Exploring the Substantive Significance of Laryngoscopic Observations as Reliable Prognostic Indicators for the Therapeutic Efficacy in Cases of Laryngopharyngeal Reflux

Laryngopharyngeal reflux (LPR) can be defined as the regurgitation of gastric acid and peptic substances into the laryngeal and hypopharyngeal regions, even in the case of a singular occurrence. A substantial body of recent research underscores the significance of non-acid reflux as a notable contributor to LPR symptoms. This current investigation delves into the assessment of laryngoscopic observations in their predictive capacity regarding the therapeutic outcomes of empirically administered proton pump inhibitor (PPI) therapy in the context of LPR. In this study, 145 patients who had received a clinical diagnosis of laryngopharyngeal reflux (LPR) underwent rigorous laryngoscopic examinations. These patients were subsequently categorized into three distinct groups based on the Belafsky reflux findings score, which included the criteria for normal (scores ranging from 0 to 7), mild to moderate (scores ranging from 8 to 16), and moderate to severe (scores ranging from 17 to 26). Among the participants, 12 individuals from the normal group, 44 from the mild to moderate group, and 31 from the moderate to severe group reported experiencing a noteworthy alleviation of symptoms following a three-month period of proton pump inhibitor (PPI) therapy and lifestyle adjustments. It is important to note that these findings yielded statistically significant results. Preliminary laryngoscopic observations hold significant potential as predictors of favourable treatment outcomes in the context of empirical proton pump inhibitor (PPI) therapy for laryngopharyngeal reflux (LPR).

Effect of Rhinoplasty on Various Angles of Nose on Ideal Position and Alignment in Indian Population

Study of anthropometric measurements of the nose makes possible a qualitative and quantitative analysis of surgical results. Analysis of pre- and post-operative changes in nasal tip projection, rotation and nasofrontal angle may also emphasize the fact of over correction or under correction of deformed nose to surgeon. Aim of our study to compare preoperative and postoperative nasal tip projection, rotation and nasofrontal angle after rhinoplasty. The present study was a 1.5 years prospective interventional study conducted at SMS Medical College, Jaipur, India from January 2021 to July 2022. Total 51 patients with external nasal deformity were included in our study. Pre-operative, immediate post-operative and 6 months follow-up nasofrontal, projection and nasolabial angle were recorded, compared and analyzed objectively. In our study significant improvements were observed in the nasolabial angle from 92.9 ± 16.4 to 101.6 ± 10.4 and 110.3 ± 9.8 and nasal tip projection from 0.74 ± 0.17 to 0.58 ± 0.11 and 0.52 ± 0.09 immediate post-op and at 6-months follow up respectively. Mean Nasofrontal angle at pre-op, intra-op and post-op 6 months was 132.5 ± 11.9, 135.4 ± 9.6 and 134.8 ± 9.4 and this difference was not found to be statistically significant. We would like to conclude that Indian noses which are predominantly small and shorter, our surgical procedure aimed at making them more prominent aesthetically on the face, so in the present study results were satisfactory in term of anthropometric parameter.

A Comparative Study of Surgical Outcomes in Children with Cochlear Implantation Using Posterior Tympanotomy & Modified Veria Technique

Purpose: To compare the two common approaches of cochlear implantations i.e., mastoidectomy with posterior tympanotomy approach (MPTA) and modified veria technique and to know whether veria technique and its later modifications are as efficacious as the classic approach in terms of duration of procedure, gain in hearing and acquisition and incidence of complications if any. Methods: A prospective comparative study was undertaken at a tertiary care teaching institute. 30 children were selected and randomised into 2 groups who then underwent surgery from the same surgeon after proper evaluation but with 2 different approaches. Their outcomes were then observed and compared in terms of surgical technique and complications and hearing outcomes. Results: 30 children were operated with 15 in each group. In the study, patients under Group A (MPTA) had mean surgical duration of 139.67 ± 16.53 min while Group B (modified Veria) had of 84.67 ± 11.72 min, which was statistically significant (p < 0.05). 1 patient in Group A suffered House Brackman grade 4 facial nerve injury that recovered over 3 months and another had discolouration of the skin flap. No complications were observed in group B. During follow-up CAP and SIR scores were compared and were found to be statistically non-significant between the 2 groups (p value > 0.05), but the paired differences within each group showed statistical significance (P value- <0.001). Conclusion: Veria Technique (and its later modifications) for cochlear implantation is a simple, safe and easy procedure, which is as efficacious as MPTA with added benefits of consuming lesser surgical duration.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03399-1.

Traditional and Coblation Tonsillectomy in Pediatrics Population: A Comparative Study

Tonsillectomy is still surrounded by controversy, especially regarding choice of surgical technique. Despite numerous surgical techniques are present, post-operative pain remains significant postoperative morbidities. An ideal method would lessen complications and minimize operative time and costs. This is a randomized double blinded interventional study. We enrolled 70 subjects and divided into two groups of 35 subjects in each. One group underwent traditional tonsillectomy and another underwent coblation tonsillectomy. We compared operating time, intraoperative blood loss, post-operative pain, return to normal activities and diet and post-operative hemorrhage. Mean operating time in coblation group was 18.24 ± 5.37 min and in traditional group 30.04 ± 7.08 min. The mean blood loss in coblation tonsillectomy group was 82.79 ± 21.13 ml and in traditional tonsillectomy 150.4 ± 37.91 ml. The mean of post-operative pain score in coblation tonsillectomy group was 3.2 ± 1.47 and in traditional tonsillectomy group 6.11 ± 1.61. The mean day of regaining activity in coblation tonsillectomy group was 6.26 ± 0.92 days and in traditional tonsillectomy group 8.26 ± 1.09 days. Mean time by which patients of coblation tonsillectomy group regained their diet was 4.11 ± 0.87 days whereas in traditional tonsillectomy group it was 6.14 ± 1.14 days. There was no case observed with episode of primary or secondary hemorrhage. We conclude from this study that coblation tonsillectomy takes less operating time with less blood loss, also associated with less post-operative pain, less time taken to achieve normal diet and activities.

Lateral Skull Base Lesions: Our Experience of 15 Years

To analyse and report various aspects of lateral skull base surgery by describing the incidence and demographic variables, diagnostic and management challenges, surgical choices along with complications and their management and the long term morbidity and survival outcomes in our experience of 15 years. Retrospective review of complete records of all cases operated for lateral skull base tumors at a tertiary care teaching institution in India between timespan of 15 years from 2003 to 2018 was undertaken. 53 cases were selected and analysed. Those having follow up of less than 6 months were excluded. Outcomes were assessed in terms of incidence of types of tumors, benign or malignant, age and sex variation of the patients, staging status at presentation, status of facial and other lower cranial nerves pre-operatively, surgical techniques with complications if any, recurrences and survival. Of 35 benign tumors, tympanojugular paragangliomas were most common. Average age for these was 53 years with 19 females and 14 males. All were non-functional. Tinnitus and hearing loss were most common presentations. Class B2 and C1 tumors were most commonly encountered and the ITF A approach was most commonly used. Hearing loss and Facial palsy were commonest complication post-operatively. There were 2 recurrences. 18 malignancies were observed. Most were stage IV at presentation. Otorrhea and otalgia were most common presenting symptoms followed by hearing loss. 5 year survival was 55%. Successful treatment of lateral skull base lesions requires a multimodality therapy with team approach. Surgical resection is the primary management choice with variable approaches. ICA status related to the tumor is the most important consideration. Malignancies require more aggressive treatment for obtaining clear margins along with pre/post-op chemoradiation. Good results with acceptable complications can be obtained even with advanced tumors.

