bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of caesarean section and womens' attitude towards caesarean section in Manipur, North-Eastern India
Authors: Oinam Joymati , Kongjenbam Shantibala , Singh Yumnam Ningthemba
Published: January 2020

Background: The rapid increase of caesarean section (CS) rate throughout the world has become a serious public health issue since the level of CS is well above the WHO (1985) recommended 15% and it is increasing over time. Objectives of the study was to determine the prevalence of caesarean section and women’s attitudes towards CS, to investigate rural-urban differences and any associated factors between attitude with socio-demographic factors.Methods: A cross-sectional study was conducted in urban and rural areas of three districts of Manipur from 2015 to 2017 among 600 eligible married women aged 18-35 years selected by simple random sampling. Household was taken as sampling unit and electoral roll (2013) as sampling frame. An interview schedule was used for data collection. Descriptive statistics like mean, SD, proportion and inferential statistics like χ2 test was used. p-value 0.05 was considered as statistically significant.Results: Mean age of the participants was 29.7±4.6 years. The overall prevalence of CS rate was 18.5% and the first child CS rate was 19.9% and majority of them belongs to 30-35 age groups. Majority of the women (84.2%) have neutral attitude and only 7.6% have favorable attitude towards CS. Favorable attitude towards CS was more among women who married at ≥30 years, whose husband was >30 years and was a government employee and who ever had CS.Conclusions: Although the prevalence of CS is well above the WHO (1985) recommendation. Majority still preferred vaginal delivery and the demand for CS is low in the present setting.
Knowledge about epidemiological determinants of obesity and its management amongst medical professionals of Marathwada region of Maharashtra, India
Authors: Kausar Hina M. , Giri Purushottam A. , Siddiqui Azhar A.
Published: January 2020

Background: Obesity has become a challenge in medical care worldwide. Medical professionals have a significant role to play in preventing and diagnosing weight problems and in providing initial counseling. Health professionals are poorly prepared in weight management, which has an effect on their knowledge and management skills with regard to overweight and obese patients. Hence the present study was carried out to assess the knowledge about epidemiological determinants of obesity and its management amongst medical professionals of Marathwada region of Maharashtra, India.Methods: A cross-sectional study was carried out during the period of March to April 2019 amongst 110 medical professionals at Department of Community Medicine of IIMSR Medical College, Badnapur, Jalna, Maharashtra, who were actively participated in continued medical education (CME) on obesity and its management where the knowledge of medical professionals were assessed. Data was analysed by using appropriate statistical test whenever necessary.Results: In this study, the pre-test good knowledge score was 14 (12.7%), which increased to 61 (55.5%) post CME. The pre-test mean score of level of knowledge was 7.41±4.12 and after CME, it was 12.90±5.21 and the mean difference was 5.49, which was statistically highly significant.Conclusions: As obesity is a public health problem globally, there was marked improvement in the knowledge amongst medical professionals after CME on epidemiological determinants of obesity and its management.
Assessment of goitre among primary school children in district Chamba, Himachal Pradesh, India
Authors: Dhiman Arvind Kumar , Sandhu Sumita Kumari , Yadav Vijay Kumar , Arora Ishan
Published: January 2020

Background: Goiter is one of the most visible manifestations of iodine deficiency disorders (IDD) that is caused due to overstimulation of thyroid as an adaptation to Iodine deficiency. IDD is among the major public health threats and important micronutrient deficiencies in developing countries.Methods: This cross-sectional study was conducted among 6-12 years school children in district Chamba of Himachal Pradesh from February to June 2019. The sample size of 336 was calculated and a total of 504 children from government schools were enrolled in the study. The assessment of goitre was done clinically by inspection and palpation of thyroid gland.Results: In this study, 504 school aged children of 6-12 yrs from district Chamba with mean age of 9±1.86 years were included. The prevalence of total goitre rate was 16% with mean age of 8.75±1.37 years. The highest prevalence (%) was observed in age of 10 years (28.4%) followed by 8 years and 9 years (25.9 % and 23.5% respectively).Conclusions: This study showed mild goitre prevalence in school aged children of 6-12 years in district Chamba of Himachal Pradesh. There is dire need of periodic survey to assess the magnitude of IDD in future.
Health values of cassava compared to wheat and yam in relation to diabetes and dyslipidaemia management
Authors: Onodu Bonaventure , Culas Richard , Nwose Ezekiel U.
Published: January 2020

The objective of the study was to evaluate how diabetes and dyslipidaemia can be managed by increasing the consumption of root and tuber crops such as cassava and yam. Journal literatures based on research reports as well as institutional publications and databases on nutritional values of various foods were reviewed. Critical reviews were also performed to synthesize a comparison between the various foods, especially in terms of their fibre values. The critical review shows that guidelines devoted six pages to protein-energy malnutrition and another seven pages on micronutrients. However, there is no mention of the dietary fibre values of the staple root and tuber food crops. From the narrative review, previous report showed that carbohydrate or fibre and fat or fibre ratios are negligible in the raw products, but highest in wheat flour and higher in yam relative to cassava flour. A further comparative review in terms of proximate analysis of the foods elaborates that unprocessed wheat is high in crude protein, carbohydrate and fibre. Thus, the extent or nature of processing is a key factor. Whether wheat has better health value over root and tuber crops has neither being expatiated, nor cassava and yam acknowledged as having any medical value relative to wheat. Since fat is pro-obesity and pro-diabetic while fibre is anti-dyslipidaemic; the foods based on processed wheat flour may possess the least pharmacological values relative to the indigenous carbohydrate food crops. This report provides indication of medical nutrition therapy potentials of indigenous carbohydrate food crops in Delta state of Nigeria.
Evaluation of a replanted finger and measuring its perfusion changes to predict its viability by laser speckle contrast imaging
Authors: Akthar Bilkis , Wang Zeng Tao , Khashru Muhsin Billah Bin , Dian Hou Zhi
Published: January 2020

