bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronopharmacology and drug prescribing pattern of physicians in a tertiary care hospital of North India
Authors: Sharma Diwanshu , Malhotra Pavan
Published: February 2018

Background: Chronopharmacology is the science dealing with the optimization of drug effects and the minimization of adverse effects by timing medication in relation to the biological rhythm. This concept came into picture to make us understand about periodic and predictable changes in both desired effects and tolerance of medication Chronotherapeutics approach gives more accurate determination of the time when patients are at highest risk and in greatest need of therapy. This Chronopharmacological principle is used in the therapy of various diseases like cardiovascular diseases, allergy and many more. The objective of the study was to analyse whether chronopharmacological approach was being applied in clinical practice by comparing chronopharmacology of 4 drugs to their prescribing pattern by the physicians.Methods: This was observational study where 700 prescriptions written by physicians were audited. To study all the drugs would have been tedious so four commonly used drugs were chosen that is, Proton pump inhibitors, statins, Beta blockers and subcutaneous Insulin.Results: Results showed that chronopharmacological approach has been applied in the clinical field though physician didn’t have clear concept about chronopharmacology and it is relation to the prescribing. Despite this, maximum physician prescribing pattern was comparable to the chronopharmacological data except in case of Proton pump inhibitors.Conclusions: It is concluded that Chronotherapeutics approach gives more accurate determination of the time when patients are at highest risk and in greatest need of therapy. Nevertheless, this variation is only seldom considered by clinicians. If drugs are prescribed by following chronopharmacological approach it can prove beneficial to the patients as more of effectiveness of the drug and lesser side effects.
Study of knowledge, attitude and practice amongst medical professionals about antimicrobial stewardship in tertiary care teaching hospital in India: a questionnaire based study
Authors: Badar Vandana , Parulekar Vidisha Vivek , Garate Priti
Published: February 2018

Background: Appropriate selection of antimicrobial drugs is critical to optimize treatment of infections ad limit the spread of antimicrobial resistance. Antimicrobial resistance is a serious global problem of antimicrobial abuse and there is a growing consensus to urgently develop new strategies for prevention of resistance of bacteria to antimicrobial agents. Relatively few studies of knowledge, attitude and practice are published regarding antimicrobial resistance.Methods: To explore the perceptions of knowledge, attitude and practice of antimicrobial agent use and its resistance in medical professionals in a tertiary teaching care hospital in India. This study was a cross-sectional, questionnaire based study conducted in tertiary care teaching hospital in India for a duration of three months and on a sample size of 300. All medical teachers, residents and interns were included in studies. Questionnaire included 8 questions of knowledge, 10 questions of attitude and 8 questions of practice. The parameters on which the data was analysed were, gender-wise distribution of data, Age-wise distribution of data, hierarchy-wise distribution- Residents, Lecturers, Assistant Professors, Associate Professors, Professors, according to years of experience, Departmental survey. Some questions were assessed by Likert scale, whose responses ranged from always to never. Some questions were of yes and no type, others were multiple choice questions.Results: The majority of respondents were males (65.66%). Most of the participants were from 21-30years (44%) followed by 31-40 years (32.66%). Almost 77.6% participants had upto 5 years of experience in their respective field. Participants had good knowledge, positive attitude and followed a rational and fair practice about antimicrobial stewardship.Conclusions: Adequate training should be given to UGs and PGs about antimicrobial chemotherapy and its usage. It should be part of their curriculum- proper prescribing, dispensing and usage of AMA so as to promote judicious use of AMA.
Prescription pattern of antiepileptic drugs in indoor patients at tertiary care hospital in Haryana, India
Authors: Narwat Arvind , Sharma Vivek
Published: February 2018

Background: Epilepsy is a challenging medical problem in India with an annual incidence of 27.27 per 100,000 population and prevalence of 572.8 per 100,000. People with epilepsy require prolonged treatment and monitoring. The main goal in the treatment of epilepsy should be adequate control of seizures, without causing any life-threatening reactions due to the medications. This study was done to get an insight into the prescription pattern of anti-epileptic drugs (AEDs) in different types of epilepsy.Methods: A prospective study was carried out for six months (Feb to June 2016) in admitted patients in super speciality ward (Lala Shyam Lal) in neurology department of PGIMS, Rohtak, Haryana. The prescription data of 100 patients of seizures was analysed.Results: Idiopathic generalised epilepsy was commonest type of epilepsy (42%) and sodium valproate was the commonest drug prescribed for its treatment (66.66%) followed by phenytoin (23.33%) Symptomatic epilepsy was second commonest seizure (30%) and phenytoin (60%) was the commonest drug prescribed for it followed by sodium valproate (30%). Common adverse effects associated with anti-epileptic drugs (AEDs) were nausea, drowsiness, weight gain, diplopia and ataxia.Conclusions: Idiopathic generalized epilepsy was the commonest type of epilepsy recorded and sodium valproate was the commonest prescribed drug.
Sustained-release niacin induced acute liver failure: an autopsy report
Authors: Tariq Hamza , Sharkey Francis E.
Published: February 2018

