Anterior septal chondroma

The cartilaginous tumours of the nasal septum are very rare and almost always arise from the posterior part. Considering the extremely rare occurrence of chondroma arising from anterior part of septum we report such a case. The tumour was well defined, homogenous in appearance and was widely excised through lateral rhinotomy approach. The least accepted traumatic etiology seems to be most appropriate for the oncogenesis in this case. We advocate a thorough histopathological examination of the tumour in to-to in order to appreciate early sarcomatous changes. This report also reviews the relevant literature.

Assessment of In vitro Sun Protection Factor of Calendula Officinalis L. (Asteraceae) Essential Oil Formulation

The present study was undertaken to study the sunscreen activity of herbal formulation. There is no evidence of the sun protection factor (SPF) studies on essential oil of Calendula flowers (Calendula officinalis L., Asteraceae). The study investigates the in vitro SPF by ultraviolet specrtophotometry method of Calendula flower oil in a cream formulation. Calendula oil was isolated by Clavenger's apparatus, compositions were identified by GC–MS and the cream of calendula flower oil was prepared by homogenization method followed by evaluation for physical parameters. The sun protection factor of cream was evaluated by in vitro method employing UV–visible spectrophotometer (Shimazdu-1600). The SPF of Calendula oil in cream formulation exhibited good activity (SPF = 14.84 ± 0.16). Finding of this study suggested that calendula oil cream can be used to protect the skin from UV radiations in form of sunscreen cream and to maintain the natural pigmentation of the skin.

Factors predicting surgical outcome of thymectomy in myasthenia gravis: A 16-year experience

Aim:

To assess the surgical outcome of myasthenia gravis (MG) following thymectomy and to determine the outcome predictors to such therapeutic approach.

Materials and Methods:

This study is a retrospective review of 80 consecutive thymectomies performed for MG over a 16-year period.

Results:

There were 41 females and 39 males (mean age, 34.32 years) with mean disease duration of 17.45 months prior to surgery. Stagewise distribution of the patients revealed 2.5% in stage I, 48.7% in stage IIA, 33.8% in stage IIB, 8.7% in stage III, and 6.3% in stage IV. The surgical approach was either trans-sternal (n=67) or video-assisted thoracoscopic route (n=13). Follow-up was obtained in 91.2% (n=73) of patients with mean duration of 67.7 months. At their last follow-up, 26.0% were in complete remission, 35.6% were asymptomatic on decreased medications, and 17.8% had clinical improvement on decreased medications. Overall, 79.4% of patients benefited from surgery, 8.2% had unchanged disease status, and 12.3% worsened clinically. Factors influencing favorable outcome include sex, disease stage, gland weight, and preoperative medication with anti-cholinesterase (P<0.05). There was one death in the perioperative period due to septicemia. Two patients died at fourth and seventh month following thymectomy.

Conclusion:

Thymectomy for MG is safe and effective. Certain influencing factors may shape treatment decisions and target higher risk patients.

Pistia stratiotes (Jalkumbhi)

Pistia stratiotes (Family: Araceae) is commonly used in Ayurvedic medicine. This review article is a compilation of all the updated information on its phytochemical and pharmacological activities, which were performed by different methods. Studies indicate that P. stratiotes possesses diuretic, antidiabetic, antidermatophytic, antifungal, and antimicrobial properties. These results are very encouraging and indicate that this plant should be studied more extensively to confirm the reproducibility of these results and also to reveal other potential therapeutic effects, along with some “leads” with possible isolation of active biomoieties and their mechanism of action.

Non-alcoholic fatty liver disease (NAFLD) is associated with low level of physical activity: a population-based study

BACKGROUND

High intensity exercise improves metabolic status and may potentially mobilise hepatic fat.

AIM

To assess the level of physical activity (PA) of subjects with non-alcoholic fatty liver disease (NAFLD).