Sublabial Approach Versus Modified Denker's Procedure: A Comparative Study of Pre-maxillary Tissue Clearance in Covid-Associated Mucormycosis

To compare the efficacy of the sublabial and modified Denker's procedure in clearance of fungal disease from the anterior wall of maxilla and the pre-maxillary area i.e. the difficult areas of maxillary sinus. A prospective observational study was conducted over a period of 2 months (April 21-June 21) in the ENT department of Sawai Man Singh hospital, Jaipur. All the patients with clinical involvement of the premaxilla or the cheek abutting the anterior wall of maxilla were included in the study population. Cases matched in both groups were subjected to debridement either by the sublabial or the modified denker's approach. Outcomes were measured by assessing the daily CRP values, post-operative DNE every 3 days after pack removal, and imaging at the end of 1 month. Repeat biopsies were performed in patients that still had persistent symptoms after getting operated on. 16 of the 60 patients (26.6%) operated on by the endoscopic approach showed evidence of residual disease on follow-up whereas only 5 patients (9.6%) in the other category had a similar outcome. Most of the recidivism was seen in the anterior maxilla. Lower rates of complications were found following debridement by the sublabial approach. Since the sublabial approach is the most direct approach for the key areas of fungal involvement of maxillary sinus, it is recommended over the modified Denker's procedure for disease clearance from pre maxilla and the anterior wall of maxillary sinus. This view is also supported by the lower rates of complications encountered following the former.

Diagnostic Efficacy of Thyrotropin to Thyroglobulin Ratio in Correlation with Histopathology of Euthyroid Patient Having Solitary Thyroid Nodule

In patients with solitary thyroid nodules, the first course of action is to determine whether the nodule is benign or malignant. Many investigations are used to differentiate between benign and malignant nodules so as to avoid surgery in those who don't need it. Among these, FNAC and USG are commonly used in association with clinical features but there are drawbacks of each technique. The present study was undertaken to assess the diagnostic effectivity of thyrotropin (also known as TSH) to thyroglobulin ratio in correlation with histopathology in euthyroid patients having solitary thyroid nodule. This is a prospective study carried out on 48 euthyroid cases of solitary thyroid nodule. All patients subjected to FNAC, USG, thyrotropin and thyroglobulin assay. Then, they underwent surgery and histopathological examination (HPE) of the specimens done. Finally, the histopathology reports were correlated with the thyrotropin to thyroglobulin ratio in order to evaluate their sensitivity and specificity by statistical methods. The sensitivity and specificity of thyrotropin to thyroglobulin ratio was 100% and 100% respectively. All malignant lesions according to thyrotropin to thyroglobulin ratio were confirmed by histopathology indicating its excellence. Therefore, TSH to thyroglobulin ratio helps in planning the correct management and avoids second surgery. It was found that serum TSH:Tg is a safe, reliable and effective diagnostic modality with a high sensitivity and specificity and is the single best investigation for preoperative evaluation of solitary thyroid nodule to differentiate between benign and malignant nodules.

Invasive Fungal Infections in Dengue Recovered Patients: A New Phenomenon in the Covid-19 Era

Invasive fungal rhinosinusitis was seen to rise to epidemic levels after the 2nd wave of ongoing Covid pandemic, especially in tropical countries, maximally in India. A similar trend is being observed for cases who have recently recovered from dengue virus infection. Post dengue invasive fungal infection is a new presentation and any associations between it and Covid pandemic need to be studied in detail to help prepare for any complications. 3 patients presented to the out-patient department of E.N.T at a tertiary level teaching hospital in East India with complains similar to rhinosinusitis. These patients were then evaluated and diagnosed to be infected from Mucormycosis and Aspergillosis fungal sinusitis after which they were managed with surgical debridement and systemic antifungal therapy. All had a recent history of recovery from Dengue virus infection and a possible association could be suspected. 3 patients presented with complains of pain over upper jaw with orbital swelling and loss of vision developing over a period of 24 days. Two of them had ulceration of hard palate. They were then subjected to Contrast MRI along with CT scan of the Paranasal sinuses which depicted pansinus involvement with intracranial extension in two patients. These were then planned for diagnostic nasal endoscopies along with biopsies which turned out to be Invasive fungal sinusitis in the form of Aspergillosis and Mucormycosis. All the 3 patients had recent history of recovery from Dengue virus infection and did not have any other co-morbidities. Covid Associated Mucormycosis (CAM) is a well-known entity now but no reports of Dengue associated Invasive fungal sinusitis are yet reported. Whether this new phenomenon has anything to do with the interactions between dengue virus and coronavirus is not known at present and needs to be studied in detail so appropriate management protocols can be formulated.

Correlation of Preoperative High-resolution Computed Tomography Temporal Bone Findings with Intra-operative Findings in Various Ear Pathologies

High resolution computed tomography (HRCT) is a tool which provide fine details of temporal bone and its associated pathologies which are of extreme use in making diagnosis, to evaluate extension of disease and most important to plan surgical approach. Aim of the present study was to correlate HRCT findings with operative findings in different ear pathologies. This observational, prospective study enrolled 70 patients of different ear pathologies required surgical intervention. They were subjected to HRCT temporal bone and its findings were correlated with surgical findings. Mean age of the study population was 20.3 ± 12.04 years with M: F = 1.12: 1. HRCT showed specificity and sensitivity of 100% and 92.31% respectively in detecting ossicular erosion. It was 100% sensitive and 98.51% specific in detecting LSCC erosion, 85.71% sensitive and 96.83% specific in detecting facial canal dehiscence, 100% sensitive and 98.11% specific in detecting scutum erosion, 75% sensitive and 96.97% specific to detect tegmen erosion, 100% sensitive and 97.01% specific in detecting sinus plate erosion, 100% sensitive and 95.38% specific in detecting high jugular bulb, sensitivity and specificity both are 100% in detecting labyrinthitis ossificans and 100% sensitive in detecting otosclerotic foci. HRCT findings showed a good association with operative findings in terms of sensitivity and specificity. Thus, HRCT is a acceptable tool to make diagnosis and to plan surgical approach.

