bluuebunny/crossref_metadata_2025 huggingface dataset:
Biomarkers in migraine: a sea of something
Authors: Joshi Siddharth , Iqbal Roshan , Harsha S. , Nemichandra S. C. , Paneyala Shasthara
Published: August 2020

Migraine is the most common headache disorder with high prevalence. Clinical features which forms basis for diagnosis are heterogenous, varying from person to person and in an individual patient from one headache to the next. In most of the migraineurs treatment is delayed, until the disease severity is high leading to significant disability and socioeconomic burden. Many patients receive various combination of prolonged therapy with no significant benefits. Identifying a biomarker for migraine might help in assessing the susceptibility, diagnosing the disease early, choosing appropriate therapeutic target and monitoring the disease course. Here in this review authors discuss most studied, promising biomarkers emerging in field of migraine. The keywords migraine, and biomarkers were used in the search engines of PubMed and Google scholar and articles identified were extensively reviewed. Genetic biomarkers ascertain susceptibility or predisposition to migraine and are valuable in diagnosis, developing novel therapeutic agents, assessing treatment response. This review briefs about most studied genetic and circulatory biomarkers of migraine. Further research into existing biomarkers with higher sample size, excluding confounding factors is necessary. Search for newer biomarkers which can be of great value in diagnosis and therapy is needed. Identifying a biomarker which is reliable, replicable, easily available and cost-effective is need of the hour in management of migraine.
Functional outcome in patient with giant cell tumour distal radius after reconstruction by en-bloc resection and non-vascularized fibular bone graft: a case report
Authors: Yudha Gede Agung Krisna , Wiratnaya I. Gede Eka , . Dwiwahyonokusuma , Putra I. Gede Mahardika
Published: August 2020

Giant cell tumor (GCT) is a relatively common benign primary bone tumor, commonly seen in end of long bones. Treatment goals for GCT of the distal radius are complete excision of the tumor and preservation of wrist function. Usually it can be treated by en-bloc resection and reconstruction using autogenous non vascularized ipsilateral proximal fibular graft. Authors present a case of twenty two years old female complaining of pain and lump in left wrist since two years ago. The pain worsened since 1 month before consultation, but did not radiate elsewhere. Pain was aggravated by movement and decreased with rest. Physical examination revealed a 3 cm mass with tenderness over left wrist. With clinical suspicion of benign bone tumor on left wrist, further evaluation was needed. Plain radiograph revealed an expansile, lytic lesion and soap bubble appearance on her left distal radius like a GCT. Open biopsy result revealed similar morphology with GCT. Reconstruction by en-bloc surgical excision, followed with non-vascularized fibular bone graft fixed with dynamic compression plate (DCP) and wrist ligament reconstruction and fixation of the head of the fibula with carpal bones and distal end of the ulna using K-wires along with palmaris longus tendon were performed. En-bloc resection of giant cell tumors of the lower end radius is a widely accepted method. Reconstruction with non-vascularized fibular graft, internal fixation with DCP with trans fixation of the fibular head and wrist ligament reconstruction minimizes the problem and gives satisfactory functional results.
Outcome following cervicothoracic junction fusion in T1 pathological fracture of breast cancer spinal metastases: a case report
Authors: Astawa Ni Made Puspa Dewi , Wigun I. Gusti Lanang Ngurah Agung Artha , Purvance Ivander , Stanu Gusti Ngurah Putra , Simanjuntak Herryanto Agustriadi , Putra I. Gede Mahardika
Published: August 2020

The cervicothoracic junction (CTJ) is defined as the area extending from vertebral segment C7 to T2. Spinal metastases of CTJ are rare, range from 10% to less than 20%. A 47-year-old woman complained sensory and motor disturbance since 3 weeks prior to admission. History of lump on the left breast was confirmed. Neurological deficit was confirmed as ASIA C at the time of diagnosis. MRI finding suggest fracture of T1 vertebral body with kypothic angle 28° that causing anterior compression of spinal cord. The patient underwent decompression and posterior fusion from C4 to T4. A biopsy sample was also collected from the spine and left breast to confirm the diagnosis. Patient evaluation was done during discharge and at certain points of follow-up for improvement on its neurological, pain, and functional status. An MRI evaluation was performed to evaluate spinal stability and fusion. Significant improvements were observed in patient ambulatory and pain status. Cervicothoracic junction fusion procedure is a considerable choice for the management of pathological vertebral fractures with cervicothoracic junction involvement caused by spinal metastases of breast cancer.
Health and nutritional status of school children from a rural area of Andhra Pradesh
Authors: G. Nanditha , Iyer Chandrakala R. , A. Chandrashekar M. , Kancherla Poojitha , Golluri Raghuveer , . Janakiraman
Published: August 2020

Background: Healthy children build a wealthy nation. Good health of children is of paramount importance to the nation’s growth. Health and nutritional status of school children is highly variable from one region to another due to different environmental, socioeconomic and cultural factors. Hence health status of school children from each area should be assessed periodically so that relevant health programmes can be applied to prevent common morbidities such as malnutrition, infections and infestations. Methods: A cross sectional study of 500 rural school children from 5 to 15 years was conducted to assess the nutritional status by anthropometry and health status by clinical examination.Results: Out of the 500 school children 46.8% girls, 71.4% were 5 to 10 years old, 70.2% studying in 1st to 5th class.  33.4% were stunted. 25.6% and 27% were underweight according to weight and Body mass index criteria respectively. Common health problems among school children in this study were anemia (31%), dental caries (27.2%), upper respiratory infections (13.4%), skin infections and scabies (12.6%), head lice infestation (6.8%), refractive errors (6%) and ear discharge (5.2%).Conclusions: Though the pattern of nutritional and health problems were same in different studies, the severity of them varied from region to region. Hence periodic screening of school children to identify them and to apply relevant health programmes goes a long way in reducing such morbidities.
Unmet goals of neonatal nursing - an observational study
Authors: Deshabhotla Saikiran , Sandeep Sonnathi , Tandur Baswaraj
Published: August 2020