METHODS

Data were obtained from NHANES (2003-2006). Activity counts obtained from accelerometer readings (ActiGraph, Fort Walton Beach, FL), from 7 consecutive days quantified total PA and time spent engaged in different levels of activity. All measures were counts/minutes/day: (sedentary <100; light 100-0027; moderate, 2020-5999 and vigorous, 6000+). NAFLD was defined as a fatty liver index >60 (FLI) in the absence of other chronic liver disease. Subjects with NAFLD were compared to controls using stratum-specific Chi-squared and t-tests. Simple linear regression analyses (with Taylor series linearised variance estimation and weighting) were used to determine the association between PA levels and NAFLD. P-values <0.05 were considered significant. Statistical analyses were conducted using sudaan version 10.1 and sas version 9.1.

RESULTS

We included 3056 participants. NAFLD patients were older, had higher BMI, larger waist circumference, higher sum of skinfolds, more likely to have insulin resistance (HOMA > 3.0) and type-2 diabetes (all P-values <0.01). Average PA for NAFLD subjects was about 28.7 counts/minute/day less than controls (P < 0.01). Furthermore, NAFLD subjects spent less time participating in activity at any level (P < 0.01). Subjects with NAFLD and DM were in the lowest quartile of average PA as well as moderate-vigorous PA (P < 0.01).

CONCLUSIONS

Data from this study show that non-alcoholic fatty liver disease patients have low level of physical activity and, when they have diabetes mellitus, they perform at the lowest quartile of physical activity and moderate-vigorous physical activity.

Anomalous origins of bilateral vertebral arteries in a child with Down syndrome and Moyamoya disease. A case report

Variations in vertebral artery origin and course are well-described in the literature. The origin of right vertebral artery from the right common carotid artery is an extremely rare variant. We describe a unique case of a child with Down syndrome with variant origins of bilateral vertebral artery, an aberrant right subclavian artery and concomitant Moyamoya disease of intracranial circulation. The presence of variations of the origin and course of craniocervical arteries might have profound implications in angiographic and surgical procedures and hence it is of great importance to be aware of such a possibility.

Computed tomographic evaluation of the effects of mandibular advancement devices on pharyngeal dimension changes in patients with obstructive sleep apnea

PURPOSE

The aims of this study were to evaluate the effect of a mandibular advancement device on oropharyngeal dimension in patients with obstructive sleep apnea (OSA) and reveal the predominate site of changes produced by mandibular advancement using computed tomography (CT).

MATERIALS AND METHODS

CT scans of 20 patients diagnosed with OSA were taken with and without the appliance. Three-dimensional changes in pharyngeal shape measured on cross-sectional CT images during two respiratory cycles after oral appliance insertion were estimated at five vertical levels using three variables: (1) lateral dimension, (2) anteroposterior dimension, and (3) cross-sectional area. Various parameters related to severity of OSA such as snoring volume, frequency, duration, and episodes; breathing pauses; oxygen saturation; Epworth Sleepiness Scale (ESS) score; and Apnea Hypopnea Index (AHI) score underwent comparative evaluation subjectively and objectively. Data were analyzed using the Student t test for parametric analysis.

RESULTS

A significant increase in the lateral and anteroposterior dimension of the pharyngeal lumen was observed at all five levels, but the mean change was greatest at the retroglossal level and smallest at the hypopharyngral level in both the lateral and anteroposterior dimensions. The cross-sectional area at all levels appeared to increase significantly, and apnea indices improved significantly. A significant decrease in snoring volume, snoring frequency, breathing pauses, snoring duration, snoring episodes, ESS score, and AHI score and a significant increase in oxygen saturation were found after treatment with the mandibular advancement device.

CONCLUSION

Within the limitations of this study, CT was shown to be useful in evaluating treatment efficacy in subjects with OSA.

