bluuebunny/crossref_metadata_2025 huggingface dataset:
Antihyperlipidemic activity of Chloroxylon swietenia in triton WR1339 induced hyperlipidemia
Authors: Guptha B. H. M. R. K. , Murty Kadali S. L. D. V. Ramana , M. Vijay Kumar , B. C. Revanasiddappa
Published: February 2018

Background: Medicinal herbs are beneficial and effective either in the management and prevention of several metabolic disorders, associated with hyperlipidemia, hypertension and insulin resistance which increases the cardio-metabolic risk and demands for the life time therapy. Current allopathic medicines are expensive and reported with several adverse effects and hence, finding of a suitable herbal medicine for hyperlipidemic disorders is very important.Methods: Thirty albino rats weighing 200-230g were randomly divided into 5 groups were rendered hyperlipidemia with a single dose of triton WR 1339. Normal control, positive control, standard, aqueous and ethanolic extract groups were treated with tween-80, tween-80, atorvastatin, aqueous and ethanolic extracts of Chloroxylon swietenia respectively for seven days. At the end of the study, blood was collected for estimation of the lipid profile.Results: Both the aqueous and ethanolic extract groups significantly reduced the TG and VLDL levels.Conclusions: The extracts exhibited remarkable activity on one or either parameter of the lipid profile. It could be due to the presence of alkaloids, steroids, flavonoids, coumarins and phenols in the extracts.
Bioavailability of curcumin from a novel mouth dissolving lozenge
Authors: Menon Sasikumar , Mhatre Mandar , Rajarshi Manjusha , Thakkar Jatin
Published: February 2018

Background: Cucurmin is the main component of curcuminoids in turmeric (Curcuma longa). Turmeric, popularly used as food colourant, is traditionally used as a medicinal herb owing to its antioxidant, anti-inflammatory, antimicrobial and anticancer properties. The gastric absorption of curcumin is poor and therefore various forms like encapsulation in liposomes, polymeric nanoparticles, cyclodextrin encapsulation, lipid complexes, polymer-curcumin complex etc. have been evaluated.Methods: In the current study, a novel lozenge of 100mg turmeric extract in mouth dissolving formulation is evaluated for bioavailability of curcumin as compared with the conventional hard gelatin capsule containing 475mg curcumin. Fourteen healthy male subjects of Indian origin are dosed in a two way, two treatments, two sequence cross-over balanced, randomized design. Blood samples are collected sequentially to cover the plasma concentration-time curve to obtain a reliable estimate of the extent of absorption. Blood plasma is processed and analyzed using a validated isocratic HPLC-MS/MS method to estimate the concentration of curcumin.Results: Curcumin is detected at m/z 369à177, while the internal standard diazepam is detected as m/z 285à193 to quantify curcumin. Results indicate a significant increase in bioavailability of curcumin from the lozenge (Cmax188.863±22.9620ng/ml; AUC0-t 897.026±65.4844ng/mL*hr) as compared to the hard gelatin capsule (Cmax 96.458±15.8272ng/ml; AUC0-t 440.744±77.3470ng/ml*hr).Conclusions: Mouth dissolving lozenge could be a pragmatic approach to circumvent the low bioavailability of curcumin from therapeutic formulations.
Cyproheptadine adverse drug interaction with anti-epileptic drugs
Authors: Bhardwaj Ankit , Shukla Anand , Singh Sunita , Kem Anil
Published: February 2018

Cyproheptadine is a H1 and 5- HT1/2 receptor antagonists, impairing the anticonvulsant activity of antiepileptic drugs and reduces threshold, increases severity of seizures, when administered chronically. Anuj a 13 years old male from Delhi, known case of SSPE stage-III with epilepsy, on oral anti-epileptic drug has seizure induction followed the use of oral cyproheptadine. Stopping cyproheptadine, patient didn’t sustain any further seizures.
Prevalence of extracardiac malformations associated with congenital heart disease
Authors: Bana Sailen Kumar , Mandal Asok Mandal , Nagaraj Niranjan , Saraswati Sameer , Shukla Ankush
Published: February 2018

Background: Congenital heart disease is defined as a gross structural abnormality of the heart or intrathoracic great vessels that is actually or potentially of functional significance. This study aims to know the prevalence of occurrence of extra cardiac malformations in patients with CHD, based on clinical features and necessary investigations when required and to study whether these extracardiac malformations occur as a part of a known syndrome or they occur in isolation.Methods: This study is a cross sectional hospital based observational study, carried out in the Department of Paediatrics, Dr. B. C. Roy Postgraduate Institute of Paediatric Sciences, Kolkata over two years from July 2014 to June 2016. A thorough general physical examination, vitals, anthropometry was undertaken. Systemic examination was done in all cases according to the study proforma. CHD was confirmed by X-ray chest, Electrocardiography, Echocardiography.Results: Twenty-three percentages (23%) of the patients were found to have an associated major ECM. Down syndrome was the most commonly identified syndrome in the present study accounting for 50% of the patients of CHD with an associated syndrome. The most common CHD among patients with Down syndrome were multiple CHD and VSD.Conclusions: Whenever more than 1 minor anomalies are found, a careful search for an underling major malformation such as CHD should be made. In all cases of congenital heart diseases with associated extracardiac malformations, effort should be made by the treating pediatrician to rule out an associated syndrome; so that parents can be counselled about prognosis, recurrence in the subsequent pregnancies.
25% oral dextrose as analgesia during neonatal immunisation with BCG
Authors: Mundol Tania Habib , Prabhu Anitha S. , Saldanha Prakash R. M.
Published: February 2018