Niacin, either alone or in combination with other anti-hyperlipidemic agents, safely and effectively addresses most lipid abnormalities in patients with mixed dyslipidemias. Niacin is the only available agent that significantly lowers lipoprotein (a) and has the greatest high density lipoprotein cholesterol-raising effects of all available agents. Despite niacin’s numerous beneficial lipid effects, patient compliance to long-term therapy is challenged by its common side effects which include nausea, pruritus, and vasodilatory flushing. The incidence of these unpleasant side effects in patients taking the Immediate Release (IR) form of the drug is close to 100 %. To avoid these side effects, Sustained Release (SR) formulations of the drug were created which lower the rate of nausea, flushing and pruritus markedly. Unfortunately, the SR form is associated with a high incidence of chemical hepatitis and rarely fulminant hepatic failure, which is not seen in patients taking the IR form. We report the autopsy findings of a 68 years old man who died of fulminant liver failure three weeks after switching from IR to SR form of niacin. All other toxic, infectious and autoimmune causes of liver failure were ruled out clinically. His liver biopsy one-week antemortem was consistent with chemical hepatitis, such as has been described for slow-release niacin. At autopsy the liver showed diffuse massive hepatic necrosis with no background fibrosis. SR Niacin is widely available over the counter; however, there is substantial scientific evidence that the drug is associated with potentially fatal hepatotoxicity.
Non albicans Candidemia: an emerging menace in neonatal intensive care unit
Authors: Shettigar Chandrashekar G. , Shettigar Sanchita
Published: February 2018

Background: Candidemia has become an increasingly major problem in neonatal intensive care unit (NICU) which is associated with high mortality and morbidity. In this study we evaluated the epidemiology of Candidemia in neonates who were admitted to NICU and their in vitro susceptibility to commonly used antifungal drugs.Methods: This was a retrospective study of candidemia in NICU from October 2014 to September 2017. The isolates were identified as per standard mycological techniques and antifungal susceptibility was determined by disk diffusion method.Results: Out of 563 blood culture analyzed, 54(9.59%) culture yielded Candida in their blood. The non albicans Candida (NAC) species were the predominant organism for candidemia in neonates, accounting for 35 (64.81%) and the remaining 19 (35.18%) isolates were of C. albicans. Among the NAC species, the maximum isolates were of C. krusei (31.48%) followed by C. glabrata (22.22%). Non albican Candida were more resistant to azole group of antifungal, especially commonly used antifungal like fluconazole (51.43%). Among NAC species, C. glabrata was most resistant and C. tropicalis was least resistant organism. Prematurity <34 weeks, very low birth weight (<1500gm), prolonged use of broad spectrum antibiotic therapy, prolonged use of central venous catheter, mechanical ventilation, parenteral nutrition, prolonged NICU stays and concomitant bacterial sepsis were significantly associated with Candida infection in blood stream. NAC species were also associated with high mortality rate.Conclusions: Increased incidences of candidemia along with emergence of NAC species have become an important health care issue. Therefore, knowledge of local epidemiological data on candidemia is essential which will guide on therapeutic decision making.
Prevalence and risk factors of anemia in under five-year-old children in children’s hospital
Authors: . Kanchana , Sr. Madhusudan , Ahuja Sam , Nagaraj Niranjan
Published: February 2018

Background: Anemia is a global public health problem affecting both developing and developed countries with major consequences for human health as well as social and economic development. This study is conducted to assess the proportion of children, aged between 6 months to 5 years having anemia and risk factors of iron deficiency anemia among selected children with anemia. Methods: The present cross-sectional study was conducted in 500 children between the age of 6 months to 5 years, who were admitted (in patients) to the Department of Pediatrics of Dr. BR Ambedkar Medical College, Bangalore, were selected and screened for anemia by hemoglobin estimation. This study was carried out from November 2012 to April 2014. Among those children with hemoglobin <11 g/dl, were screened for iron deficiency anemia (Serum ferritin estimation is done). Among these 500 children, 100 children with a hemoglobin level of 11 gm/dl and serum ferritin <12 μg/L were taken up for detailed study. All the collected data was tabulated and statically analysed by using appropriate methods Results: 77.8% of screened children were found to have anemia. In studied children 38% had mild anemia, 54% had moderate anemia and 8% had severe anemia. Male outnumbered than female in the ratio of 1.17:1. More than 50% presented with acute gastroenteritis.79% of anemic children had malnutrition. 24% of anemic children were low birth weight. Dimorphic anemia was common in 6months to 5 years age group. Mean hemoglobin level was 9.26. Mean ferritin, mean serum iron, TIBC, transferrin saturation was 7.23 μg/l, 52.60μg/dl, 346.89mg/dl and 16.31% respectively Conclusions: The diet deficient in iron and other essential nutrients is the single most important cause of anemia in children of this age Diarrhea was the chief associated symptom in more than half the cases studied. Hence it is essential to make provision for safe drinking water and to improve sanitary facilities periodic deworming measure is advised, to reduce parasitic infestation which also contributes to the development of anemia.
Effect of kangaroo mother care on neurodevelopmental outcome of low birth weight babies: a one-year randomized control trial
Authors: Doddabasappa Prathiba N. , Mahantshetti N. S. , Kamate Mahesh , E. Adarsh
Published: February 2018

