Most Western clinical decision support systems (CDSS) fail to contextualise to India’s healthcare realities, limiting their adoption by healthcare workers (HCWs) and patients. With the rapid evolution of India’s telemedicine ecosystem, there is an urgent need for an indigenous, validated, and scalable AI-based CDSS integrated within national platforms to improve diagnostic accuracy and care delivery. This study, conducted between 2022–2024 by an AI Centre of Excellence of the Government of India, focused on developing, validating, and implementing a knowledge-based CDSS symptom entry Physician Assistance Form (PAF) within eSanjeevani—India’s national teleconsultation platform. The study was conducted in three phases, each of which was interdependent, overlapping, and dynamic in nature. The AI system development utilised retrospective eSanjeevani 1.0 data (64 million consultations), extracting 0.22 million SNOMED CT–aligned records to identify 29,000 unique symptoms, which were refined to 115 for model training in the initial plan during 2022. The upgraded eSanjeevani 2.0 (2023) incorporated AI-based differential diagnosis, which was later expanded to include 300 symptoms (2025) with branching logic that integrated patient age, gender, language, and multidimensional symptom attributes. Expert clinicians validated the symptom repository, logic flow, and AI-generated diagnoses. The validated CDSS was implemented in eSanjeevani 2.0, providing real-time differential diagnosis and departmental recommendations during assisted and non-assisted teleconsultations. Integration of AI-CDSS improved structured data capture, enhanced diagnostic precision, and streamlined patient triage within teleconsultations. India’s AI-CDSS initiative represents the first government-supported, large-scale CDSS integration in a developing country, offering a replicable, ethical, and contextually grounded model for other LMICs to advance equitable and quality telehealth services.

Introduction:Stroke is a leading cause of mortality and disability in India, and the hospital and intensive care unit (ICU) beds are limited. This randomized controlled trial (RCT) aimed to assess the effectiveness of early tracheostomy (ET) in reducing 30-day mortality in stroke patients, and secondary objectives included evaluating rates of ventilator-associated pneumonia (VAP) and length of ICU stay compared to late tracheostomy (LT). Methods:This open-label RCT was conducted over 18 months at a tertiary care hospital in north India, involving 60 patients (30 in each group). Eligible participants were adults (≥18 years) with nontraumatic stroke (acute ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and vasculitic infarcts) requiring prolonged intubation (stroke-related early tracheostomy score ≥8). Exclusions included preexisting pneumonia, high oxygen needs, pregnancy, and those on ventilation for over 4 days. Patients were assigned to ET (day 4) or LT (day 10), with demographics and clinical characteristics recorded. Mortality was assessed on day 30 postintubation and data for secondary outcomes were collected every other day. Results:Sixty-four patients were randomized, 30 to the ET group, and 34 to the LT group, with a mean age of 55.48 (±15.94) years. Mortality within 30 days was 50% in both groups. VAP rates were 43.3% in the ET group and 50% in the LT group (P = 0.605). The mean ICU length of stay was 12.07 days for ET and 18.43 days for LT (P = 0.0001). Conclusion:The RCT found no significant differences in mortality or VAP rates but noted reduced ICU hospital stays for the ET group, suggesting benefits for severe stroke patients.

Mucormycosis is a serious fungal infection affecting immunocompromised individuals, caused by fungi from the Mucorales order, particularly Rhizopus species. It primarily spreads through inhalation of spores, with diabetes, cancers, organ transplants, immunosuppressive drugs, and COVID-19 being major risk factors. The infection manifests in various forms such as encephalic, cutaneous, gastrointestinal, pulmonary, and rhino cerebral, often leading to tissue necrosis and blood vessel invasion. Imaging diagnosis is aided by CT and MRI scans, while 99m Tc MDP bone scintigraphy has found to be a more accurate imaging tool to look for bone remodelling and erosive changes associated with invasive fungal sinusitis including mucormycosis. Treatment involves prompt surgical debridement and addressing the underlying immune deficiency. Here we present a series of cases where 99m Tc MDP bone scintigraphy played a key role in management of mucormycosis of the head. In conclusion, 99mTc MDP scintigraphy is a promising tool for evaluation, guiding diagnosis and management of mucormycosis.