Background: Neonatal nurses are the backbone of any neonatal service, spending maximum time in the care of the sick New-borns in the Neonatal intensive care unit (NICU). Objective of the study was to know about the educational qualification and assess the self-reported confidence in various clinical skills among the nurses working in level 2 & 3 NICUs, preferred learning methodology and assess self-reported stressors among the nurses working in level 2 and level 3 NICUsMethods: This cross-sectional study was done across Level II and Level III Neonatal intensive care units in urban areas of the city of Hyderabad, India over one year from January 2019 to December 2019. Individual questionnaires were distributed to each registered nurse working in the NICU for a minimum duration of six months who were willing to participate.Results: A total of 217 respondents were enrolled. The majority of the nurses were having General Nursing and Midwifery (GNM) qualification 52% (n=112). Nearly 26% (n=58) of the nurses were not comfortable performing bag and mask ventilation. Learning from senior nurses/colleagues as the most preferred mode of learning 45% (n=98). Low salaries 45% (n=98) followed by absence of doctors in emergency situations 37% (n=81) and high documentation (paperwork) 36% (n=78) were most frequently reported stressors.Conclusions: Most of the nursing participants qualified as GNM. Lacking skills of neonatal resuscitation. Mentor based learning needs to be facilitated by raising a cadre of neonatal nursing tutors in various nursing colleges. Paperless monitoring systems and other automation methods should be developed to reduce the documentation work of the staff.
Clinical profile of pediatric patients with tuberculosis in a tertiary care centre in India
Authors: Kumar Ashna , Ahmad Javid , Bharti Pooja , Bakshi Vasundhara
Published: August 2020

Background: India has one of the highest TB burden globally. Children contribute a significant proportion of TB burden, in whom the diagnosis can be challenging because many childhood diseases mimic TB. Therefore, a high index of suspicion is required for early diagnosis of childhood tuberculosis to prevent poor outcome. Objectives was to evaluate the prevalence and profile of childhood tuberculosis cases and to determine the risk factorsMethods: An observational cross-sectional study was conducted over a period of 6 months at a hospital in north India and the prevalence and profile of the children admitted with the clinical suspicion of tuberculosis was studied. Case specific diagnostic approach was used for diagnosis and the appropriate treatment was instituted.Results: The prevalence of childhood TB was 2.3% among hospitalized children. Of these, 66.5% were males and 33.49% were females. The majority of cases were more than 8 years. The history of contact was present only in 31.1%. Tuberculin skin test was positive in 53.11%. Pulmonary tuberculosis was the most common type of childhood tuberculosis (45.45%) followed by neurological tuberculosis (42.8%), abdominal tuberculosis (6.45%), tuberculous lymphadenitis (2.63%), others (2.61%). Malnutrition was a potent contributing factor present in 91.86%. The mortality rate observed in the study was 9.56%.Conclusions: Owing to the high burden of tuberculosis among pediatric population in India, there is an alarming need to develop more economical and advanced diagnostic methods for better patient management and above all there is urgent need of the hour to educate the masses about the transmission and risk factors for this disease.
Study of electrolyte disturbances and renal parameters in acute gastroenteritis under 5 years of age in a tertiary care hospital of Bengaluru, India
Authors: Shankar Poornima , Mahamud Shajna , C. A. Anjum Aara
Published: August 2020

Background: Diarrhoea still continues to be a major cause of hospitalization and death in under fives. Electrolyte disturbances play an important role in the associated morbidity and mortality.  Acute renal failure is one of the important complications of acute gastroenteritis (AGE) in children. Early intervention and proper fluid replacement may lessen this risk. This study was designed to find out the incidence of acute gastroenteritis and the status of associated electrolyte derangements and renal involvement.Methods: This was a cross sectional study conducted at KIMS, Bengaluru in which 117 children from the age of 1 month to 5 years with acute diarrhea were included based on a predefined inclusion and exclusion criteria. Demographic profile of the patients, details of diarrhea, clinical examination and accompanying degree of dehydration (defined as per WHO criteria) were recorded. Serum electrolytes along with renal parameters were investigated.Results: Total 117 children with acute gastroenteritis were enrolled in the study as per the inclusion criteria which constituted 5% of total paediatric admissions. Children aged 1-12 months had the highest incidence of diarrhea (50%). Male to female ratio is 1.3:1. 65% had some dehydration, 19% no dehydration and 16% had severe dehydration. Isonatremia was seen in 58% followed by hyponatremia in 35% and hypernatremia in only 7%. 83% had isokalemia, hypokalemia in 12%, hyperkalemia in 5%. Levels of serum sodium and potassium decreased with the severity of dehydration. Serum urea and creatinine were significantly high in severe dehydration (p value 0.001). Out of 28 children who were given diluted ORS before admission, majority had hyponatremia (39%) and all of them who received concentrated ORS had hypernatremia.Conclusions: Hyponatremic dehydration is the second most common type of dehydration next to isonatremic dehydration, but it is more common in children who took diluted ORS. Increased awareness regarding ORS preparation may help in preventing electrolyte imbalance in AGE. The levels of serum sodium and potassium decreased and urea and creatinine increased with severity of dehydration. Measurements of serum electrolytes and renal parameters early can help to predict the complications due to AGE and may help in the prevention of diarrhea related complications in children.
Evolution of arterial hypertension in patients with hepatitis C virus cirrhosis after antiviral treatment
Authors: Toma Letitia , Mercan-Stanciu Adriana , Zgura Anca , Bacalbasa Nicolae , Diaconu Camelia , Iliescu Laura
Published: August 2020