Background: This research aims to monitor the microcirculation of the replanted finger, which was entirely severed by using laser speckle contrast imaging (LSCI) for early detection and revision of vascular compromise for successful finger replantation.

Methods: These six months of research was taken for a survey of 40 cases of replanted fingers of patients of distinct ages and sex. Scrutinizing was done postoperatively by LSCI, every hourly for seven days, to assess changes in blood perfusion both in replanted fingers and healthy ones and analyzed graphically.  

Results: Initially, from postoperative d=0 to d=2, the perfusion value was at baseline, which ranged 40±15 perfusion unit (PU), showing a wave-like curve, then gradually increased up to 350±50 PU or above in case of those which survived successfully, showing continuous peak slope. However, a gradual drop in perfusion, <35 PU from d=2 or d=3, was seen in those despite undergoing heparinized finger pin-prick bleeding therapy and failed to thrive, showing a downslope curve. Whereas some were under meticulous observation, which flourished lately. Concurrently, a comparison was made with the healthy fingers’ of the same patient, ranging from 200±50 to as high as 400±50 or above. Clinical correlation, as well as perfusion readings of LCSI, were done simultaneously.

Conclusions: LSCI provides sensitive and reproducible finger microcirculation measurements and is reliable in predicting reductions in blood perfusion induced by venous or arterial occlusion. It is, therefore, an informative device to detect microvascular compromise during and after replantation surgery.
Management of traumatic and non traumatic hollow visceral perforation in North India
Authors: Pal Naresh , Mishra Vineet , Jangra Amit , . Poonam , Jain Udit
Published: January 2020

Background: Hollow visceral perforation is the commonest perforation among all the hollow viscera in the body. The perforation can be traumatic or non-traumatic and it constitute commonest surgical emergency worldwide. The diagnosis of perforation can be made clinically but for confirmation basic radiological investigations and sometimes special investigation are required.

Methods: This is a prospective observational study conducted in our institute in the Department of General Surgery. The patients who are included in this study were more than 15 years of age in both sexes having hollow visceral perforation presenting in accident and emergency department.  

Results: Out of 624 patients, 530 (84.93%) were males while only 94 (15.06%) were females, with a male: female ratio of 5.63:1. The site of perforation are ileum 37.01% duodenum, 28.36% maximum sites of hollow viscous perforation. Acid peptic disease was the cause of perforation in 27.40% of 171 cases. Enteric fever accounted maximally for 29% of 181 cases and all in the ileum. Acute appendicitis resulted in perforation of the appendix in 64 cases (10.25%) while blunt trauma abdomen causes perforation in 12.66% of 79 cases. Perforation due to stab injury accounted for 5.12% and fire arm injury perforation seen in 19 patients (3.04%).

Conclusions: Early diagnosis of perforation, resuscitation with crystalloids with broad spectrum antibiotic coverage and urgent surgical intervention whenever patient is fit for anaesthesia are the important factors which decides the ultimate fate of the patient in case of hollow visceral perforation peritonitis. 
Antibacterial efficacy of black seed honey in combination with penicillin and amoxiclav against gram-positive bacteria
Authors: Hossain Rozely , Rahman M. S. , Rayhan M. A. , Nawrin Kashfia , Billah Mohammad M. , Habib M. R.
Published: January 2020

Background: The emergence of antimicrobial resistance possesses a great threat for the existence of mankind. Antibiotics like penicillin and amoxiclav are at the brink of losing their efficacy entirely in exposure to resistant bacteria. Thus, the present study was aimed to find out the antibacterial efficacy of black seed honey as an alternative natural source which can act independently and boost the efficacy of standard drugs alongside.

Methods: Penicillin, amoxiclav and black seed honey were first individually trailed against four gram-positive bacteria - Bacillus subtilis, Staphylococcus aureus, Staphylococcus epidermidis and Micrococcus luteus. Afterwards, penicillin and amoxiclav were used in combination with honey and compared the synergistic effects with their individual efficacy. Zones of inhibition from well diffusion method, percentage inhibition, minimum inhibitory and bactericidal concentrations by microdilution method were determined in the present study.  

Results: Black seed honey alone demonstrated great inhibitory potential against S. aureus (9.7 mm), S. epidermidis (9.9 mm) and M. luteus (9.3 mm) in well diffusion method. Moreover, its combination with amoxiclav showed synergistic effect against all bacteria except S. epidermidis. However, its conjugation with penicillin was not able to produce any synergism as exhibited by zones of inhibition. The lowest concentration (1.56%) of honey applied individually or in combination in microdilution method found highly effective which established an inverse dose dependent relationship with efficacy.