Methods for assessing the quality of AM fungal bio-fertilizer: Retrospect and future directions

In the recent past, the mass production of arbuscular mycorrhizal (AM) fungi has bloomed into a large biofertilizer industry. Due to their obligate symbiotic nature, these fungi are propagated on living roots in substrate-based pot cultures and RiTDNA in in vitro or root organ culture systems. The quality assessment of AM inocula remains critical for the production and efficacy evaluation of AM fungi. The vigour of AM inocula are assessed through microscopic methods such as inoculum potential, infectivity potential/infection units, most probable number (MPN) and spore density. These methods marginally depend on the researcher's skill. The signature lipids specific to AM fungi, e.g. 16:1ω5cis ester-linked, phospholipid, and neutral lipid fatty acids provide more robustness and reproducibility. The quantitative real-time PCR of AM fungal taxa specific primers and probes analyzing gene copy number is also increasingly used. This article intends to sensitize AM fungal researchers and inoculum manufacturers to various methods of assessing the quality of AM inocula addressing their merits and demerits. This will help AM producers to fulfil the regulatory requirements ensuring the supply of high-quality AM inocula to end-users, and tap a new dimension of AM research in the commercial production of AM fungi and its application in sustainable plant production systems.

Vertical Strut Ossiculoplasty: A Versatile Alternate to Conventional Techniques-A Randomized study

INTRODUCTION

Various ossicular reconstruction materials and techniques have been described in literature using autologous ossicle, cortical bone, autologous cartilage, synthetic materials and implants like total/partial ossicular replacement prosthesis (TORP/PORP) etc., but it has always been a topic of controversy in terms of the efficacy, longevity and complications of the material or method used.

MATERIAL AND METHODS

This is a prospective, interventional, comparative, double-blind randomized control study which was done at a tertiary care center to compare outcomes of conventional and carved conchal cartilage (vertical strut) type III Tympanoplasty in terms of graft uptake and hearing gain. A total number of 52 cases were enrolled, randomized and allocated to 2 groups (26 each) i.e. group A (conventional type III) and group B (vertical strut technique).

RESULTS

Graft uptake was seen in 25 (96.16%) patients in group B while it was observed in 23 (88.5%) cases in group A. Hearing gains were also better in group B.

CONCLUSION

This study suggests that Vertical Strut technique can be studied further as it gives better gains in Air Conduction threshold and A-B Gap along with graft uptake as it provides better middle ear space and ossicular / tympanic membrane interface resulting in better hearing.

Data-Inspired and Physics-Driven Model Reduction for Dissociation: Application to the O2 + O System

This work presents an in-depth discussion on the nonequilibrium dissociation of O₂ molecules colliding with O atoms, combining quasi-classical trajectory calculations, master equation, and dimensionality reduction. A rovibrationally resolved database for all of the elementary collisional processes is constructed by including all nine adiabatic electronic states of O₃ in the QCT calculations. A detailed analysis of the ab initio data set reveals that for a rovibrational level, the probability of dissociating is mostly dictated by its deficit in internal energy compared to the centrifugal barrier. Because of the assumption of rotational equilibrium, the conventional vibrational-specific calculations fail to characterize such a dependence. Based on this observation, a new physics-based grouping strategy for application to coarse-grained models is proposed. By relying on a hybrid technique made of rovibrationally resolved excitation coupled to coarse-grained dissociation, the new approach is compared to the vibrational-specific model and the direct solution of the rovibrational state-to-state master equation. Simulations are performed in a zero-dimensional isothermal and isochoric chemical reactor for a wide range of temperatures (1500-20,000 K). The study shows that the main contribution to the model inadequacy of vibrational-specific approaches originates from the incapability of characterizing dissociation, rather than the energy transfers. Even when constructed with only twenty groups, the new reduced-order model outperforms the vibrational-specific one in predicting all of the QoIs related to dissociation kinetics. At the highest temperature, the accuracy in the mole fraction is improved by 2000%.

Modified Veria Technique for Cochlear Implantation by Postaural Approach

There are various surgical techniques for cochlear implantation, classical one being mastoidectomy and posterior tympanotomy which has some disadvantages and complications like extensive bone work, violation of mastoid air cell system and fear of injury to vital structures like facial nerve. To minimize these problems, various modifications in cochlear implantation surgery has been done which includes introduction of Veria technique which also has certain disadvantages like extensive dissection and prolonged surgical time. In this article we are introducing an innovative technique of cochlear implantation where we have modified the pre-existing Veria technique that has been described in detail in the coming sections. Total 9 cases have been done so far with this modified Veria technique. This technique includes postaural approach with minimal soft tissue and bone work, making the cochlear implantation simple, easily doable, with less operating time, with minimal morbidity, faster healing due to smaller incision and avoiding facial nerve injury.

Is thyroid excision mandatory with laryngectomy in carcinoma larynx?

Background

Advanced stage operable cancers of larynx are treated with total laryngectomy including thyroid resection in most of the cases, which may expose patient to hypothyroidism and hypoparathyroidism. The requirement of thyroidectomy during Total Laryngectomy is controversial.

Methods

A cross sectional observational study was set out to review preoperative clinical and radiological assessment; intraoperative and histopathological findings; and follow-up data to predict thyroid gland invasion in the setting of squamous cell carcinoma of the Larynx.

Results

11 (16%) out of 69 patients had thyroid gland involvement on histopathological examination with mean age 63 years. Out of these 11 cases, 8 (72%) underwent primary total laryngectomy. 90% patients with thyroid gland involvement were male. 9 cases with thyroid gland involvement were staged as T4a preoperatively.

Conclusion

Invasion of thyroid gland by laryngeal cancer is uncommon. Unnecessary hemithyroidectomies lead to hypothyroidism and hypoparathyroidism. The study points out the clear indications of thyroid excision in patients undergoing total laryngectomy. We can suggest that total thyroidectomy should be done with total laryngectomy in cases which have gross clinical, radiological or intraoperative thyroid gland involvement, subglottic extension and thyroid cartilage invasion. This can save the patients from the brunt of unnecessary morbid hypothyroidism and hypoparathyroidism.

Construction and characterization of protein-based cysteine nanosensor for the real time measurement of cysteine level in living cells

Cysteine plays a critical role in maintaining normal human metabolism, redox homeostasis, and immune regulation. Despite its functional versatility, cysteine metabolism in the human body is not well understood because of the lack of a robust tool for real-time measurement of cysteine at the cellular and sub-cellular level. In the present study, a genetically encoded nanosensor was developed using Cj0982 protein of Campylobacter jejuni, Enhanced Cyan Fluorescent Protein (ECFP) and Venus. The Cj0982 was sandwiched between ECFP and Venus for the construction of the nanosensor, named as Cys-FS (Cysteine-Fluorescent-Sensor). The Cys-FS is pH stable, specific to cysteine and has an affinity of 1.2 × 10^-5 M. A range of affinity mutants were also developed with a cumulative cysteine detection range from 800 nM to 3.5 mM. The Cys-FS nanosensor was expressed in bacterial, yeast and mammalian cells, and the dynamics of cysteine level was measured in living cells using the confocal microscopy. The results showed that the Cys-FS nanosensor successfully monitored the dynamics of cysteine in both prokaryotic and eukaryotic systems without disrupting the cell. Thus, this study presents a novel nanosensor that can measure cysteine in living cells. This nanosensor is minimally invasive and non-toxic.