Background: Chronic hepatitis C (HCV) infection has direct and indirect manifestations that promote vascular resistance. On the other hand, HCV infection leads to liver cirrhosis and complications such as cardiomyopathy, characterized by a hyperdynamic state with low peripheral vascular resistance. The aim of this paper is to study the evolution of arterial hypertension in patients with liver cirrhosis, after the cure of HCV infection.Methods: This is a prospective observational cohort study including 261 hypertensive patients with compensated HCV cirrhosis who underwent direct-acting antiviral treatment. Blood pressure was monitored at the initiation of antiviral therapy and at 3, 6 and 12 months follow-up. Screening for cirrhosis complications was performed and patients were also monitored by electrocardiography, liver and kidney function tests, serum lipids and N-terminal pro-B-type natriuretic peptide.Results: Virologic response after antiviral treatment led to a better control of arterial hypertension with a decrease of 24 hours mean blood pressure by 15% (p=0.04, CI 95%). In patients with stable liver disease serum levels of N-terminal pro-B-type natriuretic peptide slowly decreased at 6 and 12 months (p=0.02, p=0.03), while in patients with cirrhosis decompensation the levels increased. Also, patients with decompensated cirrhosis presented lower blood pressure values and required discontinuation of antihypertensive drugs.Conclusions: Curing HCV infection may lead to a better control of blood pressure in patients with compensated liver disease. However, an abrupt decrease in blood pressure may be a clinical sign of progressive liver disease and cirrhotic cardiomyopathy.
High-sensitivity C-reactive protein and interleukin-6 as risk predictors in patients with stable angina pectoris
Authors: Kunal Shekhar , Meena Pradeep Kumar , Pathak Pooja , Mahla Himanshu , Gupta Kashish , Pathak Vijay
Published: August 2020

Background: Cardiovascular diseases are a leading cause of morbidity and mortality especially in developing countries such as India. Biomarkers such as high-sensitivity C-reactive protein (Hs-CRP) and interleukin-6 (IL-6) can help in risk stratification and better management of patients with stable angina.Methods: This was a prospective observational study wherein symptomatic patients with stable angina were enrolled. Coronary angiogram was done in those consenting to the procedure. Severity of coronary stenosis was graded as per the modified Gensini score (mGS). Hs-CRP and IL-6 levels were determined pre-procedure and 24 hours post percutaneous coronary intervention (PCI). Based on angiographic profile, patients were subdivided into four groups: group 1: normal coronaries, group 2: single vessel disease, group 3: double vessel disease and group 4: triple vessel disease. Primary outcome was occurrence of major adverse cardiovascular events over one-year period.Results: A total of 158 patients completed the study with a mean age of 62.8±9.6 years. A significant difference was observed between the four groups in terms of age, Hs-CRP and IL-6 levels. Of the 124 patients undergoing PCI, significant difference was observed in terms of pre and post procedure Hs-CRP (P<0.0001) and IL-6 levels (P<0.0001). Strong positive correlation was seen between Hs-CRP and IL-6 levels with modified Gensini scoring (mGS). Patients with MACE (15/158; 9.4%) had significantly higher levels of Hs-CRP and IL-6. Multivariate logistic regression analysis revealed that Hs-CRP, IL-6, ΔHs-CRP and ΔIL-6 were independent predictors of major adverse cardiovascular events (MACE).Conclusions: Hs-CRP and IL-6 levels were independent predictors of outcomes and can be used for risk stratification in these patients..
A study of hepatobiliary involvement in adult patients with sickle cell disease
Authors: Mohanty Ambika Prasad , Yellapu Venkatesh , Kumar Kanduri Manoj , Saxena Akshay , Deo Dandi Suryanarayana
Published: August 2020