Background: Low birth weight (LBW) is one of the risk factor for neurodevelopmental delay. The present study was undertaken to assess the role of the Kangaroo Mother Care (KMC) in the neurodevelopmental outcome of low birth weight babies. Methods: The present study was undertaken at Department of Paediatrics, Jawarharlal Medical college, Belgaum during the period from January 2009 to October 2010. The study includes 80 stable LBW babies were randomized into 40 in the KMC group and 40 in convention method of care group. 36 babies in the KMC group and 33 babies in the CMC group completed the study. The Neurodevelopmental outcome was assessed by the Amiel Tison test at three, six, nine and twelfth months of age. This was compared with BSID test, at one year.Results: The neurosensory examination and passive muscle tone (PMT) were found to be abnormal. Majority of the babies in both groups has a normal neurosensory and PMT development at one year. Statistically significant to muscle tone deficit was observed in the CMC babies at six months and nine months (p = 0.005 and p = 0.013). With respect to BSID, 16 and 29 KMC babies had a normal Psychomotor Development Index (PDI) and Motor Development Index (MDI) scores when compared to 8 and 18 CMC babies (p = 0.003 and p = 0.057 respectively). Number of babies with significant delay was observed to be higher in the CMC group being 11 versus 1 for PDI scores and 4 versus 1 for MDI scores.Conclusions: The present study shows that KMC has a beneficial effect on the neurodevelopmental outcome of low birth weight babies and BSID II is a better test to detect the psychomotor and mental developmental delay when compared to the Amiel Tison test.
Cord blood lipid profile in late preterm and term neonates
Authors: T. Yashodha H. , Anjum Syeda Kausar
Published: February 2018

Background: Atherosclerotic cardiovascular diseases are the major causes of mortality and morbidity both in developed and developing countries. High concentrations of lipids in neonates with low gestational age may increase the risk of cardiovascular diseases in the future. It has been suggested that early diagnosis along with appropriate diet and drug therapy may provide an opportunity for long term amelioration of risk factors that contribute to atherosclerosis and cardiovascular diseases in adult life. This study is conducted to compare lipid profile and atherogenic indices in late preterm and term neonates.Methods: It is a prospective comparative study conducted over a period of 12 months in a tertiary care hospital, Bangalore. A total of 170 neonates between 34 to 42 weeks were included in the study. Umbilical cord blood was collected immediately after delivery and lipid values were measured. Atherogenic indices were calculated. Results: Out of 170 neonates, 93 (54.7%) were male and 77 (45.3%) were female. 88 (55%) were late preterm and 72 (45%) were term. The cord blood lipid levels were not affected by the gender of the neonates. TG, TC, LDL, VLDL, LDL/HDL, TC/HDL were higher in late preterm babies compared to term babies (p <0.05), HDL levels were not statistically significant. The mean serum lipid levels (TG, TC, LDL and VLDL) and atherogenic indices were higher in SGA babies than AGA, but HDL levels were not statistically significant. (p >0.05)Conclusions: Lipid levels are inversely correlated with the gestational age. This could be regarded as a risk factor for development of atherosclerosis and cardiovascular diseases in later life.
An observational study of meconium aspiration syndrome and its immediate outcome with relation to thick and thin meconium stained amniotic fluid
Authors: Kumar Sushant , Akhouri Minni Rani
Published: February 2018

Background: Meconium-stained amniotic fluid (MSAF) accounts for approximately 10-15% of live births and Meconium aspiration syndrome occurs in 5% among infants born through MSAF. The purpose of this study was to evaluate the outcome in neonates with meconium aspiration syndrome with regard to thin and thick meconium. Methods: A prospective cohort study of inborn neonates was done from April 2016 to August 2017 admitted in neonatal intensive care unit, Department of Paediatrics and Neonatology, RIMS, Ranchi after obtaining written informed consent from the parents or guardian and diagnosis of MAS was made depending on the clinical criteria and its clinical outcome was observed. MAS babies were studied on the basis of thin and thick meconium stained amniotic fluid.Results: The mean birth weight in thin meconium was 2760±394. The mean APGAR score in thin meconium at 1 minute (3.57±1.01) and 5 minutes (5.57±1.62) was significantly more than thick meconium. The mode of delivery in thin meconium was commonly by cesarean section (76.9%). There was need for resuscitation in 46.1% in thin meconium neonates which was significantly higher than neonates born with thick meconium 6.6% (P value 0.000). The most common complication in thin meconium was birth asphyxia (69.2%), followed by ARF and septicemia. Death was significantly higher in neonates born with thin meconium (69.2%)as compared to thick (20%) with P value of 0.000Conclusions: Amniotic fluid with thin meconium may cause more respiratory and other complications in neonates than amniotic fluid with thick meconium. Hence proper diagnosis and timely intervention can reduce the morbidity and mortality in neonates with meconium aspiration syndrome.
An observational study of clinical profile of infants born to pregestational and gestational diabetic mothers
Authors: Elango Sivakumar , Sankarasubramanian Murugesa Lakshmanan , Marimuthu Balasubramanian
Published: February 2018

Background: Diabetes has now become a global pandemic because of sedentary lifestyle, urbanization, and increasing incidence of obesity and the prevalence is on the rise in developing nations like India. The objective of this study was to study the clinical profile and complications of neonates born to established diabetic mothers and gestational diabetic mothers on insulin.Methods: Over a period of one year, all consecutive live born neonates born to diabetic mothers, both gestational and pregestational (known/established diabetic), on insulin were included in the study.Results: The incidence of hypoglycemia in IPGDM was 2-fold higher (55%) than 25% in IGDM (25%) which was statistically significant (p = 0.009). Congenital anomalies were seen more in IPGDM (41.9%) compared to 18.2% in IGDM which was statistically significant (p=0.02).Conclusions: Congenital anomalies mostly involving cardiovascular, renal system were seen significantly more in newborns born to mothers with established diabetes compared to infants of gestational diabetic mothers. Hypoglycemia was the most common complication followed by hypocalcemia and hyperbilirubinemia.
Nutritional status and its corelates in under five slum children of Kanpur Nagar, India
Authors: Gautam S. K. , Verma Mahesh , Barman S. K. , Arya A. K.
Published: February 2018