Long-term prediction of greenhouse gas risk to the Chinese hydropower reservoirs

China is undergoing an extensive hydropower development, but the magnitude of greenhouse gas (GHG) emissions risk to reservoirs is not well known. Electricity generation from hydropower is a challenging issue when it comes to sustainable development. In this study, the data on Chinese hydropower reservoirs (n = 12) were collected from the literature and is used as in input to Greenhouse Gas Risk Assessment Tool (GRAT) to predict long-term GHG (CO₂ & CH₄) risk to the hydropower reservoirs and its associated lifecycle GHG emissions (GHG-LCA). The model predicted that till recently (i.e., year 2018) the hydropower reservoirs found under medium risk (i.e., 109 < CO₂ ≤ 628 and 3 < CH₄ ≤ 45 mg·m^-2·d^-1) which will reduce slowly over a period of 100 years. Out of 12 hydropower reservoirs studied, TGR presently under high risk of CH₄ (i.e., 47 mg·m^-2·d^-1) and medium CO₂ risk. Therefore, assessment is required to know the magnitude of CH₄ and its effect on regional climate so that mitigation measures could be taken in advance. The carbon emissions as CO₂eq of the studied reservoirs are found as 134.69 ± 225.23 Gg yr^-1, with a large share from CH₄ emission. The associated life cycle GHG emissions are also estimated as 0.06 ± 0.09 gCO₂eq·kWh^-1, which is higher than the global estimates (i.e. 0.015 gCO₂eq·kWh^-1).

Status and trend of acute encephalitis syndrome and Japanese encephalitis in Bihar, India

Background.

Acute encephalitis syndrome (AES) is a clinical condition, of which the most common cause is Japanese encephalitis (JE). Though there is deficiency of data on AES and JE from Bihar, the state ranks third in the reporting of JE cases after Uttar Pradesh and Assam. We aimed to assess the status and trends of AES and JE cases in Bihar and to know the status of the disease in the districts.

Methods.

We collected monthly epidemiological data for AES and JE for the period 2009-2014.

Results.

A total of 4400 cases (733 cases/year) with an average case fatality rate (CFR) of 30% for AES for the entire study period. A total of 396 cases of JE were reported with approximately 14% CFR. The disease peaks were during the start and end of the Indian summer and monsoon months for AES and JE, respectively. Districts such as Patna, Jehanabad, Nawada, Gaya and East Champaran reported the maximum number of AES and JE cases with annual incidence rates of 4.7-25.0 and 0.546-1.78 per 100 000 population, respectively.

Conclusion.

Since 2009, the incidence of AES and JE cases has been increasing in Bihar.

Cochlear implant in Thalassemia patient - Case report

INTRODUCTION

Beta-thalassemias are a group of hereditary blood disorders characterized by anomalies in the synthesis of the beta chains of hemoglobin. Iron overload occurs in thalassemia, with blood transfusion therapy being the major cause. Deferoxamine continues to be the mainstay of therapy to remove excess iron in patients requiring long-term transfusions. One of the most important complications of deferoxamine therapy is neurosensory toxicity, including sensorineural hearing loss (SNHL). Labyrinthine hemmorhage (LH) is thought to result from altered capillary hemodynamics or reperfusion injury. It is theorized that LH incites a reparative response that cascades from fibrosis to sclerosis and ultimately ossification of the inner ear structures.

CASE PRESENTATION

We present a case of 3-year-old thalassemic child with bilateral profound sensorineural hearing loss. Patient was on regular blood transfusions with chelation therapy. HRCT temporal bone and MRI brain and temporal bone had features of labyrinthitis ossificans (LO). Child underwent uniateral cochlear implantation and postimplantation speech perception and production outcomes were normal.

DISCUSSION

This case illustrates the unique feature of labyrinthitis ossificans in a thalassemia patient which has not yet reported in the English literature. Hearing screening of all thalassemia patients and therefore early diagnosis of SNHL prompts early intervention and improved quality of life.

Cochlear Implantation in Children with Anomalous Cochleovestibular Anatomy: Our Experience

To report operative findings, postoperative course, and postimplantation performance in patients with cochlear malformations who underwent cochlear implantation. Seventeen patients with malformations which included enlarged vestibular aqueduct (n = 6), Mondini's dysplasia (n = 5) common cavity deformity (n = 3) and incomplete partition type 2 (n = 3) underwent cochlear implantation with Nucleus 22 straight array device at our center. Operative findings described facial nerve anatomy and cerebrospinal fluid leak. Standard tests of speech perception were used to evaluate the postoperative performance for each subject. Operative findings included cerebrospinal fluid leak (thirteen patients) all of which were repaired successfully with graft. None had abnormal facial nerve anatomy. No surgical complications occurred. All the patients except two with common cavity had complete insertion. Electrode thresholds and discomfort levels were variable for several months after implantation. All patients demonstrated improved performance after implantation. Patients with enlarged vestibular aqueduct fared better than patients with other inner ear malformations. Cochlear implantation can be a successful method of rehabilitation in patients with congenital deafness who have cochlear malformations.

Estimation of green house gas emissions from Koteshwar hydropower reservoir, India

The emissions of greenhouse gas (GHG) from soils are of significant importance for global warming. The biological and physico-chemical characteristics of soil affect the GHG emissions from soils of different land use types. Methane (CH₄), nitrous oxide (N₂O), and carbon dioxide (CO₂) production rates from six forest and agricultural soil types in the Koteshwar hydropower reservoir catchments located in the Uttarakhand, India, were estimated and their relations with physico-chemical characteristics of soils were examined. The samples of different land use types were flooded and incubated under anaerobic condition at 30 °C for 60 days. The cumulative GHG production rates in reservoir catchment are found as 1.52 ± 0.26, 0.13 ± 0.02, and 0.0004 ± 0.0001 μg g soil^-1 day^-1 for CO₂, CH₄, and N₂O, respectively, which is lower than global reservoirs located in the same eco-region. The significant positive correlation between CO₂ productions and labile organic carbon (LOC), CH₄ and C/N ratio, while N₂O and N/P ratio, while pH of soils is negatively correlated, conforms their key role in GHG emissions. Carbon available as LOC in the reservoir catchment is found as 3-14% of the total ‟C" available in soils and 0-23% is retained in the soil after the completion of incubation. The key objective of this study to signify the C, N, and P ratios, LOC, and pH with GHG production rate by creating an incubation experiment (as in the case of benthic soil/sediment) in the lab for 60 days. In summary, the results suggest that carbon, as LOC were more sensitive indicators for CO₂ emissions and significant C, N, and P ratios, affects the GHG emissions. This study is useful for the hydropower industry to know the GHG production rates after the construction of reservoir so that its effect could be minimized by taking care of catchment area treatment plan.