Background: Various animal studies have shown that repeated painful exposures can have deleterious long-term effects on neonates. Sick newborns are exposed to multiple painful procedures such as venipunctures, suctioning even removal of plasters. There are various physiologic and behavioral indicators of pain used in various standardized pain scales such as NIPS, NFCS, FLACC scale and Wong-Baker Faces pain scale. Sucrose, as an analgesic, has been used and recommended for minor painful procedures in neonates. The optimal dose of oral sucrose has not been established. The objective of this study was to study the analgesic effect of oral administration of 2 ml of 25% oral dextrose during neonatal immunization with BCG vaccine using NIPS (Neonatal/Infant Pain Scale).Methods: 40 consecutively selected newborns were given 2 ml of 25% oral dextrose solution 2 minutes prior to receiving the routine intradermal BCG vaccination. 40 consecutively selected newborns served as controls. The pain response in both groups was assessed using the standardized Neonatal Infant Pain Scale (NIPS).Results: Of the total 80 neonates included in the study, 40 were included in the dextrose group and 40 served as controls. 77.5% of the dextrose group were term babies compared to 72.5% in the control group. 20% of the dextrose group showed a NIPS score ≥6 while 40% in the control group had a similar NIPS score. Conclusions: A total of 80 newborns were included in this study, of which 40 (22 males, 18 females) received 25% oral dextrose solution prior to the BCG vaccine. The group which received dextrose was found to have less indicators of pain such as change in breathing pattern, cry and facial expression.
Race specific nomograms: time for change?
Authors: Varughese Pearl Mary , Rajan Nishanth , Mani Manikandan , Krishnan Lalitha
Published: February 2018

Background: Hyperbilirubinemia is a common problem in neonates. Because of the genetic differences in bilirubin metabolism, an hour specific nomogram is better in each geographical location. No studies in South India for creation and validation of a nomogram for significant hyperbilirubinemia. The aim of this study was to create and validate a bilirubin nomogram in South Indian infants.Methods: A prospective cross-sectional study. The data was collected in 2 parts, over 18 months (264 infants) and 20 months (450 infants) respectively. Babies with established direct hyperbilirubinemia, polycythemia, hypothyroidism, culture proven sepsis, major congenital anomalies and jaundice on day 1 of life were excluded. For all babies, cord bilirubin (for first set of infants), total serum bilirubin values were sent at 24 hours of life and at the time of discharge. An hour specific nomogram was created with 834 bilirubin values (first set of data). The predictive ability of this nomogram and Bhutani nomogram were tested and compared using 972 total serum bilirubin values (second set of data)Results: A nomogram was created with serum bilirubin values from the first set of infants and validated it with the serum bilirubin values from the second set of infants. Bhutani nomogram was also validated. Comparing with Bhutani nomogram, our nomogram was better in predicting significant hyperbilirubinemia in our population.Conclusions: Discharging neonates without risk assessment for severe hyperbilirubinemia may be dangerous. A nomogram generated and validated with our data is an accurate tool for predicting significant hyperbilirubinemia in our population.
A profile on the spectrum of neonatal mortality and morbidity pattern of extramural neonates in the Specialised Neonatal Care Unit (SNCU) in a tertiary care hospital
Authors: D. Anuradha , S. Rajesh Kumar , A. Aravind M. , M. Jayakumar , J. J. Ganesh
Published: February 2018

Background: Every year, nearly four million newborn babies die in the first month of life. India carries the single largest share (around 25-30%) of neonatal deaths in the world. Neonatal deaths constitute two thirds of infant deaths in India. 45% of the deaths occur within the first two days of life. It has been estimated that about 70% of neonatal deaths could be prevented if proven interventions are implemented effectively at the appropriate time. It was further estimated that health facility-based interventions can reduce neonatal mortality by 23-50% in different settings. Facility-based newborn care, thus, has a significant potential for improving the survival of newborns in India. This research has been planned with an aim to study the profile of pattern of admissions in a SNCU and their outcomes following admission and management in the unit.Methods: All babies referred for neonatal problems (less than 28 days) and admitted in NICU will be included. Both term and preterm babies will be considered. The criteria for admission includes various causes like low birth weight, preterm, birth asphyxia, respiratory distress, hyperbilirubinemia, congenital anomalies, risk factors (maternal, neonatal, prenatal), infections and outcome will be analysed.Results: Among the 2927 admissions term babies and boys outnumbered. The common causes for admission were birth asphyxia, respiratory distress, low birthweight and preterm. Most babies had an uncomplicated stay. The mortality in the extramural neonates was due to neonatal sepsis, extreme preterm and congenital malformations.Conclusions: Intensive and interventional management, along with good neonatal monitoring and care can reduce the mortality and improve the survival of low birth weight babies and other treatable problems. Thus, a combined effort of management by pediatricians, nursing care, neonatal intensive care unit can improve the survival rates of neonates.
Role of ursodeoxycholic acid in neonates with indirect hyperbilirubinemia-an open labelled randomised control trial
Authors: Jafari Shazia , Khan Kabeer A. , Bhatnagar Shrish , Srivastava Geetika , Nanda Chhavi , Chandra Anu
Published: February 2018

