Augmentation in bioleaching potential of indigenous Bacillus sp. ISO1 for metals recovery from waste computer-printed circuit boards.

The bio-cyanidation process of various cyanogenic microorganisms is found to be a sustainable and effective method for metals recovery from primary and secondary sources. This process has surpassed the limitations of the chemical cyanide treatment process; thus, prioritized as a promising approach for e-waste "urban mining" strategies. The main focus of the study was to enhance the bioleaching capacity of indigenous Bacillus sp. ISO1 and to implement optimized parameters in large-scale bioleaching operations. The assessment of various amino acids unveiled that like other cyanogenic microorganisms Bacillus sp. ISO1 also preferred glycine as a prime precursor for cyanide synthesis, as maximum metal solubilization was achieved with glycine amino acid. Other amino acids influenced the bacterial growth but not significantly affected the biocyanidation process. The evaluation and optimization of methionine as a lixiviant stimulator demonstrated that the addition of 1 mg/L methionine effectively enhance the production of glycine-utilizing cyanide lixiviant, that led to a significant solubilization of Cu (86%), Au (75%), and Ag (63%) metals. Furthermore, the kinetics of metal solubilization and operating conditions were explored at increased volume (i.e., 3 L working volume) of bioleaching medium to assess the industrial scale potential of this potent bacterial strain with optimized parameters such as temperature, pH, pulp density, and inoculum size. The significant recovery of Cu (˃ 60%) and other metals at this substantial volume suggested the implementation of a bioleaching process with this potent bacterial strain at industrial scale operations.

Association of Vitamin D Deficiency in Patients with Tinnitus with Normal Audiogram.

In the present study we aim to evaluate serum vitamin D levels in participants having tinnitus with normal audiometric findings. Total 98 participants in the age range 20-70 year were included in the study. Participants underwent detail case history, ear examination, pure tone audiometry and impedance audiometry. 68 participants with subjective tinnitus for more than 3 months and with normal audiometric thresholds and "A" type tympanogram were included in study group and 30 participants without tinnitus in the control group. The participants fullfillng the inclusion criteria underwent thorough tinnitus evaluation which included administration of tinnitus severity index tinnitus handicap inventory, psychophysical evaluation of tinnitus (pitch matching, loudness matching) and assessment of Vitamin D levels. It was seen that the mean Vitamin D levels were significantly lower in study group, and out of 68 participants only 11 had optimal Vitamin D levels, 57 (83%) had Vitamin D levels less that 30 mg/dl. In the control group 20 (66%) had vitamin D deficiency. The difference came out to be statistically significant. Our study suggests that there is a link between vitamin D and tinnitus, in view of these findings we recommend evaluating serum Vitamin D levels in patients of chronic idiopathic tinnitus, especially in adults with normal hearing. Our study suggests vitamin D deficiency may be one of the risk factor for tinnitus in people with normal hearing in the absence of other manifestations.

Exploring bioleaching potential of indigenous Bacillus sporothermodurans ISO1 for metals recovery from PCBs through sequential leaching process.

The low efficiency and selectivity limitations of biohydrometallurgy technique compel the researchers to explore novel microbial strains acclimated to metal existence site with higher toxicity tolerance and bioleaching capability in order to improve the role of bioleaching process for e-waste management. The current study aimed to explore bioleaching potential of indigenous Bacillus sporothermodurans ISO1; isolated from metal habituated site. The statistical approach was utilized to optimize a variety of culture variables including temperature, pH, glycine concentration and pulp density that impact bio-cyanide production and leaching efficiency. The highest dissolution of Cu and Ag, 78% and 37% respectively, was obtained at 40 °C, pH 8, glycine concentration 5 g L-1, and pulp density 10 g L-1 through One Factor at a Time (OFAT), which was further increased up to 95% Cu and 44% Ag recovery through the interactive effect of key factors in the Response Surface Methodology (RSM) approach. Furthermore, Chemo-biohydrometallurgy approach was utilized to overwhelm the specificity limitation; as higher concentration of Cu in computer printed circuit boards (CPCBs) causes interference to recover other metals. The sequential leaching through ferric chloride (FeCl3), recovered Cu prior to bio-cyanidation by B. sporothermodurans ISO1 and resulted in the improved leaching of Ag (57%), Au (67%), Pt (60%), etc. The current work reports on B. sporothermodurans ISO1, a new Bacillus strain that exhibits highest toxicity tolerance (EC50 = 425 g L-1) than earlier reported stains and has higher leaching potential that can be implemented to large-scale biometallurgical process for e-waste treatment to achieve the agenda of sustainable development goal (SDG) under the strategies of urban mining.

Recurrent Epistaxis: An Unusual Manifestation of Clinical Spectrum of Migraine -Case Series with Scoping Review of Literature.

