissue and covered partially by unremarkable epithelium. The nodules are composed of bland mononuclear cells, short spindle cells and osteoclast giant cells. The mononuclear and giant cells lack striking atypia. However; the mononuclear cells exhibit brisk mitotic activity. The tumor was completely excised and follow up was scheduled after 1 year

Vocal cord nodules (VCNs) can be treated with a variety of therapeutic approaches, with controversy regarding the optimal management. This review provides an overview of the most commonly used management strategies and their outcomes to enhance decision making. We conducted a systematic literature search on PubMed, Web of Science, and Scopus to include relevant original articles published in peer-reviewed journals from inception through April 2024. We used a broad search strategy including the following search keywords: "Vocal" AND "Nodules" OR "Lesions." All interventions were included, such as speech or voice therapy, medication, surgery, and other therapies. Two authors independently conducted initial screening, full-text screening, inclusion, and data collection. Disagreements were settled by consensus or, if persistent, by a senior author. A total of 18 articles were included in the current scoping review. Voice therapy is highlighted as the preferred non-invasive treatment; however, it requires a longer duration to show results. In children, voice therapy is further limited by non-compliance, which may result in delayed recovery and increased psychological and economic burden. Surgery offers immediate improvements but necessitates postoperative voice therapy to prevent recurrence. In hard or mature nodules, surgery showed superior efficacy compared to voice therapy. Pharmacotherapy is principally indicated to treat an underlying disease and is often prescribed as an adjunct to voice therapy. Patient age, duration of the disorder, morphological features of VCNs, and compliance with voice therapy are significant prognostic factors in determining the success or failure of different treatment modalities. We propose a management algorithm that incorporates these key factors to assist in effective management and decision making. In addition, the management of VCNs requires a methodical approach that considers the prognostic factors associated with each treatment modality. We propose a key-factor-based algorithm that incorporates these factors to assist in therapeutic decision making and guide future research toward establishing definitive guidelines.

Respiratory disease caused by a mutant coronavirus variant has spread rapidly worldwide. According to reports, the COVID-19 version propagated at the end of 2019 and originated in Wuhan, China. On January 30, 2022, the World Health Organization declared the outbreak a Public Health Emergency of International Concern, and on March 11, 2020, the outbreak has declared a pandemic. The COVID-19 infection might appear with no symptoms, very few symptoms, or extremely severe symptoms We are the first to identify sudden sensorineural hearing loss (SSNHL) as a side effect in COVID-19 patients who have fully recovered from the illness. Additionally, all reported cases of this presentation have an unexplained unilateral left ear involvement. This article reviews the literature and four cases of COVID-19 patients with SSNHL. We present four cases of COVID-19 positivity that were verified by PCR analysis of nasopharyngeal swabs. After fully recovering from the infection, all patients developed acute sensorineural hearing loss on the left side. A deterioration in the hearing ability among COVID-19 survivors makes it possible that the problem persists long after their recovery from infection. To support such a claim, additional in-depth research is required. The current study, in our opinion, will contribute to an increase in understanding about COVID-19, promote awareness, and alert healthcare professionals to take into account and discuss any symptoms.