Background: Ursodeoxycholic Acid (UDCA) is a bile acid widely used in the treatment of cholestatic liver disorders. Few studies have been conducted using UDCA in indirect hyperbilirubinemia. We planned this study to know the role of Ursodeoxycholic acid on indirect hyperbilirubinemia in neonatesMethods: The study was conducted in Department of Paediatrics and Neonatology at Eras Lucknow Medical College and Hospital from November 2015 to September 2017 in 96 term neonates with total bilirubin levels in phototherapy range. They were randomized into 3 Groups receiving either phototherapy only or UDCA at 10mg/kg/day or 20mg/kg/day along with phototherapy.Results: Present study showed that there was a higher rate of fall and less duration of phototherapy required in children receiving UDCA. However, there was no difference in the group receiving 10mg vs 20 mg /kg/day Conclusions: We conclude that by giving UDCA at 10mg/kg/day along with phototherapy in neonate with indirect hyperbilirubinemia leads to faster resolution of hyperbilirubinemia.
Study of morbidity pattern of children up to age of five years with special reference to osseous development
Authors: Mandal Pradyut Kumar , Rahaman SK. Rafikul , Karmakar Mrinalkanti Kanti , Chatterjee Kripasindhu , Kothari Sanjay , Ahmed Rafique
Published: February 2018

Background: The first few years of life are the most crucial period as this age is known for accelerated growth and development and any adverse influences during this period may result in severe limitations in their development which warrants regular monitoring. Methods: The present study had been conducted to find out the total growth profile in relation to skeletal age, nutritional status and the disease pattern so as to give a clear idea of total growth profile in the age group of 3 months to 5 years. The cases were evaluated after proper history taking, clinical examination and conventional anthropometric measurements. The patients were divided in three different age groups as 3 months to 1 year, ≥1 to 3 years, and ≥3 to 5 years. Bone age was determined in all 52 cases by taking proper radiographs of both wrists and hands. Results: It was observed that 16 (30.77%) were normal, 11 (21.15%) were in both grade I and II, 10 (19.23%), 4 (7.7) were grade III and IV respectively among 52 children. The mean weight was 7.06±1.65, 9.33±1.92 and 11.18±2.90 in the age groups of 3 months to 1 year, 1-3 years and 3-5 years respectively. The length/heights were 68.55±5.54, 79.44±7.54 and 91.97±10.15 in the age group of 3 months to 1 year, 1-3 years and 3-5 years respectively. Conclusions: This study gave a true reflection of total growth of a child which comprised of anthropometrical measurement and skeletal development as the distribution of sex and racial distribution were not a factor. There was a statistical significant result in different three groups in regard to weight, length/height, head and chest circumference.
A study of neonatal outcome in infants born to diabetic mothers at a tertiary care hospital
Authors: Anjum Syeda Kausar , H. T. Yashodha
Published: February 2018

Background: Diabetes is the most common medical complication in pregnancy, affecting about 0.5-5% of all pregnancies. In developing countries, management of diabetes in pregnancy still poses a challenge. Infants of diabetic mother are at increased risk of periconceptional, fetal, neonatal and long-term complications. Methods: It was a prospective hospital-based study conducted in tertiary care hospital, Bangalore during a period of one year to assess the outcome in infants of diabetic mother and association of various complications to maternal glycemic status. Results: The incidence of diabetes in pregnant mothers in our hospital was 2.8%. Diabetic mothers with gestational diabetes mellitus (GDM) were 86 (86%) and with pre-gestational diabetes were 14 (14%). Various complications like hypoglycemia, hypocalcemia, polycythemia, hyperbilirubinemia, macrosomia, prematurity, respiratory distress syndrome, TTNB, congenital heart diseases were observed in infants of diabetic mothers. Among them hypoglycemia was the most commonly observed complication with frequency of 54%, followed by hypocalcemia which was seen in 43%, polycythemia in 35% and macrosomia in 15%. Significant association was found between various complications and glycemic control in mothers.Conclusions: High frequency of complications is seen in infants born to diabetic mothers. Hence, these babies should be delivered at hospitals where special neonatal care is available for management of high risks babies. Screening for GDMs should be performed in all pregnant women. Strict glycemic control in mother, planned pregnancy, proper antenatal care and strict monitoring in babies is required to prevent morbidity and mortality in infants of diabetic mother.
Parental knowledge, attitude and practices regarding febrile convulsion
Authors: S. Srinivasa , Anjum Syeda Kausar , Patel Shruthi , S. Harish , G. Bhavya
Published: February 2018

Background: Febrile convulsion is a condition which can emotionally traumatize most parents. Inadequate knowledge regarding febrile convulsion can cause parental anxiety. This study is conducted to assess the level of parent’s knowledge, attitude and practices regarding febrile convulsion.Methods: It was a prospective questionnaire study conducted over a period of one year from January 2016 to January 2017 in Department of Paediatric of a tertiary care hospital KIMS, Bangalore. 110 children with febrile convulsion in the age group of 6 months to 5 years were enrolled.Results: Out of 110 children, 82 had single convulsion and 28 had recurrent convulsions. Mean age of onset of first febrile convulsion was 20 months. About 50 (45.45%) had experienced convulsion with one-episode of fever. Only 46 (41.8%) of parents recognized convulsion. Others interpreted convulsion as shivering (20.9%), evil effect (7.2%), excessive cry tantrum (10.9%), fainting spell (8.18%) and lethargy (20%). 88 (80%) did not carry out any intervention prior to getting the child to hospital. Effect of convulsion on parents was fear of death (82.7%), fear of epilepsy (17.3%), fear of recurrence (34.5%). 85% parents did not know that convulsion can occur due to fever. 32% thought that traditional treatment would help. Only 38% had thermometer at home and 23% knew the normal range of body temperature. Preventive measures were known to 44%.Conclusions: A higher level of understanding regarding practices was shown among higher socioeconomic and higher educational status. The efficiency of parental first aid practices can be evaluated and significant improvement can be achieved by giving adequate awareness and education.
Hypoglycemia in low birth weight neonates: frequency, pattern, and likely determinants
Authors: Saini Aanchal , Gaur Bablu Kumar , Singh Parvinder
Published: February 2018