Background: Sickle cell disease (SCD) encompasses a group of hemoglobinopathies characterized by a single amino acid substitution in the ß-globin chain. Hepatobiliary complications are frequent among sickle cell disease patients. Sickle cell disease has been extensively studied. However, data about hepatobiliary abnormalities among the adult age group are limited. Aim of our study aims to find the prevalence of hepatic-biliary involvement in Sickle cell disease in adult patients admitted to our hospital.Methods: A prospective study was done for a period of two years from October 2017 to October 2019. Subjects of both sexes above the age of 18 years with SCD admitted to our hospital were enrolled. Thorough history taking, full clinical examination, hematological and biochemical parameters assessment, and abdominal ultrasonographic studies were performed to all patients.Results: The results obtained showed that 59% of patients had hepatobiliary involvement. The most common symptom among these patients was bone pain, and the pallor was the most common sign. Biochemical tests revealed reduced hemoglobin concentration, elevated bilirubin, and compromised liver function. The most common ultrasound finding in this study was hepatomegaly, hepatosplenomegaly, cholelithiasis, and gall bladder sludge. The incidence of viral hepatitis was low compared to previous studies. Other hepatobiliary complications were cholelithiasis (14%), benign hyperbilirubinemia (14%), cholecystitis (8%) hepatic crisis (9%), hepatic sequestration (1%) , liver cirrhosis (1%), choledocholithiasis (1%) and cholangitis (1%).Conclusions:Hepatobiliary complications, particularly gallbladder diseases, are frequent among SCD patients. The early detection of hepatobiliary complications by repeated ultrasound screening and liver function tests is significant as their frequency and intensity are related to the patient's age and the duration.
Microalbuminuria can predict the development of acute kidney injury in intensive care unit admission
Authors: G. Bharath , Kumar Prasanna , V. Mahendra S.
Published: August 2020

Background: Microalbuminuria, defined as 30–300 mg/day of albumin excretion in urine is a common finding in ICU patients and has shown not only as a predictor of organ failure but prolonged intensive care unit (ICU)  stay. Objective of the study was to determine the prediction of acute kidney injury using urine microalbuminuria and to determine the presence of urine microalbuminuria and relationship between ICU length of stay.Methods: The present study is conducted on patients admitted to Medical ICU in SDMCMSH, Dharwad from December 2016 to November 2017. 75 patients who met the inclusion and exclusion criteria were included in the study.Results: The present study included 75 patients, among which 50 were males and 25 were females. The mean age was 60.2years. AKI was developed more in non-diabetics than diabetics and non-hypertensives than hypertensives. The median urine microalbumin at admission in AKI was 80.9 and at 48 hr was130.1 predicted the AKI mean (1.79) in 59 patients with a p value of <0.001 using Mann Whitney test and P value statistically significant.Conclusions: Urine microalbuminuria at 48 hr has predicted AKI in 59 patients with median of 130.1 with statistical significance. Urine microalbuminuria of high value in AKI is directly proportional to prolonged ICU stay. At 48 hours of admission, increased levels of microalbuminuria compared at admission and 48 hour, indicates its prognostic significance among AKI and NON-AKI’s in ICU patients.
Profile of patients undergoing third line anti-retroviral therapy
Authors: Maharajan P. Dhileeban , Singh T. Jeetenkumar , Devi S. Bhagyabati , Singh H. Rebachandra , Paul Dipul Rudra , L. Janani
Published: August 2020

Background: India has the third largest human HIV epidemic in the world. The advent of antiretroviral drug began a revolution in the management of HIV. Recent studies have shown that an increasing number of patients experiencing virologic failure on second line Antiretroviral therapy and require third line ART.Methods: This prospective cohort study was conducted in Regional Institute of Medical Sciences, Imphal for a period of two years, to study the clinical, immunological, and virological profile of patients undergoing third line Antiretroviral therapy and to study the early immuno-virological response to third line Antiretroviral therapy.Results: Mean CD4 count before third line ART initiation was 95.90±111.85 cells/μl with 60% of them had CD4 count <100 cells/μl. The mean CD4 count improved significantly (p<0.005) to 246.70±123.78 cells/μl after six months and 340.70±198.57 cells/μl after one year of the therapy. At the time of initiation of third line ART, none of the patients had viral load <150copies/ml while 60% of the population had viral load >100000 copies/ml. After one year of third line ART, 80 % of the patients showed viral suppression (VL<150copies/ml). At the end of one year, the improvement in CD4 count comparing to the Viral load was significant in those who showed viral suppression (VL<150 copies/ml).Conclusions: This study showed significant improvement in the CD4 count and viral suppression with third line medication without any major clinical adverse effect.
Effectiveness of ultrasound guided ethanol motor points block in reduction of spasticity and improvement of upper limb function in hemiplegic patients: a randomized controlled study
Authors: C. Sreejith , Singh Akoijam Joy , Singh Longjam Nilachandra , Rajkumari Kanti , Chabungbam Margaret , Pilania Chandrakant , Moirangthem Janet
Published: August 2020

Background: Stroke is the third leading cause of disability in general population commonly causing upper motor neuron syndrome complications like spasticity, which is more common in upper limb. Ethanol injection into spastic muscle is an emerging effective treatment in the spasticity management. Ethanol causes selective destruction of nerve fibers through denaturation of protein.Methods: A randomized controlled study was conducted for a period of 2 years from March 2018 on sixty-eight hemiplegic patients to assess the effectiveness of ethanol muscle block in reduction of spasticity and improvement in functional ability. The patients were allocated into two groups (Group A and B). Group A received ultrasound guided intramuscular ethanol injection along with range of motion (ROM) exercises and wrist hand orthosis (WHO) and Group B received ROM exercises and WHO. The outcomes were measured by modified ashworth scale (MAS) for spasticity and modified version of motor assessment scale for functional improvement.Results: Intervention group showed significant improvement in spasticity shown by reduction of MAS of elbow flexors from 3 at baseline to 1.15±0.3 at 12 weeks as compared to control group with 3 at baseline to 1.76±0.5 at 12 weeks (p<0.05). Upper limb function scale of study group improved from 1.5±0.8 to 3.0±0.6 at 12 weeks compared to control group 1.3±0.8 to 2.8±0.6 (p<0.05).Conclusions: It can thus be concluded that intramuscular injection of ethanol accompanied by wrist hand orthosis have beneficial effect on improvement of spasticity and upper limb function.
Assessment of clinical and hematological profile in dengue fever
Authors: Patel Mehul K. , Patel Hitesh J.
Published: August 2020