Conclusions: From the data it can be concluded that the black seed honey is a highly potent natural agent which can be utilized in antimicrobial therapy. However, further investigation is recommended to identify the responsible compound for such activity.
Partial mastectomy as management for unilateral gangrenous mastitis in a lactating Red Sokoto goat
Authors: Abubakar Nura , Bande Faruku , Bodinga Hassan A. , Barmo Aminu , Ayobami Hameed S. , Abubakar M. S.
Published: January 2020

A 7-year-old lactating Red Sokoto goat was presented to the veterinary clinic, Aliyu Jodi Road Sokoto, with the complaint of inappetance, weight loss, reduced milk output and foul smelling udder four weeks after kidding. The goat weighed approximately 25 kg. The patient appears dull with rough hair coat, the right mammary gland was necrotic and blue-greenish, atrophied, hardened with a lacerated base, painful to touch with foul smelling. Gangrenous mastitis was diagnosed and animal as scheduled for surgery. The surgery was successfully conducted; the animal was later discharged 16 days post surgery.
A review of the clinical applications and performance of laser speckle contrast imaging
Authors: Khashru Muhsin Billah Bin , Wang Zeng Tao , Akthar Bilkis , Talukder Md Faisal
Published: January 2020

Laser speckle contrast imaging (LSCI) is a useful tool for visualizing full-field blood flow images. Speckle pattern is formed when a coherent light illuminates a rough object, and the backscattered radiation is transformed into images and be shown on a screen. Movement within the object results in the fluctuation of patterns over time. The same data can be obtained by employing the Doppler effect, yet producing a two-dimensional Doppler map needs scanning; speckle imaging renders the same information without the requirement to scan. Nowadays, LSCI has gained expanded consideration, in part because of its accelerated adoption for blood flow studies in the different surgical departments. Here we represent and review the application of laser speckle contrast methods to the field of perfusion visualization as clinical studies from various medical fields and discuss the limitations hindering clinical acceptance.
Side effects of medications in professional opera singers’ voice: survey findings
Authors: Clarós Pedro , Mikolajczyk Kinga , Pujol Astrid Clarós , Pujol Carmen , Sabater Juan , Clarós Andrés
Published: January 2020

Background: Opera singers are classified under level I, as the elite vocal performers, being the quintessential representatives of this group. As the professional voice users, they meticulously observe any changes relevant to their health, therefore self-reported side effects should be taken under serious consideration. The aim of this study was to initiate the process of gathering general information about the most common side effects of medications taken by the opera singers.

Methods: The study group consisted of 264 professional opera singers, treated in Clarós Clinic in a 35 years period, who were asked to complete a questionnaire. The response rate was 62.1% (n=164) with a male-to-female ratio being 1.27:1 (72 men and 92 women). 46 cases of adverse effects of medicines were updated and analysed. All the responses were collected between February and April 2018.  

Results: The mean age of our study group was 38.3 for females and 49.95 for males, with the range between 18-83 years. The vocal categories were as follows: 39 tenors, 17 baritones, 14 basses, 64 sopranos, 23 mezzo-sopranos and 5 contraltos. Patients with chronic diseases and comorbidities represented the 39.1% of the study group. The most common adverse effect reported was dryness (15.2%). The most frequent voice side effects raised by singers were clearing the throat frequently (14.63%), hoarseness and coarse or scratchy sound (10.37%), and vocal fatigue (7.32%).

Conclusions: We believe that exploring the subject of vocal side effects of medications in professional opera singers is extremely important.
Laryngo-tracheo-bronchial foreign bodies: epidemiological, diagnostic and therapeutic aspects
Authors: Amana Bathokédéou , Pegbessou Essobozou Plaodezina , Amana Essobiziou , Foma Winga , Dolou Warou , Laws Stephen , Boko Essohanam , Kpemissi Eyawelohn
Published: January 2020

Background: The objective of the study was to describe the epidemiological, diagnostic and therapeutic aspects of laryngo-tracheo-bronchial (LTB) foreign bodies (FB).

Methods: A 20-year retrospective study, performed in the ENT, head and neck surgery department of Sylvanus Olympio Teaching Hospital in Lomé, dealing with patients treated for this LTB.  

Results: Sixty-one cases of LTB FB were collected. The LTB FB represented 3.05 cases per year, 11.71% of the FB airways and 4.08% of ENT FB. Thirty-two patients (52.46%) were male, a sex ratio of 1.10. The average age of patients was 5.08 years, with extremes of 4 months and 43 years. In 31 cases (50.82%), the accident occurred during the meal and in 30 cases (49.18%) during a game. The penetration syndrome was found in 54 cases (88.52%). FB was extracted by rigid tube bronchoscopy in 50 patients (81.97%). The most common site of endoscopy was right bronchus in 30 cases (49.18%) and in 11 cases (18.03%) FB was laryngeal. Organic FB accounted for 31 cases (50.82%) and was dominated by peanuts (29.5%), for non-organic FB they were dominated by pebbles (8.2%). The evolution was favorable in 58 cases (95.08%).