Background: Hypoglycemia is the commonest metabolic disorder of neonates. If not detected in time, it can lead to considerable morbidity and mortality. Hypoglycemia both symptomatic and asymptomatic can lead to long term neurological sequelae. Therefore, it needs early management to prevent brain damage in a developing neonate. The objective to study the frequency and pattern of hypoglycemia in low birth weight neonates (LBW) and the factors associated with hypoglycemia.Methods: All neonates less than 2500 gm were carefully examined, and a detailed antenatal, natal and postnatal history was obtained. The measurement of blood glucose was estimated by glucometer by taking blood sample by prewarmed heel prick and the same time venous blood sample was sent for laboratory confirmation by glucose oxidase method. Blood glucose was estimated by glucometer at 0, 1, 2, 3, 6 and every 6 hours till 72 hours and the clinical profile of these neonates was recorded.Results: Out of 50 neonates, 12 (24%) had one or more episode of hypoglycemia overall 20 episodes were recorded 15(75%) in first 24 hours and 5(25%) between 49-72 hours all the episodes were asymptomatic. Out of 12 hypoglycemic neonates 7 (58.3%) were small for gestational age (SGA) and 5 (41.7%) were AGA (P = ns). Sepsis was significantly noticed after hypoglycemia (p = 0.00). The pattern of blood glucose levels was significantly different among hypoglycemic babies and normoglycemic babies over first72 hours.Conclusions: Hypoglycemia was frequent among low birth weight babies more so in SGA babies in first 24 hours.
A clinical study of risk factors for acute severe asthma in children
Authors: A. Pragalatha Kumar , Gowdra Aruna , Pise Dattatreya
Published: February 2018

Background: Asthma is one of the most prevalent diseases worldwide with an estimated 300 million affected children. Acute severe asthma in children is one of the common causes of emergency admissions. There is no much study regarding the risk factors for acute severe asthma in children in India. Hence the present study was conducted to know the risk factors for acute severe asthma in children.Methods: A prospective observational study of 100 children between the age group of 5 and 18 years who presented with symptoms and signs of acute severe asthma admitted to the pediatric intensive care unit (PICU) of Indira Gandhi Institute of Child Health (IGICH) for a period of 12 months between January 2015 to December 2015 formed the study group. These children were evaluated for the risk factors responsible for acute severe asthma.Results: A total of 100 children with acute severe asthma were enrolled in the study. The predominant age group was between 5-10 years (68%), the risk factors responsible for acute severe asthma were poor drug compliance (68%), which was statistically significant (p-value <0.0001), exposure to house dust (61%) and smoke (42%) (p <0.0001). There was also marked rise in absolute eosinophil count (62%).Conclusions: Acute severe asthma in children is one of the common causes of emergency admissions. The present study has shown that poor drug compliance, exposure to house dust and smoke were significant risk factors for acute severe asthma.
Hepatic dysfunction in children with complicated malaria
Authors: Mannu Alexander , Agarwalla Sunil Kumar , Vasudevan Jaishree , T. Kathir Subramaniam , A. Ahamed Basha
Published: February 2018

Background: Complicated malaria caused by Plasmodium falciparum alone or with P. vivax can lead to multi organ dysfunction. There is a paucity of studies about hepatic dysfunction in children with complicated malaria. Hence, this retrospective study was done to find out the clinico-biochemical profile of children with complicated malarial hepatic dysfunction from a malaria endemic region of India. Further, liver function test (LFT) response to Artemisinin-based combination therapy (ACT) i.e. artesunate + sulfadoxine-pyrimethamine therapy in the malarial hepatic dysfunction children was assessed. Methods: Out of 203 children confirmed to have malaria, 60 children were found to have complicated malaria with jaundice as per WHO malaria guidelines (total serum bilirubin >3 mg%). Physical examination, malaria related biochemical and ultra-sonographic findings were noted. All the children were found to be uniformly on ACT as per institute protocol adapted from WHO guidelines. Biochemical parameters of hepatic function were compared between day 1 and 4.Results: Presentations were fever, pallor and clinical jaundice in 100%, reddish urine in 63.3%, tender hepatomegaly in 100% and splenomegaly in 81.7% of the study population. Liver function test showed mild to moderate elevation of serum bilirubin and enzymes with remarkable recovery noticed with the use of ACT in all the study subjects.Conclusions: Clinical presentations of malarial hepatic dysfunction although mimics viral hepatitis, LFT showed mild to moderate elevation only. Further, ACT therapy was found effective in the management of all children with hepatic dysfunction in complicated malaria.
Hemolytic disease of the new-born due to ABO incompatibility
Authors: Kattimani Vijaya S. , C. B. Ushakiran
Published: February 2018