To assess the outcomes of carotid body tumor (CBT) excision using a microscope and microinstruments in a tertiary care center. This retrospective study reviewed six CBT patients treated between August 2021 and June 2024. Preoperative evaluations included clinical examination, contrastenhanced CT, and MRI with Angiography. All procedures were performed under general anesthesia using a Leica F20 M525 microscope. Surgical strategies involved microscope-assisted dissection with microvascular instruments and the use of bipolar cautery, suction, forceps, and irrigation for tumor removal. Postoperative outcomes and complications were documented. The average age of patients was 37.2 years, with a male-to-female ratio of 1:2. All patients presented with painless neck swellings, lasting an average of 6.2 years. Four tumors were Shamblin type III, and two were type II. The magnification,focal length, and field diameter ranged from 1.3x to 4x, 350 to 400 mm, and 4.2 to 14.7 cm, respectively. Tumor excision was successfully achieved in all cases, with an average operative time of 4 hours. Intraoperative complications included external carotid artery injury in one case. Postoperative issues included transient marginal mandibular paresis and vocal cord palsy in two patients. Microsurgical excision with microinstruments of CBTs is feasible and effective, providing precise tumor removal even in Shamblin type III and revision cases with minimal blood loss and cranial nerve injury. The microscope setting with microvascular instruments enhanced dissection, leading to superior outcomes for complex cases.

To estimate the association of mucormycosis with markers of iron metabolism and to correlate levels of serum ferritin with stage of mucormycosis. We conducted a case control study in hundred (50 cases and 50 controls) patients. Biopsy proven mucormycosis patients were taken as cases. Controls were selected from the same study population as the cases, and they were representative of the population at risk. Controls were matched for the age, gender, and all known risk factors of mucormycosis, and for each case, one control was taken. We enrolled 50 cases and 50 controls. Rhino-orbital mucormycosis (50

Malignancies arising from the external auditory canal are rare, with just 0.2% of all head and neck cancers. Only 4% of the external ear cancers arise from the external auditory canal. The most common histological variant is Squamous cell carcinoma, while neuroendocrine tumours are quite rare, with just 8 cases previously reported in EAC and few others in pinna. To the best of our knowledge, ours is the first reported case of poorly differentiated NET of EAC, which is involving pinna. The patient was a 56-year-old lady who presented with complains of right ear mass, blood-stained purulent discharge, decreased hearing and pain. Biopsy showed WHO grade III Neuroendocrine tumour. She was operated (lateral temporal bone resection with superficial parotidectomy and neck dissection with cervicofacial flap reconstruction). However, due to surgical site infection and flap failure, wound was again reconstructed with supraclavicular flap. She was planned for radiotherapy, but never turned for followup. The case represents the challenges in diagnosis, management and follow-up of such a rare entity.

Objectives: This study aims to analyse the surgical outcomes and quality of life (QOL) in surgically treated patients of JNA operated via open or endoscopic approach. Materials and methods: 30 patients diagnosed and surgically treated for JNA at AIIMS Rishikesh over a period of 6 years were recruited. It was an observational study wherein University of Washington Quality of Life questionnaire Hindi translated validated version (UW-QoL) was administered to patients to assess the QOL in the immediate post operative period under Physical, Physiological and Psychological domains. Results: The surgical outcomes of endoscopic approach group were comparatively better in terms of complications, intraoperative blood loss, hospital stay and quality of life. The items of 'Pain', 'Appearance', 'Speech', 'Swallowing', 'Chewing' and 'Activity' had significantly better outcomes in the Endoscopic approach, with p-values <0.05. The items of 'Taste', 'Saliva', 'Mood', 'Anxiety' and 'Recreation' had better scores in the Endoscopic approach group; however, the difference was not significant (p-values >0.05). Conclusion: Despite the aggressive nature and extent of surgery entailed in JNA, its effect on QoL has not been well reported. In today's era, the assessment of surgical outcomes has changed from clinical symptom improvement to improvement in mean physical and mental health. The medical model is shifting from radical to conservative approaches. This study throws insight into the better post-surgical outcomes and QoL via endoscopic approach, thus imparting lesser morbidity, lesser psychological stress, better cosmesis, haemostasis, early restoration of physiological functions of chewing and swallowing in the post-operative period with minimal complications and lesser duration of hospital stay in the young population. It also emphasizes the need of framing a robust questionnaire which will effectively help clinicians to develop new intervention tools towards less morbidity.