Recurrent respiratory pappillomatosis: national registry

Recurrent respiratory pappillomatosis is a rare condition with unpredictable nature of disease presentation and behaviour. This write up highlights our institutional experience and the importance of having a national registry for the same. An existing registry created by our team is introduced to facilitate maximum participation by our national otolaryngologists.

Viability kinetics, induction, resuscitation and quantitative real-time polymerase chain reaction analyses of viable but nonculturable Vibrio cholerae O1 in freshwater microcosm

AIM

To study the induction of a viable but nonculturable (VBNC) state in Vibrio cholerae O1 in freshwater, in response to cold temperatures (4°C) and starvation.

METHODS AND RESULTS

Vibrio cholerae O1 cells were inoculated in freshwater microcosm and incubated at 4°C. The cells became coccoid, rugose and subsequently nonculturable by day 16 on tryptic soy agar (TSA) and by day 23 on TSA-SP, while 87 and 65% of the cells retained their membrane integrity, respectively. Viable cells were observed until day 30 using direct fluorescent antibody-direct viable count method. In vitro resuscitation was demonstrated by temperature upshift. Utilizing 16S rRNA as an endogenous control, the DNA pol II (27·43-fold), fliG (12·44-fold), ABC transporter (27·11-fold), relA (60·76-fold) and flaC (15·29-fold) were significantly up-regulated in VBNC cells, while the expression of fadL-3 was comparable. The expression of DNA pol II, fliG, ABC transporter, relA and flaC was 3·3, 1·1, 5·9, 5·8 and 1·2-fold, respectively, for resuscitated cells. VBNC cells were found to be virulent, as ctxA and tcpA were expressed.

CONCLUSIONS

Vibrio cholerae undergoes both phenotypic alteration and genotypic modulation to protect itself from stress in freshwater.

SIGNIFICANCE AND IMPACT OF THE STUDY

Induction and resuscitation of the VBNC state in freshwater is important for an understanding of the epidemiology of cholera in the freshwater environment.

Distribution and ethnic variation of â-thalassemia mutations in Nepal

This is the first study characterizing spectrum of beta-thalassemia mutations in Nepalese population. Mutations were analyzed in 22 patients using 10 sets of allele-specific primers. Five of the mutations, namely F.S 41/42 (--TCTT), IVS1 nt5 (G-->C), IVS1 nt1 (G-->T), 619 bp deletion and F.S 8/9 (+G), were found to constitute 87.82% of total alleles studied. F.S 41/42 (--TCTT) was the commonest mutation. -88 (C-->T), Codon 16 (--C) and Codon 15 (G-->A), had a combined frequency of 12.18%. Distribution of mutations causing beta-thalassemia in different ethnic Nepalese groups was analyzed. The mutational profile in Nepal share several similarities with that from the two neighboring countries, India and China. Detection of more than one mutation in three cases of thalassemia trait raises the likelihood of existence of multiple mutations in cis in Nepalese thalassemic carriers. Such possibility has to be carefully considered while developing prenatal screening program for Nepalese population.

Oral Sex and HPV: Population Based Indications

Human pappilloma virus (HPV) is well established in etiology of uterine cervical cancers, but its role in head and neck cancer is strongly suggested through many epidemiological and laboratory studies. Although HPV-16 induced oropharyngeal cancer is a distinct molecular entity, its role at other sub-sites (oral cavity, larynx, nasopharynx, hypopharynx) is less well established. Oral sex is supposedly the most commonly practiced unnatural sex across the globe and may prove to be a potential transmitting link between cancers of the uterine cervix and the oropharynx in males particularly in those 10-15% non-smokers. In India with the second largest population (higher population density than China) the oral sex is likely to be a common 'recreation-tool' amongst the majority (poor) and with the concurrent highly prevalent bad cervical/oral hygiene the HPV is likely to synergize other carcinogens. Hence in accordance (or coincidently), in India the cervical cancer happens to be the commonest cancer amongst females while oral/oropharyngeal cancer amongst males. Oral sex as a link between these two cancer types, can largely be argued considering a poor level of evidence in the existing literature. The modern world has even commercialized oral sex in the form of flavored condoms. The inadequate world literature currently is of a low level of evidence to conclude such a relationship because no such specific prospective study has been carried out and also due to wide (and unpredictable) variety of sexual practices, such a relationship can only be speculated. This article briefly reviews the existing literature on various modes and population based indications for HPV to be implicated in head and neck cancer with reference to oral sexual practice.