Background: Better understanding of the clinical characteristics of HDN due to ABO incompatibility helps to optimise care. The objective of this study was to investigate the clinical manifestations and outcome of treatment modalities.Methods:This study was a hospital based cross sectional study conducted in the neonatal unit of Cheluvamba hospital attached to Mysore Medical College and Research Institute. A total of 50 neonates with blood group A or B born to mothers with blood group O; with jaundice and or anemia were enrolled during the period from January 2015 to December 2015. The various maternal and neonatal parameter and their association with development of jaundice and or anemia was studied. The outcome of treatment modalities was studied.Results: Out of 50 ABO Incompatible neonates 24 (48%) were male and 26 (52%) were female. The percentage of O–A and O–B incompatible neonates were 38% (19) and 72% (31), respectively. Jaundice was detected within the first 24 hours in 6% and 18% neonates had anemia. The mean age of presentation was 2.9±0.89 days. The various maternal and neonatal factors had no significant association with development of jaundice and or anemia due to ABO Incompatibility. The mean initial Indirect Bilirubin was 21.26±3.97, initial hemoglobin was 14.3±2.31 and the mean Reticulocyte count was 16.6±5.3. Total 22 (44%) neonates had laboratory evidence of hemolysis (microspherocytosis). DCT was positive in 4 (8%) neonates. The main clinical manifestation was jaundice and was treated with phototherapy in 49 (98%) of the cases. The mean duration of phototherapy was 53.84±9.82 hours. Only one infant required exchange transfusion and on follow up had no neurological sequelae. The mean total duration of stay was 3.6±1.2 days. There was no significant difference in the HDN due to either O–A or O–B incompatibility.Conclusions:Early identification of high risk neonates with ABO Incompatibility, diagnosis and early intervention can reduce morbidity and mortality.
Acute Pancreatitis: a late complication of dengue fever
Authors: A. P. Krithika , R. Ramya
Published: February 2018

Acute pancreatitis following viral infection is rare in children. Acute pancreatitis complicating viral infections has been described in the form of isolated case reports and small series. The commonly implicated viral infections have been coxsackie virus, hepatitis viruses, mumps, varicella, herpes simplex and cytomegalovirus. However, the etio- pathogenesis of pancreatitis in viral infections remains unclear. Also, the natural history of such pancreatitis has not been adequately studied. Here we present a case of acute pancreatitis following dengue infection.
Severe pneumonia leading to death in an achondroplasic infant: a rare case report
Authors: Matharoo Mankiran K. , Narang Gursharn S.
Published: February 2018

This report concerns a 9-month-old male with achondroplasia presenting with severe respiratory distress having history of frequent respiratory infections, developmental delay and failure to thrive. Child had septicemia and ended up in multiorgan failure, ultimately leading to death due to cardiopulmonary arrest.
Effect of nasal obstruction in the acoustic analysis of voice
Authors: Sanchez-Balderas Victor R. , Fernández-Olvera María , Ascencio-Padilla Rubén D. J.
Published: February 2018

Background: The voice is the main form of communication between humans and the nasal and sinusal cavity participates in the resonance process. An alteration in the nasal diameter can produce changes in the voice. The objective of this study was to relate the degree of nasal obstruction measured by the SNOT 20 questionnaire to the acoustic analysis of the voice.

Methods: 58 non-smoker volunteers without laryngeal pathology where included, 25 women (43%) and 33 men (57%). The average age was 22.1 years (±1.7). The laryngopharyngeal reflux and SNOT20 questionnaires were applied together with an acoustic analysis, we measured fundamental frequency, Jitter and Shimmer. The analysis was done separating in groups by sex and by SNOT score (less than 20 points and equal or higher than 20).  

Results: The average of SNOT questionnaire was 15.06 (±11.8), we found no relation between the scores of the SNOT20 questionnaire with Jitter, fundamental frequency, Shimmer or voice intensity (p≥0.01). When separated by groups, the analysis by sex or by scores (SNOT > or < than 20 groups) did not show a statistically significant relationship.

Conclusions: In this study we did not find a relation between changes in acoustic analysis in Fundamental frequency, Jitter and Shimmer and the degree of nasal obstruction measured by SNOT 20. The groups of gender and severity of SNOT did not show relationship. More studies are necessary in order to evaluate the relation of nasal obstruction and the acoustic analysis of the voice.

 
Study of impact of surgical intervention (adenotonsillectomy) and conservative management on quality of life in patients with SDB
Authors: Ali Arshed , Nisar Jasif , Ali Ihsan , Ahmad Rauf
Published: February 2018

Background: SDB is an important cause of morbidity in children. SDB has been associated with decreased quality of life (QOL). In this study, we tried to determine The impact of surgical intervention (adenotonsillectomy) and conservative management on quality of life in patients with SDB.

Methods: A total of 112 pediatric patients were included with SDB, who visited our OPD. Diagnostic methods include history and physical examination, audiotaping or videotaping, pulse oximetry. OSA 18 questionnaire was used to assess the quality of life with conservative treatment (pre and post-treatment) and after surgical intervention-before and after adenoidectomy or adenotonsillectomy.  