Background: Dengue is one of the most important viral diseases especially in the tropical regions. According to the WHO almost 50 million people get dengue infection annually and WHO estimates almost half of the world’s population lives in countries having endemicity for dengue infection. This study is an attempt to elucidate the positive laboratory profile of serologically diagnosed dengue patients so as to facilitate early diagnosis, treatment, management and vector control measures, to reduce the morbidity and mortality because of this disease.Methods: This study was conducted on 80 indoor patients. Patients presenting to the emergency department, outpatient department (OPD) or pediatric OPD with complaints of fever and clinical features of dengue with positive NS1 antigen test or dengue antibody serology IgM or IgG or both were included in the study. Hemogram was done on automated cell counter analyzer (Sysmex XP 100) which included hemoglobin, hematocrit, total leucocyte count (TLC), differential leucocyte count (DLC) and platelets count.Results: Raised hematocrit (>47%) was noted in 10 (16.6%) of patients at presentation and the hematocrit ranged from 20- 51%. The total leukocyte count ranged from 1500 cells/cumm to >11000 cells/cumm. Leucopenia with less than 4000 cells/cumm was present in 25 % cases.  In the present study out of 80 cases of dengue fever, 85% cases had thrombocytopenia and 15% cases had severe thrombocytopenia (< 20,000/cumm) with bleeding manifestations.Conclusions: Hemoconcentration, leucopenia, thrombocytopenia, and raised liver enzymes SGOT and SGPT along with reactive/ plasmacytoid lymphocytes on peripheral smear gives enough clues to test for dengue serology so that dengue cases can be diagnosed in their initial stages.
Study of maximum phonation time and S/Z ratio in laryngeal paralysis
Authors: M. S. Sudhakar Rao , Koripalli Keerthi , P. Apoorva , Malipatil Vijayalaxmi
Published: August 2020

Background: Alterations in human voice occur frequently and patients usually complain of hoarseness of voice. Laryngeal paralysis is an important differential diagnosis in patients complaining change of voice. Because of simplicity and ease, maximum phonation time (MPT) and S/Z ratio have become the most frequently used clinical tools to assess phonatory mechanics. Published research studying analysis of MPT and S/Z ratio in patients with vocal cord paralysis (VCP) is scanty. Hence this study was taken up to study MPT and S/Z ratios in patients with laryngeal paralysis.

Methods: 62 patients with VCP were included in our study. Complete history was taken and examination was done in all patients. VCP was confirmed by indirect laryngoscopic examination. The MPT and S/Z ratios were evaluated in a quiet room. Data was analyzed using IBM SPSS Version 22.

Results: Mean MPT in males with VCP was 6.71±0.54 and in females it was 6.80±2. Mean S/Z ratio in males was 1.69±0.54, in females 1.59±0.35. The difference between laterality of VCP and MPT was statistically highly significant and the difference between laterality of VCP and S/Z ratio was also statistically highly significant. Our study shows no statistically significant difference in MPT and S/Z ratio with respect to age and gender. There was a significant negative correlation between MPT and S/Z ratio.

Conclusions: Irrespective of age and gender MPT and S/Z ratio are simple and effective objective clinical tests to diagnose paralytic laryngeal pathologies. As laryngeal pathology heals on treatment MPT and S/Z ratio are expected to normalize indicating therapeutic progress.
Pediatric aero-digestive foreign bodies in the emergency setup: an otorhinolaryngologist’s perspective
Authors: Goswami Abhilasha , Borah Hironya
Published: August 2020

Background: The objective of the study was to investigate cases of foreign bodies in the aero-digestive tract among the paediatric population.

Methods: This study was carried out under the aegis of the department of otorhinolaryngology over a one-year period, from April 2019 to March 2020. A total of 82 paediatric patients presented to the emergency department with aero-digestive foreign body, where opinion of the otorhinolaryngologist was sought. All the patients were initially stabilised and assessed clinically. Detailed history was obtained, thorough clinical evaluation done and necessary investigations including radiological tests were performed. After ascertaining the nature and location of the foreign body, prompt removal of the same was done in all the patients under general anaesthesia.

Results: A total of 82 children presented to the emergency with history of inhalation/ingestion of foreign body or suspicion of such, and requiring otorhinolaryngological intervention. There were 55 boys and 27 girls, with 74 cases of ingestion and 8 cases of aspiration of foreign body. The most common foreign body ingested was coin and the most common foreign body aspirated was small button battery.

Conclusions: Foreign bodies in the aero-digestive tract are a common problem encountered by the otorhinolaryngologist in the emergency setup. It constitutes a health hazard in all age groups, but more so among the paediatric population, requiring effective management and immediate intervention. Careful clinical and radiological evaluation followed by prompt removal of the aero-digestive foreign body is essential to reduce the morbidity and mortality. Prevention and public education are the most vital and ideal management for this serious problem.
Clinical outcome following septoplasty with or without inferior turbinate reduction
Authors: Sharma Amrit Raj , Jain Shalini , Sen Kanwar , Gupta Ankur
Published: August 2020

Background: Deviation of nasal septum towards one side is often associated with over growth of inferior turbinate, which occupies expansive space of contralateral nasal cavity. The enlargement of inferior turbinate can be due to mucosal elements or bony expansion. Many surgeons are of the belief if septoplasty is done, compensatory hypertrophy regresses on its own. There are others who argue that these changes are not spontaneously reversible and should be corrected in conjunction with nasal septal surgery. Otherwise surgery may relieve the obstruction on one side of nose but leave other side of obstructed because of relocation of septum towards hypertrophied turbinate.