Background: In Kanpur, overall there were an estimated 43.6% stunted, 24.1% wasted and 41.8% underweight under-five children. There is a critical window of opportunity to prevent undernutrition by taking care of the nutrition of children in the first two years of life. With this background the present study was undertaken with the aim to assess the nutritional status in under five children in the slum area of Kanpur Nagar.Methods: The present study was conducted in 30 slums of Kanpur Nagar selected through 30 cluster sampling technique. The sample size was calculated as 390. From each cluster, approximate 13 study subjects aged 0-60 months were studied. Mothers of study subjects were interviewed to illicit the requisite information, using a predesigned and pretested questionnaire. Anthropometric measurements were taken using standard technique for each study subject. Data collected was analyzed using statistical tool.Results: Based on WHO classification, the prevalence of stunting and severe stunting was observed to be 31.28% and 13.59%. 14.62% study subjects were wasted while 6.15% subjects had severe wasting. 40.51% had mild-moderate malnutrition and 7.95% had severe malnutrition as per the criteria of mid upper arm circumference. Malnutrition was significantly associated with the age of the study subjects (p <0.05). The prevalence of malnutrition decreased significantly with higher maternal education and among those whose mother’s were housewives (p <0.05). Lower birth order and middle socio-economic class was associated with decreased prevalence of malnutrition (p <0.05). Conclusions: The nutritional status of children is dependent on maternal education and occupation and socioeconomic status. Nutrition education can have a significant effect in its reduction.
Application of WHO-2009 guidelines in management of dengue in children and its outcome evaluation
Authors: Badiger Shriharsha , Matti Mahantesh , Goudar Vikram
Published: February 2018

Background: Dengue is the commonest mosquito born viral infection. The numbers of dengue cases are increasing in recent days. Though the manifestations of dengue are complex, management is made simple by WHO-2009 guidelines. Many of clinicians are unaware or not sensitized about WHO-2009 guidelines in classification and management of dengue cases.Methods: 143 suspected dengue cases were selected based on presumptive diagnostic criteria and were classified as group A, B and C, and all the patients were treated according to WHO guidelines. 108 cases with positive dengue IgM/IgG were chosen for analysis and rest of the cases were excluded from the study. The ELISA for IgM & IgG was sent on 5th-6th day of fever.Results: 108 dengue IgM/IgG positive cases were selected for the study. They were grouped as Group A (20), Gr B (60), Gr C (28) according to guidelines. Most common associated symptoms were vomiting (60%), pain abdomen (61%), and puffiness of face (58%). Rashes were present in small number of patients (7.4%) and bleeding in 2.7% children. 5% in group A, 6.6% in group B and 17.8% in group C had platelet counts of <20000/mm3. 70% children of Group -A, 75% of Group -B and 85.7% of Group -C had PCV of >35, with maximum of 53.2 belonging to Group C. None of the patient received platelet transfusion. All children recovered well.Conclusions: In the present study we managed all the dengue cases as per guidelines of WHO-2009.  The treatment is cost effective and has very good outcome with less complications. The mortality, morbidity and duration of hospital stay were reduced. The need for iv fluids, blood and blood products were brought down significantly.
Anthropometric assessment in children with congenital heart disease
Authors: Rubia Begam , Kher Anjali
Published: February 2018

Background: Congenital Heart Diseases (CHD) are often associated with malnutrition with prevalence of 64%. Malnutrition in CHD increases morbidity and mortality in these children and hence it is essential to assess the nutritional status of the children with CHD so that proper nutritional therapy and rehabilitation can be done.Methods: In this case control study 126 cases of un operated CHD in the age group of >28 days to 10 years and 126 age and gender matched controls without CHD were studied during a period of 2 year. Informed consent from the parents was obtained and they were interviewed using pre-validated proforma and relevant clinical examination, detailed anthropometric assessment was done of all cases and control.Results: Male to female ratio was 0.9:1. Maximum cases were in age group of 1 to 5 years. Acyanotic CHD was seen in 80.16% and cyanotic CHD was seen in 19.84%. Stunting was seen in 58.72% cases and in 41.26% of controls. 82.53% of cases and 24.6% of controls were underweight. Conclusions: The prevalence of acyanotic CHD was more common than cyanotic CHD. In acyanotic CHD cases VSD was commonest and in cyanotic CHD cases TOF was the commonest lesion. The overall prevalence of underweight and stunting was high in cases than controls. In acyanotic CHD underweight and stunting was high than cyanotic CHD. In this study malnutrition correlated significantly with congestive heart failure, low hemoglobin level, poor dietary history and pulmonary hypertension and this was statistically highly significant.
Intravesical foreign body in a 12-year-old boy
Authors: S. Pramod , J. Anukethan , K. Ravikiran
Published: February 2018