Results: We had 112 patients with majority being males 69 (61.60%) and females 43 (38.30%), majority of patients were in the age group of 5-7 yrs (49.10%). In 47 patients (who underwent adenotonsillectomy/tonsillectomy), OSA-18 questionnaire was used pre-operatively, at 2 and 6 months. OSA-18 when used pre-operatively showed majority of patients 33 (70.21%) having score >80, and 14 (29.79%) patients having score between 60-80. No patient was below 60 score. Mean OSA-18 score pre-operatively was 84.15. OSA-18 score at 2 months and at 6 months were 30.06 and 26.40 respectively, which showed a lot of improvement in post-operative score and hence the post –operative quality of life. In 65 patients (conservative treatment) OSA-18 was used pre-conservative, at 2 and 6 months of treatment. OSA-18 when used before conservative treatment showed majority of patients 44 (67.6 9%) having score 60-80, and 21 (32.30%) patients having score between >80. No patient was below 60 score. OSA-18 score at 2 months showed improvement in 69.23% patients (<40), OSA-18 at 6 months showed recurrence in 12.33% patients.

Conclusions: SDB substantially impact QOL in pediatric patients. QOL significantly improves following adenotonsillectomy. There is subset of patients 12.33% with SDB in whom there was recurrence of symptoms after conservative treatment. Thus showing that conservative management is inferior to surgical management in the treatment of SDB. SDB improved after an observation period. Thus, observation with close follow-up is another treatment option.

 
An evaluation of preoperative high resolution computed tomography of temporal bone in cholesteatoma
Authors: Khavasi Prabhu , Malashetti Santosh , H. Chandrashekarayya S.
Published: February 2018

Background: Cholesteatoma is relatively common and potentially dangerous disease of the ear. It is characterised by local destruction and osseous erosion leading to complications. High resolution computed tomography (HRCT) is the imaging modality of choice for evaluation of middle ear structures and pathology. The aim of this study is to evaluate role of preoperative HRCT in the diagnosis of the disease, its extension and complications and plan for surgery.

Methods: This prospective study was conducted at a tertiary referral teaching hospital and 40 cases of cholesteatoma were selected and their pre-operative HRCT temporal bone findings and intraoperative findings were correlated.  

Results: This study showed good correlation between preoperative HRCT findings of cholesteatoma, and intraoperative findings.

Conclusions: We conclude therefore the preoperative HRCT temporal bone is useful guide for the surgeon for the diagnosis and management of cholesteatoma.
Swallowing difficulties among healthy elderly: prevalence and aetiology
Authors: Abdul Khader Fathima , Somayaji K. S. Gangadhara , . Mubeena
Published: February 2018

Background: Dysphagia is a common problem among elderly individuals. Very few studies have been done to know the prevalence of dysphagia among healthy elderly individuals. So a study was done to assess the prevalence of swallowing difficulties among healthy elderly individuals and to find out the various causes for it in them.

Methods: 259 elderly individuals were screened using the swallowing disturbance questionnaire to assess the prevalence of swallowing disorders. Those individuals with swallowing disorders were further subjected to modified Barium swallow to know the aetiology.  

Results: Of the 259 elderly individuals screened, 85 were females and 174 were males. The mean age and standard deviation was 66.16±6.233. The prevalence of swallowing difficulties was 20.1%, with no significant difference in the gender wise distribution or age wise distribution. Among the various aetiologies diagnosed, idiopathic cause is the commonest, followed by oesophageal neoplasm (21.1%), and then the achalasia cardia (9.6%). Among oesophageal neoplasm, mid-thoracic esophageal neoplasm (9.6%) is the commonest.

Conclusions: Considering the time and cost involved, it is not feasible to subject all elderly for instrumental swallowing evaluation like videofluoroscopy. Hence it would be beneficial to screen the elderly individuals for dysphagia and educate them regarding its importance, as dysphagia can also be associated with serious underlying pathology and complications such as aspiration.

 
Dyadic wavelet analysis and detection of sinusitis using near infrared sensor
Authors: Kamatchi S. , Sundararajan M.
Published: February 2018

Background: Sinusitis is a chronic infection or inflammation which affects the paranasal sinus cavities and the associated nasal cavities. As the symptoms of sinusitis greatly resemble upper respiratory infections, diagnosing sinusitis clinically is a major issue. Though imaging techniques serves as a standard in confirming the diagnosis of chronic sinusitis, the availability at the primary care settings, affordability and diagnosing acute cases calls upon an alternative technique in practice. Recent researches confirming the diagnosis of sinusitis using Near-infrared imaging gives us hope in taking up the research using optical sensing. The objective of the study was to successfully diagnose sinusitis using NIR-LED optical sensor and to signal process the data obtained from the patients using Dyadic Wavelet Transform (DyWT) to confirm and to validate diagnosis using regression analysis. The study also correlates the plain radiographic findings with the NIR device sensing to make the device feasible.

Methods: This was a one year pilot study (June 2014–May 2015) conducted with forty patients suspected of sinusitis and with clinical history along with ten healthy individuals as controls.  

Results: Patients age ranged from 18-65 years were included in the study. Results from NIR sensing device well correlate with the radiographic examination of the registered candidates. The regression result perfectly matches with the dyadic wavelet results of the patients, confirming the diagnosing of sinusitis using near- infrared sensor. Radiographic examination well correlates with the results from the NIR diagnostic device providing a valuable evidence of the hardware.