The purpose of this study is to assess the HRQOL and identify the potential risk factors for its deterioration in thyroid cancer (TC) survivors in India. We also aim to strengthen the existing COH-QOL (thyroid) Questionnaire by adding two missing items of tingling or numbness and scar on the neck in the physical and psychological domains, respectively. TC survivors were recruited from the ENT OPD and the Uttarakhand Thyroid Surgeries Registry System from a period of 2017 to 2022. Participants completed a Hindi-validated modified version of the COH-QOL (thyroid) Questionnaire to assess QOL domains. The correlation of QOL scores with different health conditions was done. QOL is affected after the initial TC diagnosis and treatment, with poorer scores in all domains. Quality of work is the most affected item in the social domain. The potential risk factors for deterioration in QOL scores are age, gender, employment, educational status, stage of disease, comorbidities, extent of surgery, hypocalcemia, RAI therapy, and thyroid hormone withdrawal. Given the rapidly increasing number of TC survivors, mostly of the middle age group, and the fact that it grossly affects the work performance scale, our study will help to develop robust monitoring tools, awareness programs, intervention strategies, and TC-specific survivorship plans.

Background Oral cavity squamous cell carcinoma (SCC) is responsible for 84% to 97% cases, with most common site being mobile tongue, buccal mucosa, floor of mouth and lip. The main alterations in 8th edition of AJCC for oral cavity SCC were addition of depth of invasion (DOI) of primary tumor in T category, and extra-nodal extension (ENE) in N category. Numerous studies have shown that the risk of neck lymph node metastasis increases apparently when the pathologic DOI is greater than 4.0 mm. Our study was first prospective study from North India in which 90 patients of oral cavity SCC were enrolled, after introduction of 8th edition of AJCC staging system. In these patients, diagnostic validation of MRI was done in assessment of DOI of oral cavity SCC, and these results were compared with histopathology, after surgery. Aim and Objective To determine the role of MRI in assessment of DOI of Oral Cavity SCC. Material and Method This prospective, cross-sectional study was conducted in a tertiary care hospital in North India, after Institutional Ethical Clearance, with 90 patients enrolled over a period of 18 months. All the patients fulfilling the inclusion criteria was subjected to thorough history, including chief complaint, smoking history, family history, and thorough clinical examination, followed by MRI scan. Observation and Result There were 78 male and 12 female patients, with age ranging from 27 to 83 years. Tongue (67), followed by buccal mucosa (22) and floor of mouth (1) were the most commonly involved primary site in oral cavity SCC. All patients had surgical resection with curative intent, based on appropriate clinical assessment and MRI staging. There was a strong correlation between DOI (mm) (HPE) and DOI (mm) (MRI), for both subsite tongue and subsite buccal mucosa, which was statistically significant. Mean DOI by histopathology and MRI was 16 mm and 17 mm respectively. Strong correlation was found between the MRI and pathological staging, in T stage assessment, N stage assessment and tumor stage assessment. Near perfect agreement was seen between two methods, which was statistically significant. Conclusion MRI is a highly accurate, preferred imaging modality for preoperative assessment of oral cavity SCC, especially for determining the true DOI. In summary, using MRI to estimate invasion depth before surgery, is crucial in planning appropriate treatment strategies for oral cavity SCC, especifically in determining the extent of elective neck dissection. It ensures more accurate and effective surgical planning, and helps in achieving optimal outcome for patients.

In India, the incidence of mucormycosis reached high levels during 2021-2022, coinciding with the COVID-19 pandemic. In response to this, we established a multicentric ambispective cohort of patients hospitalised with mucormycosis across India. In this paper, we report their baseline profile, clinical characteristics and outcomes at discharge. Patients hospitalized for mucormycosis during March-July 2021 were included. Mucormycosis was diagnosed based on mycological confirmation on direct microscopy (KOH/Calcofluor white stain), culture, histopathology, or supportive evidence from endoscopy or imaging. After consent, trained data collectors used medical records and telephonic interviews to capture data in a pre-tested structured questionnaire. At baseline, we recruited 686 patients from 26 study hospitals, of whom 72.3% were males, 78% had a prior history of diabetes, 53.2% had a history of corticosteroid treatment, and 80% were associated with COVID-19. Pain, numbness or swelling of the face were the commonest symptoms (73.3%). Liposomal Amphotericin B was the commonest drug formulation used (67.1%), and endoscopic sinus surgery was the most common surgical procedure (73.6%). At discharge, the disease was stable in 43.3%, in regression for 29.9% but 9.6% died during hospitalization. Among survivors, commonly reported disabilities included facial disfigurement (18.4%) and difficulties in chewing/swallowing (17.8%). Though the risk of mortality was only 1 in 10, the disability due to the disease was very high. This cohort study could enhance our understanding of the disease's clinical progression and help frame standard treatment guidelines.