Self-insertion of foreign body in lower urinary tract is rare in children. It is commonly seen in adults. The reason for self-insertion may be accidental, due to psychiatric illness, curiosity, sexual stimulation or therapeutic in cases of stricture. Most of the cases reported are in adults. Here we present a 12-year-old child presenting with self-insertion of metallic hair pin into the lower urinary tract with symptoms of dysuria and retention of urine. X-ray and ultrasonography were diagnostic modalities which aided in the diagnosis. The child underwent successful cystoscopic removal of foreign body after thorough investigation. Post removal child underwent psychiatric evaluation. He was not suffering from any psychiatric condition. He admitted having inserted the hair pin out of curiosity. Child was passing urine in good stream at time of discharge. At six months follow up child remains asymptomatic.
Endonasal endoscopic dacryocystorhinostomy in Misrata central hospital, Libya
Authors: Jahan Abdussalam M. , Eldanfur Yousef M. , Ben Ghuzi Abdulhakim
Published: February 2018

Background: Dacryocystorhinostomy (DCR) is a surgical procedure performed for the relief of nasolacrimal duct obstruction (NLDO). This procedure involves the creation of ostium at the lacrimal bone to form a shunt in the nasolacrimal pathway. It can be performed externally or endoscopically. The aim of this study is to evaluate the success rates and complications of endoscopic dacryocystorhinostomy in Misurata Central Hospital.

Methods: Prospective study includes 30 patients admitted to the ENT-Department, Misrata Central Hospital over a period of one year, starting from April 2016 to March 2017. They underwent endoscopic endonasal dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction.  

Results: Thirty patients were included in the study. Their age ranged from 11-60 years, with mean age of 33 years. Most of the patients were in the age range of 31 to 50 years. There were 24 (80%) females and 6 (20%) males. The most common complaint of patients before surgery was epiphora. There was more obstruction on left side -21 (70%) than on the right side-9 (30%). Bilateral involvement was not seen. Three patients (10%) were required septoplasty during the endoscopic DCR procedure. Twenty four out of thirty (80%) patients had complete resolution. There were no any significant major complications observed in any patient in our study.

Conclusions: Endoscopic DCR is safe, successful procedure for the treatment of nasolacrimal duct obstruction and has several advantages over conventional external approach.
Ultrasonic cutting and coagulation device versus conventional diathermy dissection in thyroid surgery: prospective randomized trial
Authors: Singhal Aditya , Baskota Dharma Kant , Acharya Kunjan
Published: February 2018

Background: The objective of this study was to compare the operative time and postoperative outcomes in thyroid surgeries using the ultrasonic cutting and coagulation device with conventional diathermy dissection.

Methods: This study was a prospective, interventional, cohort study. The patients   were randomized in two groups by lottery system. The patients operated with ultrasonic device were labeled as Group A: UCCD and by conventional diathermy as Group B: CDD. The operative time, postoperative drain volume, pain score on VAS and complications were assessed and compared in between the two techniques of surgery.  

Results: Total of 18 males and 58 females underwent thyroid surgery with age ranging from 17 to 75 years. The operative time in UCCD group was less than CDD group (93.29 min vs. 106.59 min; p=0.06). The cumulative mean amount of drain was found to be less in UCCD group, this difference was statistically significant (77.86 ml vs. 138.05 ml; p=0.00018). The drain was removed earlier in UCCD group, this comparison was also statistically significant (2.49 days in UCCD group vs. 3.02 days in CDD group; p=0.000009). The mean pain score was found to be statistically significant on all the postoperative days in UCCD group.

Conclusions: The patients experienced less pain and complication while using UCCD as technique for surgery.  Hence, ultrasonic device using both cutting and coagulating mode at the same time is efficient in hemostasis and lesser post-operative pain, and found to be advantageous.
Myringoplasty: underlay versus overlay techniques- a comparative study
Authors: S. G. Mahesh , Pai Vishwas K. , Pavithran Pallavi , P. S. Nithin
Published: February 2018

Background: Chronic suppurative otitis media is an inflammation of the mucoperiosteal lining of the middle ear cleft. 10% of Indian population suffers from hearing impairment.

Methods: The study comprises of 60 patients admitted in the department of ENT and head and neck surgery, AJIMS, Mangalore between June 2015 and May 2017. All patients suffered from CSOM, tubotympanic type. Selection criteria was patients with CSOM, TTD type with no or minimal SNHL, AB gap more than 20dB, absence of ossicular defects, no history of previous ear surgery and was operated on worse hearing ear. Exclusion criteria were atticoantral disease, ossicular defects, previous ear surgery, otomycosis and systemic diseases.  

Results: The majority of the patients were between the age group of 20-40 years. Out of the 60 patients, 28 were male and 32 female. 8 patients with moderate size and 20 with large perforations underwent underlay myringoplasty. For onlay corresponding numbers were 17 and 13. 26 patients (86.7%) who underwent underlay and 27 patients (90%) who underwent overlay had good hearing improvement. 43.3% of the group had significant hearing improvement at 6 months follow up. 20 patients had pneumatised and 40 patients had sclerotic mastoids in the study. Graft take up was 90% for underlay and 96.6% for overlay. The hearing loss was more with larger perforations.18 patients with large perforations who underwent underlay had good hearing improvement versus 13 for overlay whereas for moderate perforations, only 8 patients had good hearing improvement for underlay versus 15 for overlay.