Conclusions: NIR-LED sensor device can provide qualitative evidence in differentiating the mild and severe patients based on air-fluid level present in the sinus. The results strongly recommend that NIR sensing device can be a best alternative in case of frequently sinus affected patients and for the unaffordable patients without the risk of radiation.
Comparing endoscopic microdebrider assisted adenoidectomy with curettage procedure
Authors: Ravishakar C. , Killera Shambulinga
Published: February 2018

Background: Adenoid is a mass of lymphatic tissue situated posterior to the nasal cavity, in the roof of the nasopharynx, forming a part of the Waldeyer's ring, was initially described in 1868 by Meyer. Adenoidectomy is one of the commonest operations done on children. It is done alone or along with tonsillectomy or with ventilation tube insertion for otitis media with effusion. Objective of the study was to compare the results of endoscopic microdebrider assisted adenoidectomy with that of conventional curettage adenoidectomy.

Methods: A prospective randomized study of 60 patients with clinical features of adenoid hypertrophy. These patients were randomly divided into two groups, 30 each using the table of random numbers. Group I, underwent endoscopic microdebrider assisted adenoidectomy and group II underwent adenoidectomy by curettage. All the patients were followed up for a period of 3 months. Parameters such as operating time, blood loss, intra-operative/post-operative complications and residual adenoid tissue were assessed.  

Results: In this study mean age of patients in group I (EAA) was 9±0.50 years (range 6–15 years) and group II (CA) was 9.86 ± 2.31 years (range 6-15 years). The mean operating time was 20.79 minutes for the group I (range: 12 to 35 minutes) and 14.42 minutes for group II (range: 10 to 22 minutes, p=0.001). Blood loss was around 31.06 ml (range: 21 to 46 ml) in group I and 22.26 ml (range: 10 to 60 ml) in group II. Adenoidectomy by curette group showed more residual nasopharyngeal adenoid tissue (43.33%) than by endoscopic microdebrider assisted adenoidectomy (20%).

Conclusions: Endoscopic microdebrider assisted adenoidectomy is a safe and more effective compared to curettage method, with very minimal chances of injury to the surrounding structures during the procedure.
Foreign bodies in adult upper digestive tract: a series of 30 cases
Authors: Jayaraman Nirmal Kumar , V. J. Vikram , M. Kalaiselvi , M. Sudha
Published: February 2018

Background: Rigid endoscopy under general anaesthesia has traditionally been used by otolaryngologist for diagnosis and management of variety of disorders affecting the upper digestive tract including the removal of foreign body. Smooth foreign bodies does not pose much threat but may cause airway obstruction. Sharp foreign bodies, if not removed the earliest may penetrate oesophageal wall and cause complications.

Methods: A Retrospective analysis was done for patients who underwent rigid oesophaghoscopy under general anaesthesia for 30 patients of foreign body ingestion at Upgraded Institute of Otorhinolaryngology, Madras Medical College, Chennai, between November 2016 – November 2017. The records of age, sex, co-morbidities, X-ray finding, complications were recorded.  

Results: Majority of adults in this group belonged to 40-50 years age. The most common foreign body impacted was chicken bone totalling 16. 2 patients of denture ingestion were referred for flexible endoscopy after failed attempt, 1 developed oesophageal perforation.

Conclusions: Rigid endoscopy is the gold standard for removal of sharp foreign body as the sharp ends can be clasped and brought in to the endoscope there by preventing damage to the mucosa. Foreign body with multiple sharp ends which cannot be negotiated into rigid endoscope, should be pushed into the stomach and attempted removal by cutting sharp ends of foreign body or by gastrostomy, as pulling such foreign body will lead to full length tear of oesophagus leading to morbidity and mortality. 
Migratory fish bone complicating as neck abscess
Authors: Chiluveru Prawahar , Kumar Ajay , Chavadaki Jyothi
Published: February 2018

Accidental ingestion of fish bone is usually uncomfortable, some cases it may be dangerous to a patient, a challenging diagnosis. A retained fish bone may have potentially disastrous complications which may affect the morbidity or mortality. Fish bone may even penetrate extra-luminally and reside in the soft tissue of the neck. Computed tomography (CT) of the neck is of great assistance in diagnosing a migrating fish bone. Surgical exploration is mandatory.
Femoral diaphysis fractures: treatment with unreamed intramedullary nailing and its results
Authors: Demiroğlu Murat
Published: February 2018

Background: Femoral shaft fractures are an important cause of mortality and morbidity in the lower extremity injuries.

Methods: 21 femoral body fractures of 19 adult patients were treated with the unreamed intramedullary nailing. Of 19 patients 14 were males and 5 were females.

Results: All fractures healed. Deep infection was not encountered. According to the Thoresen criteria, the rate of excellent-good results was 78%. In two patients, who had also cranial trauma, development of excessive callus was observed. None of the patients required a secondary operation.

Conclusions: Unreamed intramedullary nailing, if it can be implemented with closed technique and with double lock screw at the distal side, provides satisfactory results in the femoral shaft fractures.