Methods: A prospective interventional randomized comparative study is carried out from 1st November 2017 to 31th March 2019, with a sample size of 40 patients. Patients were divided in two surgical groups; group A, with conventional septoplasty done and group B, with reduction of inferior turbinate along with conventional septoplasty done. Post operatively patients’ symptoms will be evaluated using nasal obstructions evaluation scale (NOSE) and nasal airway with nasal endoscopy at 1, 3 and 6 months, and compared with preoperative findings.

Results: Data is analyzed using percentage graph and tables. The comparisons of NOSE score at 1, 3- and 6-months interval showed the p value of 0.001 which was significant. Also comparison of two groups with NOSE score showed significant improvement in group B.

Conclusions: The study shows that hypertrophied turbinate need reduction along with septoplasty in cases of long standing nasal obstruction.
Demographic profile of ear nose throat and head neck patients undergoing shortwave diathermy in a tertiary care centre of Punjab: a five-year study
Authors: Munjal Manish , Teotia Avkash , Kaur Jatinder , Rishi Porshia , Sidhu Harjinder , Munjal Shubham , Verma Hitesh
Published: August 2020

Background: Short wave diathermy is a panacea in many otorhinolaryngology and head neck pathologies where either conservative therapeutic modality or surgical intervention has been undertaken. The profile of subjects who underwent short wave diathermy in a period of 5 year is discussed.

Materials and Methods: 490 subjects undergoing short wave diathermy in the otorhinolaryngology and physiotherapy services of a tertiary care centre of Punjab were analyzed during a period of five years. The subjects were studied for their demographic profile.

Results: Maximum patients 42.24% (207 patients) who underwent shortwave diathermy were in the middle age group (21-60 years). Females 62.04% (304 patients) outnumbered the males 37.95% (186 patients). Maximum sittings of male patients were 54 (13.91%) and for females were 47 (12.11%) during the period 2015-2016.

Conclusion: Short wave diathermy is an effective pain therapy for inflammations of ear, nose neck and the maxillofacial region.  
Effect of endoscopic sinus surgery on general health related quality of life domains in chronic rhino sinusitis patients
Authors: Jose Amal P. , George Shibu
Published: August 2020

Background: Chronic rhino sinusitis (CRS) is a common health problem affecting around 5-12% of the general population in a year. Treatment of CRS consist of medical and surgical management. Surgical management is considered when patient is not responding to maximal medical treatment or in case of complication. Sino nasal outcome test 22 (SNOT- 22) is considered as the most appropriate instrument in the evaluation of HRQOL impairment in CRS patients. This study evaluated general health related quality of life (QOL) domains of SNOT- 22 changes following endoscopic sinus surgery.

Methods: This study was conducted in 53 subjects who underwent endoscopic sinus surgery for chronic rhino sinusitis in Department of otorhinolaryngology, Government Medical College, Kottayam over a period of one year. Detailed history including SNOT-22 questionnaire enquired. Clinical, radiological and endoscopic examinations were performed. This patient followed up after 1 week, 1month and 3 months. SNOT-22 scores were recorded at each visit; data compiled and analysed with help of SPSS.

Results: The baseline SNOT-22 score for study population was 37.51. General health related quality of life domains was assessed separately. The score for psychological dysfunction and sleep dysfunction decreased from 10.72, 6.00 to 1.58 and 1.02 respectively at the end of 3 months.

Conclusions: Chronic rhinosinusitis patients reported significant improvement in psychosocial dysfunction and sleep related symptoms after endoscopic sinus surgery. Chronic rhino sinusitis patient with anxiety and depressive disorders need special attention to improve health related quality of life (HRQOL).
Evaluation of the quality of life before and after septoplasty among patients with deviated nasal septum using nasal obstruction symptom evaluation questionnaire
Authors: Deeba Farah , Khalid Faheem , Ahmed Rauf
Published: August 2020

Background: The objective of the study was to evaluate the quality of life before and after septoplasty among patients with nasal obstruction.

Methods: This study was done in Government Medical College Srinagar from September 2017 to September 2018 for a period of 12 months. A total of 33 patients with deviated nasal septum who underwent septoplasty were included in the study. They were given a questionnaire nasal obstruction symptom evaluation (NOSE) to be fulfilled preoperatively, then 3 months and at 6 months after surgery.

Results: The preoperative NOSE score was 72.62±22.69 and postoperative score was 10.78±15.27 at 3 months, 5.72±10.1 at 6 months.

Conclusions: Disease specific health related quality of life measured with NOSE in patients undergoing septoplasty showed improvement at 3 months and 6 months postoperatively.
Prevalence of oral mucosal lesions in a tertiary care centre: one-year prospective study
Authors: Tripathy Smruti Milan , Gupta Poonji , Jain Akshay , Chatterji Probal
Published: August 2020

Background: Lesions of the oral cavity are very common among the general population and account for a significant number of patients in the outpatient department of otorhinolaryngology. The lesions of oral cavity can cause varied symptoms like pain, dysphagia, and difficulty in speaking. The lesions can range from simple benign conditions to life threatening malignancies.