Conclusions: The hearing improvement obtained with underlay and overlay myringoplasty are comparable. The cellularity of mastoid has no influence on the hearing improvement. The size of the perforation correlates well with the degree of hearing loss. Underlay myringoplasty seems to give better results for large perforations, overlay for moderate sized ones.

 
Study of pathology of ossicles in non-cholesteatomatous chronic suppurative otitis media, its repair and outcome
Authors: Vijay Bharath Reddy C. R. , Santhosh Reddy M.
Published: February 2018

Background: If the ears have perforation of long standing durations, even without cholesteatomas, they remain infected. Three times as many operations were performed in the United States in 1978 for this disease as were performed for cholesteatoma. The objective of the study was to study of pathology of ossicles in non-cholesteatomatous chronic suppurative otitis media, its repair and outcome.

Methods: This is a clinical study of patients presented to outpatient, department of Vijayanagar Institute of Medical Sciences, Bellary during the period of November 2004 to November 2005 with non-cholesteatomatous chronic suppurative otitis media. This study is aimed to study the various ossicular abnormalities encountered in non-cholesteatomatous chronic suppurative otitis media and their reconstruction techniques.  

Results: 12 ears (40%) had central and 18 ears (60%) had subtotal perforation. The average hearing loss in patients with isolated erosion of lenticular process of incus was 50.72±6.95 dB. In our study, autologous incus was used for ossicular reconstruction in 14 (46.67%) patients and homologous septal cartilage in 10 (33.33%) cases. Twenty-nine of the 30 cases underwent myringostapediopexy (type IIIb tympanoplasty) with the ossicular graft as short columella between the tympanic membrane graft and the stapes superstructure.

Conclusions: Excellent results were noted only with the autologous incus graft. 28.57% of the total patients with autologous incus graft showed excellent post-operative results. Good results were found for autologous incus, homologous septal cartilage and teflon PORP, with percentage of 28.57, 50 and 25% respectively.
A comparative study of superiorly based circumferential tympanomeatal flap tympanoplasty with anteriorly anchoring flap tympanoplasty in large, subtotal, and anterior tympanic membrane central perforations in chronic suppurative otitis media of mucosal type
Authors: Rathi Amitkumar , Gite Vinod , Bhargava Sameer , Shetty Neeraj
Published: February 2018

Background: The main objective of the study was to assess and compare the graft uptake, hearing improvement, complications in large, subtotal, and anterior moderate perforations by each technique viz; superiorly based circumferential tympanomeatal flap tympanoplasty (STT)/full cuff and anterior anchoring flap tympanoplasty (AAT)/anterior tucking.

Methods: In our study of 30 cases age group in the range of 10 years to 60 years. The mean air bone gap for the 8 patients with anterior moderate perforation was 31.75 db, for 17 patients with large central perforations was 38.75 db and for 5 patients with subtotal perforations was 41.4 db.  

Results: Mean air bone gap closure after 3 months of surgery in the STT group was 21.4 db while that after 6months of the surgery for the same group was 22.06 db. Mean air bone gap closure after 3 months of surgery in the AAT group was 18.2 db while that after 6months of the surgery for the same group was 18.73 db.

Conclusions: Comparing the air bone gap closure in patients who underwent surgery by AAT and STT technique we found that there is no statistical difference. Both techniques (viz: superiorly based circumferential tympanomeatal flap tympanoplasty and anteriorly anchoring flap tympanoplasty) can be used for the repair of large, subtotal, and anterior tympanic membrane central perforations in chronic suppurative otitis media of mucosal type.
Evaluation of efficacy of fixed dose combination of montelukast and levocetirizine compared to monotherapy of montelukast and levocetirizine in patients with seasonal allergic rhinitis
Authors: Bylappa Kiran , Silvia C. R. Wilma Delphine
Published: February 2018

Background: Allergic rhinitis (AR) is a global health problem. Almost 10%–25% of population worldwide is affected by AR. Seasonal allergic rhinitis (SAR) is caused by an IgE-mediated reaction to seasonal aeroallergens and is fairly easy to identify because of the rapid and reproducible onset and offset of symptoms in association with pollen exposure. SAR can result in hyperresponsiveness to allergens. Treatment of allergic rhinitis is aimed to achieve optimal symptom control and reduce nasal congestion, sneezing and rhinorrhea over the course of the entire day and night.

Methods: Out of total 274 subjects, 92 subjects in the FDC of montelukast 10 mg and levocetrizine 5 mg group, 92 subjects in montelukast 10 mg group and 90 subjects in levocetrizine 5 mg group were enrolled in the study. The total study duration was 16 days. Criteria for evaluation of primary efficacy were mean change in daytime nasal symptoms score from baseline to end of treatment. Mean change in night time symptoms score from baseline to end of treatment. Mean change in daytime eye symptoms score from baseline to end of treatment. Patient's and physician's global evaluation of allergic rhinitis at the end of treatment. Mean change in rhinoconjunctivitis quality-of life score from baseline to end of treatment.  

Results: Primary efficacy endpoint that fixed dose combination (FDC) of montelukast 10 mg and levocetirizine 5 mg was superior to montelukast 10 mg monotherapy or levocetirizine 5mg monotherapy in the treatment of patients with seasonal allergic rhinitis. Other secondary endpoints and global impression results are also supporting the therapeutic benefit of fixed dose combination over monotherapy.