Carbon stock estimation in the catchment of Kotli Bhel 1A hydroelectric reservoir, Uttarakhand, India

Constructions of dams/reservoirs all over the world are reported to emit significant amount of greenhouse gases (GHGs) and are considered as environmental polluters. Organic carbon is contributed by the forest in the catchment, part of soil organic carbon is transported through the runoffs to the reservoir and undergoes aerobic and anaerobic degradation with time to release GHGs to the atmosphere. Literature reveals that no work is available on the estimation of 'C' stock of trees of forest catchment for assessing/predicting the GHGs emissions from the reservoirs to atmosphere. To assess the GHGs emission potential of the reservoir, an attempt is made in the study to estimate the 'C' stock in the forest catchment of Kotli Bhel 1A hydroelectric reservoir located in Tehri Garhwal district of Uttarakhand, India. For this purpose, the selected area was categorized into the site-I, II and III along the Bhagirathi River based on type of forest available in the catchment. The total carbon density (TCD) of tree species of different forest types was calculated using diameter at breast height (dbh) and trees height. The results found that the TCD of forest catchment was found 76.96MgCha^-1 as the highest at the site-II and 29.93MgCha^-1 as lowest at site-I with mean of 51.50MgCha^-1. The estimated forest 'C' stock shall be used to know the amount of carbon present before and after construction of the dam and to predict net GHGs emissions. The results may be helpful to study the potential of a given reservoir to release GHG and its subsequent impacts on global warming/climate challenges.

Diphtheria: It is still prevalent!!!

BACKGROUND

Diphtheria is a respiratory infectious disease of childhood. It is a fatal disease and may cause complications if not recognized early and treated properly. Despite availability of effective vaccination it continues to be reported from many parts of the world particularly developing countries.

OBJECTIVE

To assess the demographic and clinical characteristics of diphtheria patients, and the predictors of outcomes of respiratory diphtheria.

METHODS

A prospective analysis of 180 patients with a clinical diagnosis of respiratory diphtheria admitted from 2011 to 2014 at a tertiary referral hospital. They were evaluated with respect to demographic details, immunization status, clinical features, complications and outcomes.

RESULTS

Most common age group affected was children less than 5 years of age (87 cases, 48.33%). The peak incidence of diphtheria was seen in the months of September and October (111 cases, 62%). Majority of the patients were unimmunized (54%), followed by partially immunized (21%). The most common complication was respiratory in 80 cases (44%), followed by cardiac complications in 54 cases (30%), and renal (16%) and neurological complications (10%). Cardiac complications were associated with the highest mortality rate (63%). The presence of bull neck and pseudomembrane score >2 was associated with a high mortality.

CONCLUSION

Diphtheria is still a preventable public health problem in many developing countries. Improved vaccination coverage, including booster dosage, coupled with early detection and effective treatment, may all reduce incidence and mortality.

New ethnomedicinal claims from Gujjar and Bakerwals tribes of Rajouri and Poonch districts of Jammu and Kashmir, India

BACKGROUND

Medicinal plants are frequently employed by Gujjar and Bakerwal tribes in Rajouri and Poonch districts of Jammu and Kashmir, India for treatment of various ailments in humans and livestock. Hence, extensive field work was conducted to document the ethnomedicinal plants used by these tribes.

METHODOLOGY

Ninety one key informants were interviewed using both in situ and ex situ type of survey methods. The data were analyzed using user value (UV), informant consensus factor (Fic), fidelity level (FL) and relative frequency of citation (Rfc).

RESULTS

A total of 104 species of medicinal plants used in the treatment of 40 different non-communicable ailments with 138 remedies are reported. Cephalanthera longifolia (L.) Fritsch was recorded for the first time with ethnomedicinal uses and the rest of the species were previously reported with different medicinal uses by other tribal people. Out of 138 remedies, 129 were employed for human ailments and the remaining seven were used to treat livestock. Most of the species were harvested for leaves (24 species). Herbs (66 species) were the major life form used for medicinal purpose and the most common method of remedy preparation was decoction/tea (27.8%). The highest use value plant was Verbascum thapsus L. for the treatment of stomachache and snake bite.

CONCLUSIONS

Plants such as Allium humile Kunth, Angelica glauca Edgew, Arnebia benthamii (Wall. ex G. Don) I.M.Johnst, Asparagus racemosus Willd., Balanophora involucrata Hook. f. & Thomson, C. longifolia (L.) Fritsch, Cuscuta epithymum (L.) L., Geranium wallichianum D. Don ex Sweet, Gloriosa superb L., Habenaria intermedia D. Don, Phyllanthus emblica L., Ramaria Formosa (Pers.) Quel. and V. thapsus L. showing high Rfc and FL values may be studied for associated pharmacological activities.

Assessing the impact of irrigation treatments on thiram residual trends: correspondence with numerical modelling and field-scale experiments

The present study was undertaken to study the trends of transport of thiram, a dithiocarbamate pesticide, at different time and depth in the fields under real field conditions for wheat crop. Numerical simulations were carried out by solving the coupled soil-water content movement and mass transport equations using HYDRUS- 1D. The supplementary data used for paramaterization of HYDRUS-1D comprise of irrigation treatments, climatic conditions, and soil characteristics. Results focus on the effects and influence of irrigation treatments on pesticide persistence and mobility. Modelling results were in good agreement with the experimentally determined thiram concentrations. Application of the model to measured field data of thiram movement indicates that the modelling approach can provide reliable and useful estimates of the mass flux of water and non-volatile pesticide in vadose zone. For policy-makers and planners, some regulation strategies are suggested for controlling inappropriate pesticide application under deficit irrigation or rain-fed conditions.

Catalytic regeneration of mercury sorbents

Traditionally, mercury sorbents are disposed of in landfills, which may lead to contamination of soil and groundwater. In this work, the regeneration of activated carbon (AC) as a mercury sorbent was investigated. The decomposition of HgCl2 on the surface of pure AC was studied, as well as sorbent which has been treated with FeCl3 or NaCl. In all cases, the sorbent is found to be structurally stable through a single regeneration, which is verified through BET, XRD, and XPS analysis. The desorption of mercury from the sorbent is found to follow Henry's law. Additionally, a kinetic analysis suggests that although the presence of activated carbon lowers the energy requirement for the desorption of mercury, it significantly decreases the rate by decreasing the concentration of the HgCl2. FeCl3 and NaCl both promoted the decomposition of HgCl2, but FeCl3 did so more significantly, increasing the rate constants by a factor of 10 and decreasing the activation energy for the decomposition of HgCl2 by 14% to 40%.

Auto-immune pancreatitis--an uncommon type of chronic pancreatitis

Auto-immune pancreatitis is an increasingly recognised disorder of presumed auto-immune aetiology. It has to be differentiated from other forms of chronic pancreatitis and pancreatic cancer as it has dramatic response with steroid therapy. So, early and prompt diagnosis of this disorder in early stage of disease is essential. Here a case of auto-immune pancreatitis in a 16 years old young male is reported.

Complete nucleotide sequence of cherry virus A (CVA) infecting sweet cherry in India

Cherry virus A (CVA) is a graft-transmissible member of the genus Capillovirus that infects different stone fruits. Sweet cherry (Prunus avium L; family Rosaceae) is an important deciduous temperate fruit crop in the Western Himalayan region of India. In order to determine the health status of cherry plantations and the incidence of the virus in India, cherry orchards in the states of Jammu and Kashmir (J&K) and Himachal Pradesh (H.P.) were surveyed during the months of May and September 2009. The incidence of CVA was found to be 28 and 13% from J&K and H.P., respectively, by RT-PCR. In order to characterize the virus at the molecular level, the complete genome was amplified by RT-PCR using specific primers. The amplicon of about 7.4 kb was sequenced and was found to be 7,379 bp long, with sequence specificity to CVA. The genome organization was similar to that of isolates characterized earlier, coding for two ORFs, in which ORF 2 is nested in ORF1. The complete sequence was 81 and 84% similar to that of the type isolate at the nucleotide and amino acid level, respectively, with 5' and 3' UTRs of 54 and 299 nucleotides, respectively. This is the first report of the complete nucleotide sequence of cherry virus A infecting sweet cherry in India.