 
Clinical outcomes in management of dislocation of carpometacarpal joints of hand: a rare orthopaedic presentation
Authors: Das Aurobinda , Mishra Sanket , Panda Damodar , Misra Sanchaita , Sharma Manish , Satapathy Deepankar , Mall Bibhudutta
Published: February 2018

Background: Dislocation of carpo-metacarpal (CMC) joints especially involving the 2nd and 3rd or paired dislocations, presents a rare pattern of orthopaedics hand injuries. They are associated with high energy trauma usually involving motorbike accidents. Severe soft tissue inflammation over the affected hand and associated injuries often makes detection of these fractures difficult. They require prompt management at presentation. Failure to be diagnosed and treated at early stage leads to joint stiffness, restrictions of wrist movement, deformity and sometimes ruptures of tendons crossing the wrist. Most of them require open reduction and internal fixation for stabilization. The objective of the study was to clinically evaluate outcomes in management of carpometacarpal joint dislocations.

Methods: We prospectively studied 6 cases of CMC dislocation presenting at average of 1week from the original injury. All were clinically and radiologically evaluated. 3 cases were managed with open reduction and internal fixation with K wire and 1with closed manipulation and percutaneous k wire fixation and 1 case by arthrodesis of CMC joint. Functional assessment was done with Quick DASH score at 6 weeks, 3 months, 6 months and 1 year.

Results: All the patients went on to have good functional recovery. The average quick DASH score showed improvement from 77.39 to 4.07 over 1 year follow-up.

Conclusions: Careful and meticulous examinations of hands are necessary in high velocity trauma cases to avoid missing diagnosis of CMC dislocation. ORIF remains the gold standard treatment which can also be used for cases presenting late, followed by aggressive post-op physiotherapy can lead to excellent recovery of hand function.
Treatment of trochanteric fractures by PFN or DHS
Authors: Sahoo B. S. , Chand Dillip Kumar
Published: February 2018

Background: Intertrochanteric fracture is one of the common fractures of the hip in the elderly over the age of 50 years. Dynamic hip screw is still considered the gold standard for treating intertrochantric fractures by many. Not many studies compare the DHS with proximal femoral nail (PFN).

Methods: This prospective study included 32 patients of intertrochanteric fractures in which 16 patients were treated by PFN and rest 16 by DHS. All patients were operated under image intensifier control. Average age of the patients was 65 years (20-80) years.

Results: In our series the patients with DHS has increased intra operative blood loss (160 ml), longer duration of surgery (54.6 min) and required longer time for mobilization (15 weeks) while patients who underwent PFN had lower intra op blood loss (95 ml), shorter duration of surgery (41.2 min). The Salvati and Wilson hip scoring is better in PFN group.

Conclusions: PFN produces better results than DHS in terms of shorter duration of surgery, early weight bearing, lower infection rate and less blood loss.
Our experience with percutaneous autologous bone marrow injection in the management of delayed and nonunion of long bone fractures
Authors: Subash Yeshwanth
Published: February 2018

Background: Various modalities of treatment are available for the management of delayed and nonunion of long bone fractures. The aim of this study was to evaluate the role of percutaneous autologous bone marrow injection in the management of these fractures and to compare the results with studies of other authors as available in literature.

Methods: 15 patients with delayed and nonunion of long bone fractures were studied between January 2013 to January 2015 and were followed up for a period of 1 year. The patients were clinically and radiologically evaluated at regular time intervals at follow up.

Results: The age of the patients ranged from 28 to 60 years with the mean age being 44.2 years. There was a male preponderance in our study with the male to female ratio being 2:1. The left side was more commonly affected as compared to the right. The mean time to radiological appearance of callus was 6.4 weeks. The mean time to clinical union was 7.33 weeks while the mean time to radiologic union was 13.4 weeks. We had a union rate of 93.3% in our series with one fracture going in for failure of union.

Conclusions: Percutaneous autologous bone marrow injection is a minimally invasive, safe and cost effective option in the management of delayed and nonunion of long bone fractures and gives good functional results.
Challenges and outcome of total hip arthroplasty in patients with developmental dysplasia of the hip: a clinical series with a spectrum of disease manifestation and technical notes
Authors: Mohan Kumar E. G. , Yathisha Kumar G. M. , Noorudheen Mohammed
Published: February 2018

Patients with developmental dysplasia of hip eventually lead on to secondary osteoarthritis in adulthood and may end up with total hip arthroplasty at a younger age. Because of the altered anatomy of dysplastic hips, total hip arthroplasty in these patients is a technically demanding procedure. Altered anatomy of the acetabulum and proximal femur together with leg length discrepancy pose challenges during total hip arthroplasty. Since the majority of the patients are in the younger age group, soft tissue balance is of great importance to maximise postoperative functional result and longevity of prosthesis. In this paper, we present a series of our patients with a spectrum of disease manifestation from mild to severe form and also discuss the associated challenges and the technical solutions and their outcome.
Rethinking Language Education in Indonesia
Authors: Umami Maslihatul
Published: February 2018

Language education in Indonesia may be discussed by over viewing the nature of the three language categories in the country: Indonesian language, indigenous languages, and foreign languages. From the picture of how the three groups of languages work and function, the problem raised in this paper is based on two fundamental assumptions. Language education in this multilingual and multicultural country is not done on the context of literacy, on the one hand, and it is not yet considered important in comparison with that of the subjects related to basic science and technology, on the other. After reviewing a number of models of bilingual education and comparing them with what has been done in Indonesia, a preferred model will be offered. Finally, it will also be suggested that language education in Indonesia should be associated with literacy development in a wider sense. Furthermore, meanwhile language education should be given an adequate room; language teaching should be based on the functional use of the existing languages in the country and should be done in tandem with the teaching of content since content is delivered through the medium of language. Keywords: education; language function; literacy development; content