Methods: This study was conducted in the department of otorhinolaryngology, Teerthanker Mahaveer Medical College and Research Centre from January 2019 till December 2019. All the 256 patients who presented to the outpatient department with lesions in the oral cavity during the given time period were included in the study after getting informed and written consent.  

Results: Aphthous ulcers were the most common lesion (18.7%) found in this study. Buccal mucosa (50%) and anterior 2/3rd of tongue (34.3%) were the most common sites involved. Total of 204/256 (79.6%) patient had some form of addiction which included both smoked and smokeless form of tobacco as the most common type of addiction. Among the tobacco smokers, 24/80 (30%) had pre malignant and malignant lesions while among tobacco chewers 37/76 (48.6%) had pre malignant and malignant lesions.

Conclusions: Lesions of the oral cavity are common among Indian population due to high prevalence of tobacco addiction. A thorough history taking and examination can detect premalignant and malignant lesions at an early stage, so that timely treatment can reduce the mortality rates in such patients.
Role of mometasone furoate nasal spray in children with adenoid hypertrophy: impact on life style changes
Authors: B. K. Venkatesha , Shekhar Ravi
Published: August 2020

Background: Adenoid hypertrophy (AH) is a common cause of upper airway obstruction and obstructive sleep apnea syndrome (OSAS) in children having major impact on child’s growth and development. Symptoms like nasal congestion, mouth breathing, nasal discharge, snoring, day time sleepiness, hyponasal voice, ear popping, and craniofacial abnormalities are observed. Adenoidectomy is considered the treatment of choice for symptomatic children. Co-existing medical illnesses and choice of surgical treatment is governed by the paediatricians and apprehensive parents. Need for conservative treatments in alleviating symptoms have been tried. Topical, intranasal administered, steroid preparations have been proven effective in the literature.

Methods: In this prospective study, 35 symptomatic children (3-12 years) with adenoid hypertrophy were included. Each of the symptoms was scored from 0 (absent) to 4 (severe) over Visual Analogue Scale (VAS). Nasal obstruction index was calculated. Results of mometasone furoate nasal spray 100 microgram/day used once daily at the interval of 8 weeks and 12 weeks were analysed using statistical tests.  

Results: A statistically significant reduction in nasal obstruction index and other symptoms were noted at the end of third month follow up.

Conclusions: Mometasone furoate nasal spray caused improvements in outcomes of nasal obstruction, snoring, total nasal symptoms, ear symptoms and overall quality of life.
Antero-inferior tympanic visibility during microscopy
Authors: Munjal Manish , Talwar Gopika , Munjal Shubham , Saggar Tulika
Published: August 2020

Background: The antero-inferior recess of the ear canal is not visible to the otologist, thereby effecting proper placement of the graft and thereby affecting its uptake .The visibility of this region in the adult population is assessed.

Methods: The quadrants of tympanic membrane were examined in 60 subjects with perforated tympanic membrane undergoing tympanoplasty. The study was conducted in the department of ENT-HNS (ear, nose and throat-head and neck surgery), Dayanand Medical College and Hospital, Ludhiana.  

Results: With the microscope in 48 (80%) entire perforation could be visualized and in 12 (20%) margins were not in the line of view. 5 perforations were posterior superior and 12 were total perforations. Otoendoscope examination with zero degree could show the entire margin of the perforation.

Conclusions: In 80% population the antero-inferior quadrant of the tympanic membrane is accessible to straight vision of the microscope.
Second primary chondrosarcoma of the maxilla: a case report
Authors: Pabi Shreeya , Yanthan Yanpothung , Gupta Sweety , Das Biswajyoti , Ibrahim Ajas , Kassim Naseef , Varshney Saurabh , Singh Divya , Gupta Manoj
Published: August 2020

We are reporting an uncommon case of second primary chondrosarcoma of the maxilla in a 52-year-old male patient. Patient had first been diagnosed in 2004 with chondrosarcoma of the right maxilla. He had undergone right partial maxillectomy for the same. Since 2016 he had started noticing a swelling over the left side of the maxilla. Repeated biopsies from the growth showed no evidence of any malignancy. Hence, he was kept on routine follow up. However, in 2018, during follow up the growth had increased in size - hard swelling present in remnant post partial maxillectomy cavity, non-tender -and a punch biopsy was taken, revealing a well differentiated chondrosarcoma. A diagnosis of second primary chondrosarcoma of the maxilla was made based on Warren and Gates criteria. A brief discussion on the radiologic and histologic presentation of the tumor and the treatment modalities of this unusual tumor is discussed.
Kimura’s disease as an uncommon cause of post auricular swelling
Authors: Bendiganahalli Venkate Gowda Chandre Gowda , Gandham Madhuri
Published: August 2020

Kimura’s disease (KD) is a rare chronic inflammatory disorder of unknown etiology, primarily seen in young Asian males. In India, only 200 cases have been reported worldwide since its histopathological diagnosis. The disease is characterized by painless subcutaneous swelling in head & neck region, blood and tissue eosinophilia and raised Immunoglobulin E (IgE) levels. A systematic multidisciplinary approach is mandatory to rule out the other common causes of post auricular lymphadenopathy. The diagnosis of KD can be difficult and misleading and patients with this disease are often evaluated using avoidable procedures by just not being aware of KD. Here, we present a case of a 20 year old male who presented with nodular swellings in the bilateral post auricular region. The diagnosis of KD was done based on characteristic histopathologic finding in conjunction with peripheral eosinophilia.
A rare case of ivory osteoma of mastoid bone
Authors: Maingi Sahil , Jain Shalini , Rai A. K.
Published: August 2020