Kinetics of acid base catalyzed transesterification of Jatropha curcas oil

Out of various non-edible oil resources, Jatropha curcas oil (JCO) is considered as future feedstock for biodiesel production in India. Limited work is reported on the kinetics of transesterification of high free fatty acids containing oil. The present study reports the results of kinetic study of two-step acid base catalyzed transesterification process carried out at an optimum temperature of 65 °C and 50 °C for esterification and transesterification respectively under the optimum methanol to oil ratio of 3:7 (v/v), catalyst concentration 1% (w/w) for H₂SO₄ and NaOH. The yield of methyl ester (ME) has been used to study the effect of different parameters. The results indicate that both esterification and transesterification reaction are of first order with reaction rate constant of 0.0031 min⁻¹ and 0.008 min⁻¹ respectively. The maximum yield of 21.2% of ME during esterification and 90.1% from transesterification of pretreated JCO has been obtained.

Cognitive behavior therapy for stuttering: a case series

The present investigation was aimed at studying the efficacy of cognitive behavior therapy (CBT) in reducing the symptoms of stuttering and dysfunctional cognitions and in enhancing assertiveness and quality of life in clients with stuttering. Five clients with stuttering who met the inclusion criteria (male clients with diagnosis of stuttering) and exclusion criteria (clients with brian damage), substance abuse or mental retardation were enrolled for the study. A single-case design was adopted. The pre-, mid- and post-assessment were carried out using Stuttering Severity Scale (SSI), Perception of Stuttering Inventory (PSI), Beck's Anxiety Inventory (BAI), Dysfunctional Attitude (DAS), Fear of Negative Evaluation (FNE), Assertiveness Scale (AS), Rosenberg's Self-Esteem Scale (RSES), and World Health Organization - Quality of Life Scale (WHO-QOL). Five clients received cognitive behavioral intervention comprising of psycho-education, relaxation, deep breathing, humming, prolongation, cognitive restructuring, problem-solving strategies and assertiveness. At post-treatment assessment, there was improvement. The findings of the study are discussed in the light of available research work, implications, limitations of the study and suggestions for future research.

An assessment of institutional deliveries under JSY at different levels of health care in Jaipur District, Rajasthan

BACKGROUND & OBJECTIVE

Janani Suraksha Yojana (JSY) has been implemented in the country to enhance institutional deliveries. This study assess the gaps in delivery services and utilization of resources at Basic and Comprehensive Emergency Obstetric Care Centers (BEmOCs, & CEmOCs), accredited sub centers and private hospitals in district Jaipur, Rajasthan.

METHODS

The study was undertaken during October-December 2008 in 31 selected health facilities (5 CEmOCs, 4 BEmOCs, 14 accredited subcentres and 8 accredited private hospitals) in district Jaipur. Both primary and secondary data was collected using qualitative and quantitative techniques, by facility survey, interview of service providers (specialists, medical officers, and paramedical staff) and beneficiaries.

RESULTS

There is an increase in institutional deliveries following implementation of JSY. Though the normal deliveries were conducted 24 hours by the BEmOCs and CEmOCs however the necessary drugs like parental antibiotics, mesoprostol, magsulf etc were in short supply and use of partograph was absent at the health facilities. The quality of emergency obstetric care services was still poor due to the lack of blood storage units and anesthetists in CEmOCs. Private accredited hospitals fared better as they had the manpower and managed more complicated cases as compared to government facilities, for caesarean sections. The accredited sub centers were nonfunctional negating the very objective of accreditation. Community is still unaware of the 24 hour stay post delivery and provision of grievance redressal system.

CONCLUSION

The quality aspects of institutional deliveries are far from desired level mostly because of lack of resources, both manpower and materials; non achievement of IPHS standards etc. The service quality related to antenatal, intranatal and postnatal care need to be improved. The JSY is perceived as an effective scheme by the beneficiaries but gaps in resources and lack of quality of services needs to be adequately dealt with.

Benign tumors of the larynx: a clinical study of 50 cases

OBJECTIVE

The study was undertaken to identify the common type of lesions, and the age, sex distribution, symptomatology, sites of involvement and prognosis of the same.

STUDY DESIGN

A two-year prospective study was conducted from January 2005 to December 2006.

SETTING

The study was conducted at SMS Medical College, Jaipur, Rajasthan, India-a tertiary referral hospital.

PATIENTS

A total of 50 patients with benign laryngeal lesions were included in the study based on symptoms such as hoarseness of voice, foreign body sensation, throat pain, neck mass and cough and with positive clinical findings on indirect laryngoscopy and neck examination. The patients were in the age group of 14-63 years. All nonoperative cases and malignant cases were excluded. Diagnostic hematological and radiological investigations and therapeutic microlarygoscopic procedures were employed.

RESULTS

A male preponderance with a male:female ratio of 2.5:1 was observed. Majority of the patients were in the age group of 21-30 years. Vocal cord polyps were observed to be the commonest type of lesions. In our study, hoarseness of voice, cough, foreign body sensation and throat pain were found to be the commonest symptoms. Out of the 50 patients in the study group, only 6% patients got complete relief with voice rest and vocal rehabilitation; 94% patients required surgery, which included microlarygoscopy and endolaryngeal surgery. There was no recurrence in cases of vocal polyps and nodules during the period of observation.

CONCLUSION

Microlaryngeal surgery and voice rest offer a cost-effective, useful and safe method for the management of benign laryngeal lesions. With the inclusion of lasers, they can be more precisely operated. As such, the standard treatment of choice in all types of benign tumors of the larynx should consist of a triad of approach by microlaryngeal surgery (either microscopic or endoscopic, with or without use of lasers), voice rest and vocal rehabilitation.

Body mass index and per capita income influence duodenal ulcer healing and H. pylori eradication whilst dietary factors play no part

BACKGROUND

The role of dietary and sociodemographic factors in the healing of duodenal ulcer following H. pylori eradication remains undefined.

AIM

To assess the role of diet, sociodemography and body mass index in the healing of duodenal ulcer and eradication of H. pylori.

METHODS

A cross-sectional study consisting of 67 consecutive duodenal ulcer patients was undertaken. Sociodemographic factors studied included age, sex, occupation, educational status, religion, type of family, number of family members, per capita income and residence (urban vs. rural). Personal habits studied included alcohol consumption and smoking. Regular dietary intake over a two-month period was assessed using the food frequency questionnaire. All patients had documented H. pylori infection at the time of inclusion and received standard triple eradication therapy. Follow-up endoscopy and testing for H. pylori were done 4 weeks after completion of eradication therapy.