The purpose of our study is to assess the psychometric measurement properties of various questionnaires for quality of life in adult patients with chronic otitis media (COM) using the preferred reporting items for systematic reviews and meta-analysis protocol and the COnsensus based Standard for the selection of health Measurement Instruments (COSMIN) checklist. A thorough electronic search was performed with a date limitation of 23rd September 2021 using the following five electronic databases: OVID, Embase, Cochrane Library, PubMed, and Scopus. Only full-text articles in the English language about the development or validation of a self-administered measurement instrument to assess QOL in COM patients (≥ 18 years) that assesses one or more of the measurement properties developed by the COSMIN guidelines were included in the study. Five studies were found evaluating four self-administered questionnaires: the Zurich Chronic Middle Ear Inventory-21 (ZCMEI- 21-E), the Chronic Otitis Media Benefit Inventory (COMBI), the chronic otitis media questionnaire-12 (COMQ-12) and the chronic ear survey in COM patients. Most of the PROMs included in our review did not meet the proposed criteria and need further validation. The ZCMEI-21-E performed better than other available PROMs based on the present review. The present study clarified the quality of currently available HRQoL instruments for COM. Using the COSMIN guidelines, it was shown that there are areas for improvement in study designs evaluating many of the PROMs currently being used in the COM. PROMs should follow COSMIN guidelines to adequately assess the Health-Related Quality of Life of patients suffering from various illnesses.

INTRODUCTION:In India, oral cavity cancer rates are the highest, largely due to tobacco and areca nut use. The primary goal of oncologic surgery is complete tumor resection with adequate margins, yet no accepted guidelines exist margin identification. NBI enhances mucosal lesion detection and may improve margin assessment in OSCC. AIMS:This study aims to evaluate the proportion of negative superficial resection margins using NBI and to compare these results with margins assessed using white light (WL) examination. MATERIALS AND METHODS:The study at AIIMS, Rishikesh, included 38 patients with T1-T3 biopsy-proven OSCC. Surgical margins were marked using WL and NBI. Histopathology classified margins as clear (>5mm), close (1-5 mm), or involved. Sensitivity, specificity, and predictive values of NBI were calculated. RESULTS:The average NBI examination duration was 227 s. Negative margins were achieved in 68.42 % (>5mm) and 78.94 % (>3mm) of NBI cases, compared to 71.05 % and 84.21 % for WL. NBI had a sensitivity of 12.50 %, specificity of 96.67 %, and overall accuracy of 78.95 %. DISCUSSION:NBI showed high specificity but low sensitivity. This could be due to the smaller number of patients in NBI positive group. In the present study, the single positive margin identified with NBI could also have been detected with the combined approach of white light and palpation, ensuring that no positive margins were missed. CONCLUSION:NBI can complement WL for margin assessment in oral SCC but requires a long learning curve and a dedicated team. Integrating NBI into standard protocols could improve surgical outcomes and reduce recurrence.

Biofilms in a cochlear implant can lead to severe intracranial complications like meningitis, and it can cause implant failure, thus requiring an explant, leading to financial and social loss. Meticulous sterility in the intraoperative period and proper hygiene in the postoperative period need to be emphasized in a cochlear implant Patient. We report a case of a 4-year-old girl child who presented with recurrent episodes of wound dehiscence through the cochlear implant site following the asymptomatic period after a course of antibiotics, and finally treated with debridement and flap reconstruction under general anaesthesia. We sought to use novel agents with antimicrobial activity in addition to debridement, vascularized soft tissue cover, and oral rifampicin after surgery. The child underwent serial surgeries, and finally, the use of medical grade Manuka honey and rifampicin demonstrated a successful response to biofilm up to a two-month follow-up period. This case revealed that biofilm is primarily a surgeon’s diagnosis.

The hobnail variation of papillary thyroid cancer (PTC) is an uncommon, aggressive variety with hobnail characteristics on more than 30% of the tumour cells. Because of the entity's rarity, the clinical behaviour and pathologic characteristics of these tumours are still unknown. The purpose of this case study was to look at the cytologic, clinical, and pathological aspects of the hobnail variant of PTC, because of its severe clinicopathologic features and poor outcome, the unusual hobnail type of PTC may necessitate more aggressive treatment than traditional PTCs. The cytologic features of the hobnail variety are distinctive, and FNAC specimens can be used to provide a preoperative diagnosis. Diagnostic parameters for proportion of hobnail morphology need to be refined further. More research is needed to understand how detection of this high-risk variation affects clinical treatment.