Interventions for atrophic rhinitis

BACKGROUND

Atrophic rhinitis is a chronic nasal pathology characterised by the formation of thick dry crusts in a roomy nasal cavity, which has resulted from progressive atrophy of the nasal mucosa and underlying bone. The common symptoms may include foetor, ozaena, crusting/nasal obstruction, epistaxis, anosmia/cacosmia and secondary infection with maggot infestation. Its prevalence varies in different regions of the world and it is common in tropical countries. The condition is predominantly seen in young and middle-aged adults, especially females, with a racial preference amongst Asians, Hispanics and African-Americans. A wide variety of treatment modalities have been described in the literature, however the mainstay of treatment is conservative (for example, nasal irrigation and douches; nose drops (e.g. glucose-glycerine, liquid paraffin); antibiotics and antimicrobials; vasodilators and prostheses). Surgical treatment aims to decrease the size of the nasal cavities, promote regeneration of normal mucosa, increase lubrication of dry nasal mucosa and improve the vascularity of the nasal cavities.

OBJECTIVES

To assess the effectiveness of interventions for atrophic rhinitis.

SEARCH METHODS

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 28 March 2011.

SELECTION CRITERIA

Randomised controlled trials (RCTs) studying any treatment or combination of treatments in patients with atrophic rhinitis. We excluded studies with follow-up of less than five months following treatment/intervention.

DATA COLLECTION AND ANALYSIS

Three review authors abstracted and assessed studies. We tabulated and then compared the responses of the review authors separately for the individual studies.

MAIN RESULTS

No studies met the inclusion criteria for the review. We identified one RCT comparing oral rifampicin plus nasal wash versus nasal submucosal placentrex injection plus nasal wash versus a control group (nasal wash) but had to exclude this study due to inadequate length of follow-up. A further RCT comparing Young's operation with nasal lubrication for primary atropic rhinitis is underway.

AUTHORS' CONCLUSIONS

There is no evidence from randomised controlled trials concerning the long-term benefits or risks of different treatment modalities for atrophic rhinitis. Further high-quality research into this chronic disease, with a longer follow-up period, is therefore required to establish this conclusively. 

Azithromycin in acute bacterial upper respiratory tract infections: an Indian non-interventional study

To assess the effectiveness, safety and tolerability of azithromycin in acute bacterial upper respiratory tract infections (URTIs). In this open-label, prospective, multi-center, non-interventional study in bacterial URTI, the decision to prescribe azithromycin was independent of enrolment. Follow up was 1 week after treatment and if possible, at Week 2. Investigators' assessment of clinical outcome (Success/Failure) at the end of study was the primary endpoint for efficacy analysis. Clinical outcome of 'Success' was defined as the global response of Cure or Improvement. A pharmacoeconomic analysis of management of URTIs was also attempted. Of the 410 patients recruited, all were evaluated for safety and 278 for efficacy. The median treatment duration was 3 days. Following treatment with azithromycin, overall success rate was 98.92% (95% CI 96.88-99.78%; Clopper-Pearson method). The success rate was similar across the sub-groups of acute otitis media-100%, bacterial sinusitis-95.83%, and pharyngotonsillitis-99.38%. The success rate was 100% among children and adolescents (age ≤18 years) and 98.6% among adults (age >18 years). Most of the common signs and symptoms of URTI reported during baseline, significantly improved at the end of the study. Sixteen (3.90%) patients reported treatment emergent adverse events, the most common being diarrhea-5 (1.2%) and flatulence-2 (0.5%). The average cost of treating bacterial URTI was INR 716 per patient. Azithromycin is effective and well tolerated in Indian patients with bacterial URTIs.