RESULTS

The mean age of the 67 patients (60 male, 7 female) was 39.9+/-13.6 years. Healing of duodenal ulcer was documented in 51 patients. H. pylori infection was successfully eradicated in 31 patients but not in the other 36. There was no difference between the groups (Group A1: H. pylori eradicated, Group B1: H. pylori not eradicated) with regard to dietary and socio-demographic variables, except for BMI, which was significantly higher in patients in whom H. pylori had been eradicated. Per capita income was significantly higher in Group A2 (healed duodenal ulcer) as compared to Group B2 (duodenal ulcer not healed) while there was no difference in dietary and socio-demographic variables in these two groups.

CONCLUSION

We found that higher body mass index and higher per capita income were associated with successful H. pylori eradication and duodenal ulcer healing, respectively, and that diet had no role to play in either. Further epidemiological studies from different parts of India and studies that control for Helicobacter pylori are required to establish predictive factors.

Randomized, single-blind, placebo-controlled multicenter trial to compare the efficacy and safety of metronidazole and satranidazole in patients with amebic liver abscess

The aims of our randomized, single-blind trial involving 49 patients were to study the efficacy, side effects, and tolerance of metronidazole and satranidazole in patients of amebic liver abscess. Twenty-five patients received metronidazole (800 mg TID) and 24 received satranidazole (300 mg TID with placebo at mealtime). Patients recorded side effects and tolerability through a performa. The time taken for resolution of fever and pain and the fall in abscess size was not significant. However, tolerance of satranidazole as reported by the patients was significantly better than metronidazole (P < .005). The incidence of adverse effects was significantly lower in the group given satranidazole (P < .005). The incidence of nausea and metallic taste was significantly lower in the patients given satranidazole (P < .005). Thus, despite having a similar efficacy, satranidazole showed a far lower incidence of side effects and had a significantly better tolerance than Metronidazole.

Cyst vallecula unusual presentation

Laryngeal cysts, particularly cyst vallecula are generally benign lesions which cause mild dysphagia or change in voice. We report here a case of cyst vallecula that caused soreness of throat, dysphagia and change in voice. A 22-year male presented with progressive dysphagia and muffled voice secondary to a large cystic mass involving entire vallecula and during coughing presented in oral cavity. Per oral marsupilization done and the problem resolved.

Liver abscess in children

Liver abscesses are frequently observed in pediatric clinical practice in tropics and subtropics especially in developing countries. Children have unique set of predisposing factors which have been highlighted. Expected microbiology and setting for unusual organisms are mentioned. Clinical presentations', including importance of location and number of abscesses has been discussed. Role of each modality of treatment clarified. Importance and limitations of investigations and imaging explained and complications and mortality discussed.

Detection of Entamoeba histolytica using polymerase chain reaction in pus samples from amebic liver abscess

BACKGROUND AND OBJECTIVE

Direct demonstration of Entamoeba histolytica by conventional microscopy and in vitro culture in pus obtained from amebic liver abscess (ALA) is often unsuccessful. We evaluated polymerase chain reaction (PCR) for detection of E. histolytica DNA in such pus.

METHODS

Species-specific primers were used for the amplification of E. histolytica DNA from liver pus obtained from 30 patients with ALA. Patients with pyogenic liver abscess and sterile (autoclaved) pus spiked with Entamoeba dispar and bacteria (Escherichia coli, Klebsiella spp. and Bacteroides spp.) were used as negative controls.

RESULTS

PCR was positive in 83% of pus specimens from patients with ALA, and was negative in all 25 pus specimens obtained from pyogenic abscess and autoclaved pus spiked with known bacteria. Sensitivity and specificity of PCR were 83% and 100%, respectively. The overall positivity of PCR was higher compared to serological tests.

CONCLUSION

PCR may be a more reliable and better alternative diagnostic modality for ALA.

Comparison of efficacy of pantoprazole alone versus pantoprazole plus mosapride in therapy of gastroesophageal reflux disease: a randomized trial

The present study aimed to compare the efficacy for the therapy of GERD of pantoprazole alone with a combination of pantoprazole and mosapride. The study was a prospective, randomized trial involving 68 patients suffering heartburn and/or regurgitation at least twice a week for 6 weeks. Sixty-one patients consented to be randomized to receive either pantoprazole 40 mg b.i.d. (n = 33, group A) or pantoprazole 40 mg b.i.d. plus mosapride 5 mg t.d.s. (n = 28, group B) for 8 weeks. Twenty-four-hour esophageal pH-metry and endoscopy were conducted at recruitment and endoscopy was repeated at 8 weeks in all the patients studied. There were no differences in symptomatic responses to therapy between the groups (69.7% vs 89.2%; P = 0.11). The mean symptom score after 8 weeks was significantly lower in group B (3.78 +/- 3.62 vs 1.67 +/- 2.09; P = 0.009). Nonerosive esophagitis was present in 29 patients. In patients with nonerosive GERD there was no significant difference in symptomatic response to either regimen (17/20 in group A and 7/9 in group B responded; P = 0.63). In erosive esophagitis, symptomatic responses occurred more frequently in group B, 18/19 (94.7%), than in group A, 6/13 (46.2%; P = 0.003). However endoscopic healing of esophagitis occurred equally with either regimen (6/11, 54.5% in group A; 12/17, 70.5% in group B; P = 0.44). In nonerosive GERD, the addition of mosapride offers no benefit over pantoprazole alone. A combination of pantoprazole and mosapride is more effective than pantoprazole alone in providing symptomatic relief to patients with erosive GERD.

Abdominal tuberculosis

Tuberculosis can involve any part of the gastrointestinal tract and is the sixth most frequent site of extrapulmonary involvement. Both the incidence and severity of abdominal tuberculosis are expected to increase with increasing incidence of HIV infection. Tuberculosis bacteria reach the gastrointestinal tract via haematogenous spread, ingestion of infected sputum, or direct spread from infected contiguous lymph nodes and fallopian tubes. The gross pathology is characterized by transverse ulcers, fibrosis, thickening and stricturing of the bowel wall, enlarged and matted mesenteric lymph nodes, omental thickening, and peritoneal tubercles. Peritoneal tuberculosis occurs in three forms : wet type with ascitis, dry type with adhesions, and fibrotic type with omental thickening and loculated ascites. The most common site of involvement of the gastrointestinal tuberculosis is the ileocaecal region. Ileocaecal and small bowel tuberculosis presents with a palpable mass in the right lower quadrant and/or complications of obstruction, perforation or malabsorption especially in the presence of stricture. Rare clinical presentations include dysphagia, odynophagia and a mid oesophageal ulcer due to oesophageal tuberculosis, dyspepsia and gastric outlet obstruction due to gastroduodenal tuberculosis, lower abdominal pain and haematochezia due to colonic tuberculosis, and annular rectal stricture and multiple perianal fistulae due to rectal and anal involvement. Chest X-rays show evidence of concomitant pulmonary lesions in less than 25 per cent of cases. Useful modalities for investigating a suspected case include small bowel barium meal, barium enema, ultrasonography, computed tomographic scan and colonoscopy. Ascitic fluid examination reveals straw coloured fluid with high protein, serum ascitis albumin gradient less than 1.1 g/dl, predominantly lymphocytic cells, and adenosine deaminase levels above 36 U/l. Laparoscopy is a very useful investigation in doubtful cases. Management is with conventional antitubercular therapy for at least 6 months. The recommended surgical procedures today are conservative and a period of preoperative drug therapy is controversial.