Conclusions: Severe accidental pathology, the prognosis depends on the nature of the body, its seat and the time of care.
Sleep disturbances in patient with chronic nasal obstruction due to nasal polyp: a prospective study
Authors: Giri Dhiraj , Salud Duane L.
Published: January 2020

Background: Nasal obstruction is thought to be a major cause of sleep impairment. Typical sleep-related problems seen with nasal polyp include snoring, sleep-disordered breathing and sleep apnoea. The impact of nasal polyposis on quality of life is well studied however its effects on sleep have been less well studied. In the current study, we aim to investigate sleep disturbances in Filipino patients with nasal polyposis using different sleep questionnaires VAS score for snoring, Epworth sleepiness scale (ESS) for daytime sleepiness and Pittsburgh sleep quality index (PSQI) for sleep quality and the effect of endoscopic sinus surgery on sleep quality.

Methods: A prospective, non-randomized study was done in the Department of Otorhinolaryngology Head and Neck Surgery of Southern Philippines Medical Center from February 2014 to July 2014. Number of 18 patients with chronic nasal obstruction for more than 6months due to nasal polyps at least grade II on endoscopic examination were included in the study. Visual analogue scale (VAS) score for snoring, ESS for daytime somnolence and PSQI for quality of sleep was compared preoperatively and 1month postoperatively.  

Results: Mean value of VAS score for snoring, mean value of excessive daytime sleepiness measured by ESS and mean PSQI score for sleep quality improved significantly with p<0.001 after endoscopic sinus surgery.

Conclusions: Nasal polyp patients mostly present with nasal obstruction, snoring and excessive daytime sleepiness. Correction of nasal obstruction significantly improves snoring and sleep quality. After endoscopic sinus surgery, patients may experience improvement in snoring and have better sleep quality with decreased daytime sleepiness.
Epidemiological profile of oral cancers in Benin
Authors: Hounkpatin Spéro H. Raoul , Bouraima Fatiou Alabi , Flatin Marius Claude , Balle Marie-Claire , Brun Luc Valere C.
Published: January 2020

Background: The objective of the study was to study the epidemiological profile of malignant tumours of the oral cavity in Benin from January 2009 to 31 December 2014.

Methods: This was a descriptive cross-sectional study that examined cancers of the oral cavity collected in the registers of the 5 anatomy and pathology laboratories in Benin as well as the only hospital in the country that sends its requests for histological examinations abroad.  

Results: With a rate of 19.8%, oral cavity cancer was the most frequent cancer localization in the ENT, head and neck sphere in Benin. The most frequent sites of cancers in the oral cavity were the palate (32.2%) followed by the tongue (25.4%) and the inner face of the cheeks (16.9%). The average age of the patients was 53.18±20.60 years with extremes of 1 year and 90 years. The sex ratio was 0.90. Squamous cell carcinoma was the most common histological type with 67.80%.

Conclusions: Cancer of the oral cavity must be a priority for health authorities in Benin. Research must be initiated to determine the factors that contribute to it.
Comparison of magnetic resonance imaging and high frequency ultrasonography in carcinoma of tongue and its clinicopathological correlation: a prospective study
Authors: Mir Javed A. , Masoodi Sanober M. , Rashid Tajamul , Masoodi Suhail M.
Published: January 2020

Background: Carcinoma of oral tongue has a high propensity for cervical node metastasis. The thicker the tumour, the higher would be the risk of nodal metastasis and locoregional recurrence. Ultrasonography is used for evaluation of carcinoma tongue and tumour thickness and has a high correlation with histopathological findings.

Methods: Our study is a comparative prospective study conducted on 30 patients of carcinoma tongue. All patients underwent magnetic resonance imaging (MRI) scan and ultrasonography. The findings of MRI and ultrasound were correlated with clinical and pathological findings.

Results: MRI had a better correlation with histopathology for primary tumour characteristics and nodal assessment than ultrasonography. Ultrasound with a Pearson correlation coefficient of 0.809 correlated better than MRI for tumour thickness. Tumour thickness of >5 mm was associated with 27.2% nodal positivity rate whereas no patient with primary tumour thickness <5 mm had node positive disease.

Conclusions: Ultrasonography has a high correlation with histopathological thickness. Ultrasound thus seems to be an optimal technique in early stage, node negative tongue cancer for evaluation of tumour thickness and predict nodal status. 
Role of silicone stenting in endoscopic dacryocystorhinostomy
Authors: Jahan Abdussalam M. , Eldanfur Yousef M. , Ghuzi Abdulhakim B.
Published: January 2020

Background: Dacryocystorhinostomy (DCR) is a surgical procedure performed to relief nasolacrimal duct obstruction, which involves the creation of ostium at the lacrimal bone to form a shunt in the nasolacrimal pathway. Closure of the rhinostomy opening was considered a major factor for surgical failure. Use of silicone stent in endoscopic DCR to improve the success rate of the operation have been tried by many surgeons. In this study we assess the success rates of endoscopic DCR with and without silicone stents.

Methods: Prospective study includes 30 patients were operated in the Department of ENT, Misrata Medical Center, from April 2017 to March 2018. They underwent endonasal endoscopic DCR for primary acquired nasolacrimal duct obstruction. These patients were randomly divided in two groups: A and B with 15 patients in each group. The group A patients underwent endoscopic DCR with silicone stent and group B patients underwent endoscopic DCR without stent. The results were statistically analyzed by chi-square test.  

Results: 30 patients were included in this study, their age ranged from 17 to 60 years, complaining of epiphora, 24 (80%) were females and 6 (20%) were males. The success rate was higher in patients with silicone stent (93.33%) as compared to patients without silicone stent (86.67%) but this difference in the results is not statistically significant (As p value is 0.542 which is >0.05).