Conclusions: FDC of montelukast 10 mg and levocetirizine 5 mg was superior to montelukast 10 mg monotherapy or levocetirizine 5 mg monotherapy in the treatment of patients with seasonal allergic rhinitis.
Clinical findings and risk factors associated with oral cancer: a prospective study
Authors: Gupta Yashna , Singh Parvinder , Bedi Neeru , Garg Pardeep , Singh Banipal Raja Paramjit
Published: February 2018

Background: Oral cancer is associated with high morbidity and mortality and therefore it represents a grave health problem worldwide. However there is scarcity of the studies in the literature regarding the prognostic factors amongst the subjects. The aim of the present study is to determine the various risk factors and the most commonly affected sites by the oral squamous cell carcinoma amongst subjects of different age groups.

Methods: The present prospective comparative study was conducted at the Department of Radiotherapy at Guru Gobind Singh Medical College and Hospital during a period of three months i.e. from April 2016 to June 2016. Patients were evaluated every week for a period of approximately 2 weeks. Examination of the oral cavity was done using probe and mouth mirror by trained personnel. TNM classification was used to classify tumour. Patient’s habits like alcohol and tobacco intake were also recorded. Complete demographic information was obtained from all the patients. All the data thus obtained was arranged in a tabulated form and analysed using SPSS software.  

Results: The study included a total of 60 subjects. There were 11 females in the study and 49 males in the study. There were 18.3% (n=11) subjects having cancer of tongue. There were 23.3% (n=14) subjects having cancer of buccal mucosa. Alveolar ridge carcinoma was seen in 8.3% (n=5) subjects. There were 22 patients (30%) having stage III carcinoma. Majority of the subjects i.e. 70% (n= 38) were at stage IV A according to TNM classification.

Conclusions: From the above study we can conclude that there is lack of awareness amongst the people about oral cancer. They mostly present during advanced stage of the disease. Most of the subjects are males, showing there predisposition towards harmful habits.
Rhinolith a forgotten entity: our experience in remote hilly population of Uttarakhand
Authors: Bansal Chetan , Singh V. P. , Nautiyal Deeksha
Published: February 2018

Background: Rhinoliths are mineralized foreign bodies in the nasal cavity and are diagnosed based on the presenting illness and clinical examination. Giant nasal stones are very rare in occurrence, since improved diagnostic techniques now make it possible to identify foreign bodies at an early stage of disease. The aim of the study was to revisit this rare and forgotten clinical entity with the variations in presentation in the hilly population of uttarakhand and treatment revisited.

Methods: We report a case series of 33 patients with rhinoliths who presented to our institute over a period of 10 years, from January 2007 to January 2017.  

Results: Average age was 25.48 years (range: 5 years to 60 years). 19 were female and 14 male. The incident was reported by a family member/attendant in 12.1% of cases (4 cases), discovered following nasal symptoms in 84.84% (28 cases) and was incidentally discovered in 3.03% (1 case). Symptoms comprised rhinorrhea associated with unpleasant nasal odor in 30.3% of cases (10 cases), epistaxis in 15.1% (5 cases), symptoms of sinusitis in 18.12% (6 cases), ozena in 6% (2 cases)and nasal obstruction in 84.84% (28 cases). There was one case of massive bilateral rhinolith presenting with bilateral symptoms which required an open approach in today’s era whereas all other cases were managed endoscopically.

Conclusions: Although rhinoliths are a rare occurrence, attending doctors should be aware of this entity and should have a high index of suspicion in cases with progressive unilateral nasal obstruction, unilateral rhinorrhea, unilateral nasal bleeding. In rare cases, rhinolith should be kept in mind as a differential diagnosis and also in bilateral nasal symptoms also specially if the symptoms are long standing.
Effectiveness of minimally invasive endoscopic sinus surgery in alleviating the symptom complex in chronic rhino-sinusitis
Authors: Reddy M. Santhosh , Reddy C. R. Vijay Bharath
Published: February 2018

Background: Early surgical intervention has been found to be better in terms of patient satisfaction compared even with the medical management. The objective of the study was to study effectiveness of minimally invasive endoscopic sinus surgery in alleviating the symptom complex in chronic rhino-sinusitis.

Methods: Retrospective review of the chronic rhino-sinusitis data of 164 patients done, who undergone functional endoscopic sinus surgery with or without septoplasty between 2005 and 2013. Any recurrence of symptoms and radiological evidence recorded in the patient notes. The number of patients who undergone revision surgery also recorded.  

Results: The recurrence rate of symptoms and sinus disease was 20% (33 patients). There was no relation between the severity of the symptoms and the amount of disease seen in the CT scans. The two patients, who had purulent sinusitis, WERE completely relieved of their headaches and resumed their routine work soon after the operation. About 90% patients improved regarding nasal obstruction, 75% patients improved of nasal discharge, 60% patients showed improvement for sneezing. There were adhesions in about 6% patients and polyps recurred in 30% of patients. The recurrence of symptoms improved with medication in majority of patients.