A randomized trial of oral refeeding compared with jejunal tube refeeding in acute pancreatitis

BACKGROUND

Relapse of pain during refeeding in acute pancreatitis may have a relation to the route of refeeding.

AIM

To compare the efficacy of oral refeeding with jejunal tube refeeding in patients with acute pancreatitis, and determine the frequency of refeeding pain and factors associated with it.

METHODS

Consecutive patients with acute pancreatitis, severe enough to stop oral feeding for 48 hours, were randomized to receive either oral or jejunal tube refeeding. The feeds were similar in calorie, lipid and protein content (400 Kcal on day 1, 1000 Kcal on day 2, 1400 Kcal on day 3, 1500 Kcal on day 4, and 1700 Kcal on day 5). Clinical and biological factors (serum amylase, lipase, C-reactive protein) and Balthazar CT severity index were recorded. Frequency of pain relapse and factors associated with it were analyzed.

RESULTS

28 patients with acute pancreatitis (biliary 14, alcohol 9, idiopathic 3, post-ERCP 2) were included. Fifteen patients received oral and 13 received enteral tube refeeding. Four patients in the oral group and none in the enteral tube group had relapse of pain (p=0.06). The factors associated with refeeding pain were longer duration of initial pain (p<0.02) and higher CT severity index (p<0.02). Pain relapse increased the total hospital stay (p<0.004) and hospital stay after the first attempt at feeding (p<0.001).

CONCLUSIONS

Jejunal tube refeeding may reduce the frequency of pain relapse as compared to oral refeeding although the difference was not significant in this study. Longer duration of pain and higher CT severity index score were associated with occurrence of refeeding pain.

Yogic versus conventional treatment in diarrhea-predominant irritable bowel syndrome: a randomized control study

This study was conducted to evaluate the comparative effect of yogic and conventional treatment in diarrhea-predominant irritable bowel syndrome (IBS) in a randomized control design. The patients were 22 males, aged 20-50 years, with confirmed diagnosis of diarrhea-predominant IBS. The conventional group (n = 12, 1 dropout) was given symptomatic treatment with loperamide 2-6 mg/day for 2 months, and the yogic intervention group (n = 9) consisted of a set of 12 asanas (yogic poses, i.e., Vajrasana, Shashankasana, Ushtrasana, Marjariasana, Padhastasana, Dhanurasana, Trikonasana in two variations, Pawanmuktasana, and Paschimottanasana) along with Surya Nadi pranayama (right-nostril breathing) two times a day for 2 months. All participants were tested at three regular intervals, at the start of study--0 month, 1 month, and 2 months of receiving the intervention--and were investigated for bowel symptoms, autonomic symptoms, autonomic reactivity (battery of five standard tests), surface electrogastrography, anxiety profile by Spielberger's Self Evaluation Questionnaire, which evaluated trait and state anxiety. Two months of both conventional and yogic intervention showed a significant decrease of bowel symptoms and state anxiety. This was accompanied by an increase in electrophysiologically recorded gastric activity in the conventional intervention group and enhanced parasympathetic reactivity, as measured by heart rate parameters, in yogic intervention group. The study indicates a beneficial effect of yogic intervention over conventional treatment in diarrhea-predominant IBS.

Geographical difference in antimicrobial resistance pattern of Helicobacter pylori clinical isolates from Indian patients: Multicentric study

AIM

To assess the pattern of antimicrobial resistance of Helicobacter pylori isolates from peptic ulcer disease patients of Chandigarh, Delhi, Lucknow, Hyderabad and Chennai in India, and to recommend an updated anti-H. pylori treatment regimen to be used in these areas.

METHODS

Two hundred and fifty-nine H. pylori isolates from patients with peptic ulcer disease reporting for clinical management to the Post Graduate Institute of Medical Education and Research, Chandigarh; All India Institute of Medical Sciences, New Delhi; Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow; Deccan College of Medical Sciences and Allied Hospitals, Hyderabad; and hospitals in Chennai in collaboration with the Dr ALM Post Graduate Institute of Basic Medical Sciences were analyzed for their levels of antibiotic susceptibility to metronidazole, clarithromycin, amoxycillin, ciprofloxacin and tetracycline. The Epsilometer test (E-test), a quantitative disc diffusion antibiotic susceptibility testing method, was adopted in all the centers. The pattern of single and multiple resistance at the respective centers and at the national level were analyzed.

RESULTS

Overall H. pylori resistance rate was 77.9% to metronidazole, 44.7% to clarithromycin and 32.8% to amoxycillin. Multiple resistance was seen in 112/259 isolates (43.2%) and these were two/three and four drug resistance pattern to metronidazole, clarithromycin, amoxycillin observed (13.2, 32 and 2.56%, respectively). Metronidazole resistance was high in Lucknow, Chennai and Hyderabad (68, 88.2 and 100%, respectively) and moderate in Delhi (37.5%) and Chandigarh (38.2%). Ciprofloxacin and tetracycline resistance was the least, ranging from 1.0 to 4%.

CONCLUSION

In the Indian population, the prevalence of resistance of H. pylori is very high to metronidazole, moderate to clarithromycin and amoxycillin and low to ciprofloxacin and tetracycline. The rate of resistance was higher in southern India than in northern India. The E-test emerges as a reliable quantitative antibiotic susceptibility test. A change in antibiotic policy to provide scope for rotation of antibiotics in the treatment of H. pylori in India is a public health emergency.

Laparoscopic Nissen fundoplication; results of a prospective pilot study

Laparoscopic fundoplication is rapidly becoming the surgical procedure of choice in western countries for the management of gastro-oesophageal reflux disease (GERD). Experience with this technique is limited in India. Most operations continue to be performed through the traditional open technique, thus denying the advantage of a minimal invasive approach to patients. This study was done to evaluate the feasibility and short term results of laparoscopic Nissen fundoplication. Between June 2000 and March 2002, a total of 10 patients with GERD refractory to medical therapy or requiring daily treatment underwent laparoscopic Nissen fundoplication. Preoperative evaluation included scoring of symptoms, oesophagogastroduodenoscopy, barium swallow and nuclear scan. The intraoperative and post-operative course of the patients was recorded. At 3 months post-surgery, patients were re-evaluated using pre-operative symptom scores and investigations to assess the benefit of and complications associated with surgery. Laparoscopic nissen fundoplication was successfully completed in all the patients. Follow up ranged from 3 to 18 months with a mean of 5.9 months. The mean symptom score decreased from 10.1 pre-operatively to 1.7 (p value < 0.001). Eight out of 9 patients (88%) had endoscopic resolution of oesophagitis. Seven patients (70%) were off medication following surgery while the remaining 3 (30%) were taking medication intermittently. Overall, 80% of the patients were satisfied with the surgery. One patient required re-exploration due to bleeding from a short gastric vessel. The most frequent post-operative complication was temporary dysphagia in 60% of patients, which improved with conservative management over 2 to 3 weeks. We concluded that laparoscopic Nissen fundoplication is a safe and effective procedure to treat patients with GERD.