Conclusions: Endoscopic DCR is safe, successful procedure for treatment of nasolacrimal duct obstruction and there was no significant difference in the success rates of performing endonasal DCR with silicone or without silicone stents.
Comparison of mastoid obliteration with middle temporal artery flap versus open cavity: a comparative study
Authors: Swami Himanshu , Arjun A. P. , Bhat Sweekritha N.
Published: January 2020

Background: The objective was to study the outcomes of the canal wall down (CWD) mastoidectomy patients in those with soft canal wall reconstruction by using middle temporal artery (MTA) flap in comparison to those with cavity left open.

Methods: A prospective study of 20 patients undergoing CWD surgery was done with 10 in each group of mastoid obliteration and open cavity. The outcomes were studied at 1, 3, 6 and 12 months post-surgery.  

Results: At the final assessment of 12 months post op, the obliteration group had only 10% patients with grade 1 infection while open cavity group had 40% with grade 2 infection. Obliteration of mastoid cavity and reconstruction of canal wall with soft tissue MTA flap gave excellent control of infection.

Conclusions: The MTA flap is highly flexible and versatile for otologic reconstruction with an excellent arc of rotation and robust blood supply. It does not have the issues of resorption, dehiscence or fistula formation faced in other obliteration techniques.
Outcomes of type III tympanoplasty: our experience
Authors: C. Ravishankar , Bandadka Ramya
Published: January 2020

Background: Type III tympanoplasty involves complete disease clearance from middle ear cleft and retaining or improving the serviceable hearing by ossiculoplasty. Various auto and allografts have been used with variable outcomes. The objective of the study was to evaluate hearing improvement and healing of cavity in patients who underwent type III tympanoplasty.

Methods: A retrospective chart review of 21 patients who underwent type III tympanoplasty at Bowring and Lady Curzon Hospital from January 2018 to December 2018 was done. In 7 patients autologous incus, 6 tragal cartilage and 8 teflon prosthesis was used for ossiculoplasty. Intra and postoperative events were assessed. Pure tone audiograms done after 3 and 6 months were compared.  

Results: 15 patients who underwent canal wall down procedure (CWDP) had a mean hearing gain of 20.33 dB and 26.67 dB while in 5 patients of canal wall up procedure (CWUP) group mean hearing gain was 22.5 dB and 27.5 dB at 3 and 6 months after surgery respectively. Hearing gain was similar in both groups irrespective of the prosthesis used. Autologous materials were used in most of the CWUP with intact stapes and teflon prosthesis was used in majority of CWDP where only mobile stapes foot plate was present. Prosthesis extrusion was not encountered in any of our cases so far in this series.

Conclusions: The post-operative hearing gain with autologous incus, tragal cartilage and teflon middle ear prosthesis are similar. Teflon prosthesis is an effective material for ossiculoplasty, especially useful when incus and stapes are absent while autologous incus or tragal cartilage are preferred in cases with intact stapes head.
Evaluation of eustachian tube function in chronic suppurative otitis media with reference to its treatment outcome
Authors: Gupta Sucheta , Goel Mohit , Jamwal Padam Singh
Published: January 2020

Background: The study was undertaken to find out Eustachian tube function in safe type of chronic suppurative otitis media and to study the comparison of graft uptake in normal, partially impaired and grossly impaired Eustachian tube function in safe type of chronic suppurative otitis media.

Methods: The present prospective study was conducted in the Department of Otorhinolaryngology and Head and Neck surgery, Sri Maharaja Gulab Singh Hospital, Jammu during the period from November 2016 to October 2017. Patients were diagnosed clinically and also audiometrically by pure tone audiometry and impedance audiometry. Eustachian tube function test- Toynbee test was done in all the patients.  

Results: Out of 20 patients with normal Eustachian tube function, 19(95%) showed graft uptake. Out of 20 patients with partially impaired Eustachian tube function, 18 (90%) showed graft uptake. Out of 20 patients with grossly impaired Eustachian tube functions 13 (65%) showed graft uptake. Comparison of mean values of pre and post- operative air-bone (AB) gap with respect to normal, partially impaired and grossly impaired Eustachian tube functions is highly significant statistically with (p<0.001).

Conclusions: As seen in our study, functioning Eustachian tube is an important requirement for optimum outcome of myringoplasty. Testing the functions of Eustachian tube before surgery provides a possibility of predicting the possible outcome of myringoplasty or tymapanoplasty. This is also concluded that a partially functioning Eustachian tube should not be considered to be a contraindication to these surgeries as in many of these cases graft uptake and AB gap closure was good (90%).
A prospective study of deviated nasal septum giving rise to other ENT pathologies
Authors: Kumar S. Ranga Pradheep , Patel Seema V.
Published: January 2020

Background: The deviated nasal septum (DNS) is a commonly occurring clinical condition that often causes nasal obstruction. This study, included two groups of subjects 100 each. The group A consists of subjects having DNS with nasal symptoms. The group B consists of subjects having DNS without nasal symptoms but with ear and throat symptoms. The present study makes an effort to review the types and its associated pathology.

Methods: A prospective study was carried out in the Department of ENT, Government Medical College and Hospital, Nagpur from September 2016 to October 2018. Data was collected and analysed.  