Conclusions: The meticulously performed functional endoscopic surgery effectively improved symptom complex. If properly performed it is effective in alleviating all the symptoms and decrease recurrence rate and complications can be kept at negligible levels. Hence it offers a clear advantage in reducing complications and recurrence rates in sinus disease. 
A retrospective study comparing treatment outcomes of spontaneous healing, scaffolding with silastic sheet and gelfoam in patients with traumatic tympanic membrane perforations
Authors: Patel Monika , Kaushik Maitri , Dehadaray Arun , Gaikwad Viraj
Published: February 2018

Background: Objective of the study was to compare the treatment outcome of conservative management, intervention with silastic sheet and gelfoam mixed with autologous blood in traumatic perforations of tympanic membrane.

Methods: A retrospective study was conducted on 69 patients; with traumatic ear perforation were treated by conservative management, silastic sheet placement and gelfoam with autologous blood. Patients data every week and minimum of 4 visits was documented. On follow up data was reassessed in terms of symptom improvement, healing of perforation, duration for healing and development of secondary infection. Statistical analysis was done using Fischer’s exact test.  

Results: Out of the 69 patients group1 consisted of 38 patients, group2 had 19 and group3 had 12 patients. The age ranged from 02-72 years, with greater incidence in females. In group 1 though the healing rate was very good symptom improvement was gradual. The symptom improvement in both group 2 and 3 were satisfactory and highly significant p<0.001. The difference in healing outcome of three modality of treatments was found significant p<0.05 but the occurrence of infection and local reaction did not affect the healing outcome at the end p<0.05.
Conclusions: Traumatic TM perforations have a high chance of healing. Treatment outcome should not consider only healing status as a sole measure but symptom relief from distressing symptoms like ear buzzing or tinnitus and hearing loss should also be considered. Use of scaffolding method can be useful in such cases. Hence selection of proper treatment modality should be considered based on patient complaints.
Rosai Dorfman disease: a case report
Authors: Pol Ong Yazid Bin , Siow Ping Loong , Kiang Khor Foo , Ching Gan Soon , Madatang Angeline Bt , Samsudin Ahmad Toha Bin
Published: February 2018

Rosai Dorfman disease (RDD) is a rare granulomatous disease that typically presents with massive lymphadenopathy. To our knowledge, there have only been 650 cases reported worldwide. It is more common among adults and has characteristic clinical, radiological and histopathological findings. Here, we present a case of RDD in a 51 year-old man with massive submental lymphadenopathy which was not responding to antibiotics. Computerized Tomographic Scan showed ill-defined non-enhancing soft tissue density while fine needle aspiration for cytology displayed emperipolesis which is seen in patients with RDD. The swelling followed a benign course and reduced in size progressively without further intervention.

 
Benign cemento-ossifying fibroma: a rare case report
Authors: Singh Gurbax , Kaur Jasmine , Davessar Jai Lal , Kansal Latika , Singh Ajay
Published: February 2018

Cemento-ossifying fibroma (COF) is a benign fibro-osseous lesion commonly seen in the head and neck regions. It is considered as a benign, locally aggressive neoplasm that requires surgical excision. COF has traditionally been considered to be slow growing. We report a case of 11 year-old girl who presented to the ENT Department of our hospital with 7 months history of nasal obstruction, proptosis and headache. Computed Tomography scan images showed a mass in the right nasal cavity. This case is notable because involvement of the sphenoid sinus is rare. 
A study of efficacy of tranexamic acid in reduction of blood loss in primary total knee arthroplasty
Authors: Hari Krishnan B. , Pushkar Akshay , Vikas Rohit
Published: February 2018

Background: Tranexamic acid (TXA) has been shown to be effective in reducing blood loss during trauma and surgeries. Although there is no well-established protocol, it is now increasingly being used in joint replacement surgeries. The present study was designed to study the effect of intravenously given tranexamic acid during primary total knee replacement in reducing intraoperative blood loss and need for blood transfusion requirement, compared to a placebo.

Methods: This study was designed as a parallel arm, double blind trial. 100 patients of primary osteoarthritis undergoing total knee arthroplasty under tourniquet was included in the study. The efficacy of a single preoperative bolus of TXA in the dose of 15 mg/kg on perioperative blood losses was studied against a placebo with objectives to compare the pre- and 24-hours post-operative level of haemoglobin (Hb) and haematocrit (Hct) levels and assess total volume of blood loss till 24-hours postoperatively and need for blood transfusion.

Results: Out of 168 patients, who underwent TKA in our centre during the period of the study, 100 were included in the study, 50 patients were included in placebo group and 50 patients were included in TXA group. There was a statistically significant reduction in the use of transfusion (Fisher exact test; P=0.001). A total of 46 units of blood were used; 42 units transfused to participants in the placebo group and only 4 units transfused to participants in the TXA group.

Conclusions: Intravenous TXA in primary arthroplasty leads to a statistically significant reduction in total blood loss and requirement for allogeneic blood transfusion with no apparent increased risk of thrombo-embolic complications.
Successful treatment of nonuniting fracture ICNF with Teriparatide in young adult osteopenic male
Authors: Kundu Sujoy
Published: February 2018

We present a case of fracture intra capsular neck of femur in a young adult osteopenic patient, who had a nonunion and early signs of avascular necrosis even after the initial surgical intervention. Teriparatide was administered for two monthly doses after diagnosis of nonunion and avascular necrosis of femoral neck. 90% successful union was achieved in 2 months without further surgical intervention, and no adverse events related to the use of teriparatide were observed. Our case report shows that teriparatide can be an alternative to surgical intervention in nonunion of ICNF with early signs of avascular necrosis.