Osteomas are benign slow-growing bony tumour predominantly occurring in long bones, rarely found in the skull. In the skull they are found most commonly in fronto-ethmoid region. They are very rarely found in the temporal bone. They are usually asymptomatic and treated mainly for cosmetic purposes. We describe a case of a 33 years old female presented to us with right sided mastoid swelling from last 6 years.
Management of lateral epicondylitis (tennis elbow) by local infiltration of platelet rich plasma an outcome study
Authors: Kumawat Pradeep Kumar , Goel Rajesh , Kumhar Urmila , Parmar Rahul , Sharma Rajesh , Sharma Bharat
Published: August 2020

Background: Platelet-rich plasma (PRP) has been recently the emerging biological therapy in which a large pool of signals released from platelets producing a biological microenvironment for local and migrating cells for tissue regeneration. A prospective randomized observational study was done to assess the efficacy of autologous PRP injection in lateral epicondylitis of elbow.

Methods: A total 100 patients of lateral epicondylitis were selected and treated from December 2015 to November 2017. VAS (visual analogue scale) and PRTEE (patient rated tennis elbow evaluation) scoring were used for clinical and functional assessment at pre-injection, 2nd week, 4th week, 3rd month and 6th month.

Results: At the end of 6 months follow-up 61% patients were completely relieved of pain. 34% patients had mild pain that was significantly decreased (p value <0.0001) from mean VAS (75) and mean PRTEE (78.62) to mean VAS (6.05) and mean PRTEE (5.63). 5 patients were lost their 6 months follow-up. There was a significant increase in post intervention pain for few days in 70% patients. Recurrence rate of 0% was noted at the end of 6 months follow-up.

Conclusions: An injection of PRP improves pain and function in patients suffering from lateral epicondylitis.
Functional and radiological outcomes of intertrochanteric fractures treated with proximal femoral nail
Authors: Chopra Mayur , Srivastava Sanjay Kumar , Kumar Sumit , Mishra Deepak Kumar
Published: August 2020

Background: Hip fracture is one of the most invalidating diseases affecting geriatric populations and in fall related fractures, they lead to most severe morbidity and mortality. Their surgical treatment allows stable fracture fixation which allows the early weight bearing. Many devices have been developed, yet mechanical failures still occur. The aim of this study was to assess the functional and radiological outcomes of intertrochanteric fractures treated with proximal femoral nail.

Methods: 46 patients with intertrochanteric fractures fixed with proximal femoral nail were assessed. Functional outcome was measured by Harris hip score (HHS) and lower extremity functional scale (LEFS) and radiological outcome was measured by tip apex distance (TAD), any changes in neck shaft angle, neck length and the offset as compared to uninjured hip.

Results: The tip apex distance on the postoperative X-ray was found to be 22.02±2.499 mm, change in the neck length as compared to the uninjured hip was found to be 1.507±1.1808 and change in the offset and neck shaft angle was 1.470±1.0126 and -1.602±1.5992 respectively. The LEFS was found to be 70.63±6.584 whereas the HHS was found to be 90.35±7.593

Conclusions: With the increase in TAD the functional and radiological outcome worsens. It was also seen that the cutoff of 25 mm stands true in predicting the outcome of the patients with PFN in intertrochanteric fractures. Hence, the TAD should be routinely measured and if found more than 25 mm then proper precautions like delayed weight bearing may be advised.
Management of intercondylar femur fracture with distal femur locking compression plate: outcome analysis of 72 cases
Authors: Khan Nadeem Ashraf , Atif A. M. , Chatterjee Abhinandan
Published: August 2020

Background: Supra-condylar and inter-condylar fractures of the distal femur account for 7% of all femoral fractures and have always been difficult to treat and regaining full knee function is often difficult. The purpose of this study is to evaluate the functional outcome, fracture healing, complications of distal femoral intercondylar fractures managed by locking compression plate.

Methods: Total 72 patients of intercondylar femur fracture were operated by ORIF with distal femur-locking compression plate via the standard swashbuckler approach. The functional outcomes were analyzed using modified hospital for special surgery scoring system.

Results: Muller type C2 fracture was the most common fracture type with 50 out of 72 patients. The average range of motion achieved was about 99.03°±24.73° (Closed fractures =105.83°±19.41°and open fractures = 89.50°±28.36°). There was also a significant difference in the duration of operative time, 84.28±18.32 minutes for closed fractures and 98.46±22.47 minutes for open fractures. The average duration for radiological union was 14.52±2.21 weeks for closed and 17.20±2.44 weeks for open fractures. The average knee score was 80.13±13.38 using modified Hospital for Special Surgery score.

Conclusions: Closed fractures have a higher range of motion and a better knee score compared to open fractures, supporting the fact that soft tissue compromise also affects range of motion and post-op rehabilitation of the limb. The outcome seems to correlate with the nature of injury i.e. high vs low velocity, type of fracture, anatomic reduction, associated injuries, time elapsed since injury to fixation and the stability of fixation.