Results: The mean age 31.17 years in group A and 30.07 years in group B, with male to female ratio of 1.17:1 in group A and 1.04:1 in group B. Left-sided septal deviation was more common than right-sided deviation. The most common symptoms in group A was nasal obstruction (94%) and in group B was otorrhoea (80%)."C" shaped DNS was the most common type in both the groups. Out of total 200 subjects comprising both the groups, 70 (35%) subjects had significant sinonasal disease, 138 (69%) subjects had ear pathology, 69 (34.5%) had Eustachian tube dysfunction, 35 (17.5%) had throat pathology. In this study, “S” shaped deviation was more prone to be associated with ENT pathology.

Conclusions: “S” shaped DNS was maximally associated with sinonasal pathology and there was a high correlation between the side of septal deviation to the side of ear pathology, particularly in asymptomatic DNS.

 
Correlation of clinical, radiological and histopathological cervical lymph node involvement in oral cancer
Authors: Narayana Mada Lakshmi , Kumarguru B. N. , Arafath A. Hameed , Gaur Urvashi , Lakshmi P. , Sravani Addanki Lakshmi
Published: January 2020

Background: Lymph node metastasis is the most important factor in the prognosis of oral cancers and survival drops by 50% in the presence of malignant lymph nodes. Most of the lymph node enlargement in oral cancers is due to tumor-associated inflammation rather than metastasis. The aim and objectives of the study was to assess the enlarged reactive and positive cervical lymph nodes clinically and radiologically with the histopathology of neck nodes.

Methods: All the oral cancer patients were examined clinically for enlarged neck nodes and subjected to contrast-enhanced computed tomography (CECT) oral cavity and neck. In CECT, all the characteristics of nodes were recorded, and after neck dissection, all levels of lymph nodes were assessed histopathologically.  

Results: In our study, 24 patients were included; among them, 31 enlarged lymph nodes were seen clinically. CECT showed a total of 90 enlarged lymph nodes which includes 21 positive nodes. In histopathology 538 lymph nodes were isolated, and among them, only 32 lymph nodes were found to be positive for malignancy.

Conclusions: The detection rate of enlarged lymph nodes is more with histopathology than radiological and clinical examination. In our study, 94% of lymph node enlargement was proven to be reactive, which shows more tumor-associated inflammation.
A comparative study of endoscopic and microscopic myringoplasty in a rural tertiary care teaching hospital
Authors: Kavathur Viswanathan , Anchery Vineeth Abraham
Published: January 2020

Background: Myringoplasty is the procedure done to repair the tympanic membrane perforation. In this study we aimed to compare the results of endoscopic myringoplasty and microscopic tympanoplasty.

Methods: A total of 50 patients with central perforation of tympanic membrane and dry ear of minimum 6 months were divided into two groups of 25 each. The even serial numbers were subjected to microscopic myringoplasty through post aural route and odd serial numbers were subjected to endoscopic myringoplasty done through endomeatal route. Both the procedures were done under general anaesthesia. Dried temporalis fascia graft was used and follow up till 1 year post op. Air-bone gap closure, average time taken for surgery, success and failure rates, scar evaluation by doctor and patient along with postoperative return to routine activity were compared. The p value was calculated to find out statistical significance.  

Results: Post operatively the average air-bone gap reduced to 12.6 dB in endoscopic group and 14.28 dB in microscopic group. There was no statistical significant difference in the time taken for both the procedures. There was significant difference in the assessment of postoperative scar and number of days taken for return to routine activity. The success and failure rates of both the procedures were also found to be comparable.

Conclusions: Our study showed that the success rates and average time taken for the procedures were the same for both the techniques but a better cosmetic appeal and considerably fewer days for return to routine activity by the patients who underwent endoscopic procedure.
Prospective evaluation of chronic rhinosinusitis with reference to anatomical variation
Authors: . Sindhura , Kandipilli Mamatha Devi , Shaik Ali , Ramana Venkata
Published: January 2020

Background: Rhinosinusitis is one of the commonest sinonasal condition with chronic Rhinosinusitis affecting 10% of population worldwide. Although the diagnosis of chronic rhinosinusitis is clinical, the final diagnosis should be confirmed by objective measures like radiography and nasal endoscopy. Though anatomical variations in sinonasal region are rare, they have significant impact in the causation of sinonasal diseases and pose difficulties during surgery.

Methods: This was a prospective study conducted on 60 patients who attended to the Department of ENT and HNS, Konaseema Institute of Medical Science, Amalapuram between December 2017 to July 2019. By considering AAO-HNS criteria patients were selected and subjected to high resolution computerized tomography para nasal sinuses and diagnostic nasal endoscopy.  

Results: As per study, 60% patients are having deviated nasal septum, followed by aggar nasi in 58.3%, concha bullosa in 26.8%, Haller cells in 11.7%, paradoxical middle turbinate in 11.7%, uncinate pneumatisation in 5%, and onodi cells in 5% of cases.