Prevalence of hearing impairement in the district of Lucknow, India

A multi-cluster study (survey) was carried out by department of ENT KG Medical University, Lucknow from July 2003 to August 2004 in rural and urban population of Lucknow district to estimate prevalence and causes of hearing impairment in the community. Data included audiological profile and basic ear examination that was analysed through EARFORM software program of WHO. Overall hearing impairment was seen in 15.14% of rural as opposed to 5.9% of urban population. A higher prevalence of disabling hearing impairment (DHI) in elderly and deafness in 0-10 years age group was seen. The prevalence of sensorineural deafness necessitating hearing aids was 20% in rural and 50% in urban areas respectively. The presence of DHI was seen in 1/2 urban subjects and 1/3rd of rural counterparts. The incidence of cerumen / debris was very common in both types of population and the need of surgery was much more amongst rural subjects indicating more advanced / dangerous ear disease.

Environmental and epidemiological surveillance of Vibrio cholerae in a cholera-endemic region in India with freshwater environs

AIM

To conduct epidemiological and ecological surveillance of cholera in freshwater environments.

METHODS AND RESULTS

A freshwater region of India was surveyed between April 2007 and December 2008. Vibrio cholerae was isolated from 59·5% of water and plankton samples (n = 357) and 35·5% of stool samples (n = 290). Isolation from water was dependent on air (r = 0·44) and water temperatures (r = 0·49) (P < 0·01) but was independent of rainfall (r = 0·15), chlorophyll a (r = 0·18), salinity (r = 0·2) or pH (r = 0·2) (P > 0·05). Isolation from plankton was dependent on temperature of air (r = 0·45), water temperature (r = 0·44), chlorophyll a concentration (r = 0·42), pH (r = 0·23) and salinity (r = 0·39) (P < 0·01). Cholera cases correlated with rainfall (r = 0·82, P < 0·01) and chlorophyll a concentration (r = 0·42, P < 0·05), but not with air temperature (r = 0·3, P = 0·37). Vibrio cholerae O1 possessed ctxB, ctxA, rstR and tcpA (ElTor), toxR, toxT, rtxA, rtxC, mshA and hylA. Among non-O1-non-O139, the distribution of virulence-associated and regulatory protein genes was heterogeneous with - 0·7, 2·2, 94·77, 97·76, 99·25, 100 and 100% isolates being positive for tcpA, toxT, rtxA, rtxC, hylA, toxR and mshA, respectively. Two-thirds of non-O1-non-O139 isolates exhibited antibiotic resistance to various antibiotics that did not correlate with geographical site or time of origin for the isolates. RAPD and AFLP showed V. cholerae to be a diverse bacterium. AFLP demonstrated separate lineages for non-O1-non-O139 and O1 isolates.

CONCLUSION

Environmental parameters played a significant role in the emergence and spread of cholera and the abundance of V. cholerae. But based on virulence gene profiling and genetic fingerprinting, the possibility of origin of toxigenic isolates from nontoxigenic environmental isolates seems unlikely in freshwater environs of India.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study explains the ecology, epidemiology and seasonality of cholera in freshwater environs.

A naïve Gaussian Bayes classifier for detection of mental activity in gait signature

A probabilistic modelling is presented to detect mental activity from gait signature recorded from healthy subjects. The proposed scheme is based on principal component analysis with reduced feature dimension followed by a naïve Gaussian Bayes classifier. The leave-one-out cross-validation shows the detection accuracy of 94% with specificity and sensitivity of 96% and 98.3%, respectively. The research has a potential application in the prevention of elderly risk falls, lie detection and rehabilitation among Parkinson's patients.