Importance Metastases to the submandibular gland (SMG) from oral cavity primaries are very rare. Hence, a gland-preserving level IB dissection technique is a feasible option without compromising the lymph node yield (LNY). Objective To assess the feasibility and noninferiority of the SMG-preserving dissection technique to the conventional en bloc removal of level IB in terms of LNY in patients with cN0 oral squamous cell carcinoma (OSCC) undergoing elective neck dissection. Design Parallel-design, single-center, open-label, randomized controlled trial. Setting Tertiary care health care center—Department of Otorhinolaryngology-Head & Neck Surgery, AIIMS Rishikesh. Participants Thirty-eight (n = 38) participants with 46 (n = 46) neck dissection specimens of OSCC were randomly allocated (1:1) into gland-preserving (n1 = 23) and en bloc (n2 = 23) dissection groups. Intervention Elective neck dissection comparing SMG-sparing level IB dissection technique versus en bloc level IB dissection. Main Outcome Measures LNY, lymph node density, and level IB operative time in both groups were compared between groups (α < .05). Results Median LNY ( P = .543) and lymph node density ( P = 1.000) in level IB did not show significant differences between the groups. LNY in level IB by gland-preserving technique is also not inferior to the conventional en bloc dissection technique (mean difference = 0.217; 95% CI: [−0.597, 1.032]; P = .593). The mean level IB operative time is significantly longer in the gland-preserving group ( P < .001). Conclusions and Relevance None of the examined SMGs were involved by the tumor. SMG-preserving technique is noninferior to the traditional technique of level IB clearance and can be used in elective neck dissections without compromising the LNY. Functional neck dissection has greatly evolved to decrease patient morbidity, and this method can be adopted in case-specific situations. Trial registration The trial was registered in the Clinical Trials Registry—India (CTRI/2022/05/042344) on May 2, 2023, https://ctri.nic.in/ .

We have divided the chest and neck flap elevation for neck dissection into four steps. The flaps are divided into three zones corresponding to the vascular structures, which can be injured in this area. Our modifications outline safe techniques of flap elevation for robotic neck dissection.

Objectives: To evaluate the role of Stroboscopic research instrument in the diagnosis of laryngopharyngeal reflex patients. Methods:Patients coming to otorhinolaryngology OPD after informed consent were grouped into cases and controls according to the RSI Score (≥13 and < 13, respectively).Matching was performed between cases and controls according to age, sex, and body mass index.All the subjects underwent laryngeal endoscopy and videostroboscopy, and findings were evaluated using the Reflux Finding Score (RFS) and the Stroboscopic Research Instrument (SRI) score, respectively.Results: For the 86 patients (43 cases and 43 controls) in this study, the mean RFS was 8.60 ± 2.59 among the cases and 4.98 ± 2.45 among the controls.Among the cases, only 76.7% showed a high RFS (≥7).The means SRI score in cases were 79.60 ± 73.85 and in controls were 23.86 ± 41.76.In the SRI, the amplitude, symmetry, duration of closure, and mucosal wave parameters were significantly different between cases and controls.We also found a weak positive correlation between the SRI score and RFS in cases of LPR. Conclusion:Our study tried to establish the role of SRI in the objective evaluation of LPR patients and found weak correlation between laryngoscopic and stroboscopic findings using standardized instruments.

The primary outcome measures evaluated the financial toxicity and mental well‐being of the oral cancer survivors.

The recurrent laryngeal nerve travels a variable course on either side due to the differences in the structures related during development. The nerve is at risk of injury due to a number of pathologies in any of these structures. We came across a very rare pathology causing vocal palsy in a 62-year-old male with hoarseness of voice. Laryngoscopy examination showed left vocal cord palsy without any obvious laryngeal mass. Contrast-enhanced computed tomography study of the neck and chest revealed aortic arch pseudoaneurysm with left vocal cord palsy.

Electric injuries (in the form of lightning or electric shock) may lead to various implications in the human body, the most important of which include neurological insults. The damage caused is influenced by the route of its entry into the body, its strength, and the duration of exposure. The muscles of the larynx receive motor supply from the recurrent laryngeal nerve (RLN) (except cricothyroid, which gets innervation from the external laryngeal nerve). Recurrent laryngeal nerve (RLN) palsy leading to vocal cord palsy is seen in several pathologies, but after thorough research of existing literature, we could only find a single case of vocal cord palsy following electric injuries, which was also lost in follow-up. In this report, we present a case of unilateral vocal cord palsy following an electric injury on the ipsilateral arm of a young male. He presented to the emergency department of our center soon after the accident. A multidisciplinary team was engaged in the overall management of the patient (in view of pleural effusion, acute kidney injury, and burn injury). He was started on steroids, speech therapy, and other supportive management. On follow-up, his condition improved, and laryngeal endoscopy showed positive signs. This case highlights a unique but rare possibility of vocal cord palsy following electric injuries and may help in the prompt diagnosis and management of the same.