Conclusions: Anatomical variations in sinonasal cavity predispose to chronic rhinosinusitis and hence require correction. Also, detecting these variations preoperatively by computed tomography of paranasal sinus helps in avoiding complications during functional endoscopic sinus surgery.
A study of complications of chronic suppurative otitis media at tertiary care hospital
Authors: Parmar Bhagirathsinh D. , Jha Sushil , Sinha Vikas , Chaudhury Nirav , Dave Gavendra
Published: January 2020

Background: Chronic suppurative otitis media (CSOM) is a still common disease in developing country and is found sometimes difficult to treat. Different complications can develop inspite of availability of higher antibiotics. In pre-antibiotic era, complications of acute otitis media and CSOM were very common and lead to high mortality. Inspite of initial decline in the complication of CSOM due to higher antibiotics, the incidences are still on rise. CSOM remains a serious disease, particularly in developing countries and CSOM-related complications are still found life-threatening. The aim and objective was to study various clinical presentations and management of CSOM related complications.

Methods: All patients of chronic supurrative otitis media with intra or extracranial complication who were admitted in Department of Otorhinolaryngology Head and Neck surgery, Sir. T. General Hospital, Government Medical College, Bhavnagar from July 2015 to December 2018 was included in this study. Data of clinical presentation, associated complication, management, and follow-up were analysed.  

Results: Out of 250 patients of CSOM admitted during these 3 years in ENT Department, 36 patients presented with CSOM related complications. 15 patients presented with intracranial complications and 21 patients presented with extracranial complications.

Conclusions: Inspite of availability of higher antibiotics, CSOM related complications are still common. In all the patients require higher intravenous antibiotics (which crosses blood brain barrier) followed by mastoid surgeries.
Is it wrong for doctors to be human? Can resident doctors learn to function with less sleep?
Authors: Maan Arvinder Singh , Sandhu Kulwinder Singh , Thomas Oshin , Singh Jagdeepak
Published: January 2020

Background: Medical residency programs are traditionally supposed to be having long working hours, which can be associated with a poor quality of sleep and resultant daytime sleepiness. This poses threat to both physician and patient. This study has an alarming importance in recent scenario, where India is witnessing growing incidents of assaults against resident doctors. We evaluated the subjective sleep quality, day time sleepiness, satisfaction with life, stress, anxiety and depression and their association with subjective sleep quality amongst the residents on their off-duty days and also compared these findings amongst various departments of our institution.

Methods: This cross-sectional study was conducted among 77 first year resident doctors of Government Medical College, Amritsar during the period from May 2018 to March 2019. The tools used for assessment were Pittsburgh sleep quality index, Epworth sleepiness scale, the satisfaction with life scale (SWLS) and depression, anxiety and stress scale-21 questionnaire.  

Results: Our results indicated that 71.43% residents were poor sleepers. 53.24% residents had day time sleepiness of which 46.75% had excessive day time sleepiness. 40.26% residents had mild to moderate stress, 44.16% had mild to moderate anxiety, 31.16% residents suffered from depression of which 18.18% residents suffered moderate to severe depression. 90.91% residents were satisfied with their life on applying SWLS. Poor sleep quality was perceived greatly by the resident doctors in our public hospital.

Conclusions: Understanding the potential impacts of fatigue on resident physicians performance /safety and using this knowledge to optimize shift-duty schedule may reduce the risks to both doctors and patients.
A prospective study to evaluate the impact and independency of depth of invasion in comparison with other clinicopathologic prognostic variables in oral cavity malignancy
Authors: Shanmugam Subbiah , Govindasamy Gopu , Raja X. Gerald Anand
Published: January 2020

Background: Depth of invasion is included in the staging of oral cavity malignancies in the recent 8th edition of American Joint Committee on Cancer or tumour, node and metastasis staging system. This study analyses the impact of diffuse optical imaging (DOI) on incidence of lymph node involvement, stage migration, postoperative margin and independency.

Methods: Postoperative HPE of fifty patients with oral cavity malignancy operated in our institute from January 2018 were collected. Depth of invasion and other pathological parameters were documented. DOI divided into three groups and statistical analysis done.  

Results: No lymph node metastasis is found in superficial tumours, 43% of intermediate thickness and 76% of deep tumours had lymph node involvement. Positive margin is seen only in patients with tumour DOI more than 0.5 cm, more than 50% of deep tumours had close margins while 75% of superficial tumours had adequate margin. Out of the 24 T3 tumours in this study 13 were upstaged due to inclusion of DOI, which would have been T2 according to the previous staging system. There is 54.1% (13 out of 24) upstaging in T3 tumours (T2 to T3), 23% (3 out of 13) in T2 (T1 to T2). There is no significant correlation between DOI and anatomical site, tumour size, tumour thickness, lymphovascular invasion and grade.

Conclusions: Depth of invasion in oral cavity malignancies impacts adversely lymph node metastasis and margin status. It is an independent prognostic factor in oral cavity malignancy.
Assessment of pre and postoperative voice quality in cases of vocal fold polyp
Authors: Prasad Sachana , Raychowdhury Ranjan , Roychoudhury Amitabha
Published: January 2020

Background: Benign vocal fold lesions comprise of a wide range of conditions resulting from vocal misuse or abuse (vocal nodules, polyps, cysts etc.), acute and chronic inflammatory changes, congenital vocal fold anomalies, vocal fold trauma and benign tumours. It results in significant impairment of vocal communication with major psychosocial impact.

Methods: The prospective study was conducted in Department of Otolaryngology, Vivekananda Institute of Medical Sciences, Kolkata from January 2016 to January 2018. All forty patients diagnosed with vocal fold polyp underwent phonomicrosurgery using micro-flap technique followed by voice therapy. Detailed pre-operative and post-operative (3 weeks, 6 weeks, 12 weeks follow up) voice assessment including fibre optic laryngoscopy and laryngovideo-stroboscopic findings were recorded.  

Results: Voice quality of the 40 patients with vocal fold polyps who underwent cold steel phonomicrosurgery had a statistically significant improvement at each follow up visit (3 weeks, 6 weeks and 12 weeks) as assessed by the subjective variables of voice handicap index score, visual analogue scale score and grade, roughness, breathiness, asthenia, strain score and objective variables of jitter, shimmer, harmonic-to-noise ratio, maximum phonation time and fibreoptic laryngoscopy and videolaryngostroboscopic findings. Fundamental frequency in females had statistically improved results but in males, though there was an improvement, the values were not statistically significant.

Conclusions: Cold steel microlaryngeal surgery using micro-flap technique offers excellent results in patients with vocal fold polyps. Perceptual, aerodynamic, acoustic, self-analysis and videolaryngostroboscopic parameters together allow multidimensional assessment of voice characteristics.
Role of thyroid metabolism in vestibular vertigo
Authors: . Anisa , Rai Sheetal
Published: January 2020

Background: Thyroid hormones play a role in the development and functioning of the inner ear.  Therefore, it was hypothesized that a derangement in the thyroid hormone levels can affect the cochleo-vestibular system.

Methods: The present study included 64 cases and 64 controls. All patients diagnosed with peripheral vertigo were enrolled into the study. All the subjects underwent thyroid function tests- serum T3, T4 and thyroid stimulating hormone (TSH). Free hormone levels were obtained in patients with subclinical hypo or hyperthyroidism. The data was analyzed using Independent sample t test.  

Results: Out of 64 cases only 10 patients showed altered thyroid values. Fifty-nine cases were diagnosed with benign paroxysmal positional vertigo (BPPV) out of which 9 (15%) had altered thyroid hormone levels. Among the control group, 12 were found to have deranged thyroid hormone levels.

Conclusions: There is no association between functional thyroid hormone levels and BPPV. Therefore, altered thyroid metabolism has no role in the causation of vestibular dysfunction due to BPPV. However, in case of Meniere’s disease and Vestibular neuronitis further studies with large sample size are required to ascertain the role of functional thyroid hormones in producing vestibular symptoms.
Role of lasers in glottic malignancies: our experience
Authors: Natarajan Kiran , Nandhan Raghu , Dham Ruchima , . Sandhya , Kumar Anand , Kameswaran Mohan
Published: January 2020

Background: Laryngeal malignancy is one of the commonest head and neck cancers encountered in India. Most tumors are glottic in origin. Radiation, partial or total laryngectomy gives very good cure rates for these tumors. Lasers have emerged as an integral part of the treatment paradigm for patients with laryngeal cancer. Laser surgery is one of the primary treatment options for early-stage glottic tumors and can also be used for advanced laryngeal tumors.

Methods: Fifty patients with laryngeal cancer were treated with laser over a 10-year period. Majority of patients were males with an average age of 46 years. Most patients had early (T1, T2) laryngeal malignancy (90%). There were a few patients with advanced laryngeal tumor (10%). All patients had tumor biopsy and simultaneous laserization of the tumor followed by radiation in T1 and T2 disease and chemo radiation in T3 disease. A few patients who had recurrence of disease after radiation (4%) were medically unfit for laryngectomy and underwent laserization of the tumor.  

Results: Laser surgery proved to be an important tool in the management of glottic tumors and is commonly utilized in the treatment of early-stage disease. It has also been successful for debulking of large tumors. Careful case selection is important for good outcomes.

Conclusions: Transoral laser microsurgery and radiotherapy are useful treatment modalities in the management of early glottic malignancies. Lasers have proved to be effective in glottic malignancies with excellent oncologic and functional outcomes.
Drug utilization pattern of antimicrobial agent used in ear, nose and throat outpatient and inpatient department at tertiary care teaching centre
Authors: Arora Renu , Upadhyay Sumit , Singh Hukum , Bajpai Anurag
Published: January 2020

Background: The prospective, observational study was designed to assess the prescribing pattern of drug usage in ENT Department in various diseases conditions.

Methods: Medication utilization Form has been designed based on a WHO format. The patient’s details including patient particulars, diagnosis, investigations, drug details and information regarding the indication for prescribing agents. Patient were enrolled those are either gender with age more than 20 years, outpatients and in patients who are treated in ENT department and who are diagnosed as acute and chronic disease. Exclusion criteria were below the age of 20 years, the patients who were not willing to take antimicrobial agents and those were not able to give consent were excluded.  

Results: Total 1021 prescriptions were analysed, 38.5% were males and 61.5% were females, respectively. 319 of patients were diagnosed with ear, 157 with nose and 489 with throat disorders. The most common disease reported was CSOM in 134 patients and least were only one patient with myringitis. The most frequently prescribed antibiotics were β-lactams was commonly prescribed and least were nitroimidazoles. In the concomitant medications, aceclofenac and serratiopeptidase were most commonly prescribed and least were pantoprazole and domperidone.

Conclusions: Prescribing pattern of usage of antibiotics are more compared to other drugs, β Lactams antibiotics are most commonly prescribed antibiotics in various ENT diseases, usage of brand name are higher than the generic name.