OBJECTIVE: We report four cases of migraine induced epistaxis and reviewed the published literature of migraine with epistaxis to establish demographic profiles, types of migraine, severity, family history of headache and other associated disorders in adults. METHODS: A panoramic search of the Medline database through Pubmed was done in May 2022 using search terms: {Migraine with Epistaxis}, case reports. All articles/case reports in English from January 2001 to April 2022 where age of patients was > 18 years were included in our review. RESULTS: Our search recognized total of three cases and with inclusion of the four cases who reported to us, we reviewed these seven cases and studied demographic profile, clinical features, association of epistaxis with types and severity of migraine and relationship with other medical disorders. Mean age of presentation was 28.7 years (range 18-49), with five female and two male patients. The intensity of headache was severe in three of seven cases and there was one case each of moderate and mild category. Five of seven (71%) patients had reduction in intensity of headache with onset of bleeding and various types of migraine (Migraine with and without Aura, vestibular migraine, sporadic familial hemiplegic migraine) according to ICHD classification were associated with epistaxis. Four of seven had positive family history of migraine. There was no diagnostic finding in any patient and all patients responded to migraine preventive medication. CONCLUSION: Recurrent epistaxis is not so uncommon manifestation of various types of migraine and specialist should keep this clinical diagnosis in mind to avoid misdiagnosis.

Nine Years of Retrospective Study of Mandibular Fractures in Semi-urban Teaching Hospital, Shimla, Himachal Pradesh, India.

Study Design: Retrospective study. Objective: To evaluate current trends in maxillofacial trauma, a retrospective study of mandibular fractures at Government Dental College and Hospital Shimla H.P was carried out. Methods: In this retrospective study, records of 910 patients with mandibular fractures were reviewed between 2007 and 2015 in the Department of Oral and Maxillofacial Surgery out of total 1656 facial fractures. These mandibular fractures were assessed according to age, sex, aetiology in addition to monthly and yearly distribution. Post-operative complications such as malocclusion, neurosensory disturbances and infection were recorded. Results: It was observed that mandibular fractures were most frequent in males (67.5%) and in the age group of 21-30 years; accidental fall was the most common etiological factor (43.8%) in the present study and in stark difference to already published reports. The most common fracture site was that of condylar region 239 (26.2%). Open reduction and internal fixation (ORIF) were done in 67.3% cases whereas 32.6% were managed by maxillomandibular fixation and circummandibular wiring. Miniplate osteosynthesis was the most favoured technique. The complication with ORIF was 16%. Conclusions: To treat mandibular fractures, currently there are many techniques. However, in minimizing complications and in achieving satisfactory functional and aesthetic results experienced surgical team plays an important role.

Inter Observer Agreement Among Radiologist and Otorhinolaryngologists on Paranasal Sinus Computed Tomography Scans in Chronic Rhinosinusitis.

To evaluate inter observer agreement between Radiologist and Otorhinolaryngologists in identifying important structures and pathologies on pre operative computed tomography (CT) scans of paranasal sinus (PNS) in chronic rhinosinusitis (CRS). A retrospective review of CT scans PNS of CRS patients. Archived CT scans were evaluated by 3 observers, similarly experienced radiologist and otorhinolaryngologist and a less experienced otorhinolarygologist. The degree of intra- as well as inter observer agreement was assessed by Cohen's kappa statistics. A moderate and a fair inter observer agreement was noted among experienced radiologist and otorhinolaryngologist; & experienced experts and less experienced otorhinolaryngologist respectively. The greatest disagreements among all observers were found in superior attachment of uncinate process, optic nerve's relationship with sphenoid sinus and dehiscence of anterior ethmoid canal. The present study demonstrated a considerable inter observer variability among radiologists and otorhinolaryngologists, irrespective of their experience in the field of speciality. A few critically important structures which showed an unsatisfactory level of agreement and thus need to be sought after with more training and practice, were also identified. These included Keros type, optic nerve's location, dehiscence of anterior ethmoid artery, vidian and maxillary nerves, lamina papyracia defect, sphenoid sinus pneumatization and attachment of uncinate process. The study also emphasized the importance of inter disciplinary conferences for pre operative evaluation of sinus CT scans of CRS patients.

Psychometric Validation of Hindi Version of Sino-Nasal Outcome Test-22.

The purpose of this study was assessment of reliability, validity & responsiveness of Hindi version of SNOT 22. 110 cases and controls were recruited in this prospective study. The internal consistency, test-retest reproducibility, construct & criterion validity, and responsiveness of Hindi version of SNOT 22 were assessed. Hindi SNOT 22 showed a good internal consistency (Cronbach's alpha (α) in cases = 0.823 and in controls = 0.868). Physical and Quality of life subscales also showed good internal consistency (α of 0.711 and 0.87 respectively). Test-retest reproducibility using Spearman's rank correlation coefficient (rs) showed very high correlation (rs = 0.939). There was significant difference in scores (p < 0.00001) between cases and controls (46.99 ± 13.97 and 07.58 ± 6.772 respectively). The mean pre and post-operative scores were 53.43 ± 12.241 and 20.50 ± 06.679 respectively with a significant difference (p = 0.000002) and a large effect size (Hedge's g = 2.34). Hindi SNOT 22 showed a moderate correlation with visual analogue scale (rs = 0.663) and a low correlation with Lund Mackay staging (rs = 0.388). The Hindi version of SNOT 22 is a valid, reliable and a responsive patient reported outcome measure instrument for assessment of chronic rhinosinusitis in adults. It retains most of the important characteristics of the source version (SNOT 22). This can be used as a clinical as well as research tool to aid in diagnosis, to assess quality of life as well as monitoring treatment strategies in the field of CRS in Hindi speaking patients. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-021-02808-1.

Potential effects of lowering the threshold of statistical significance in the field of chronic rhinosinusitis - A meta-research on published randomized controlled trials over last decade

Abstract Objective: To evaluate the impact of change in p-value threshold from 0.05 to 0.005, on published Randomized Controlled Trials (RCTs) over the last ten years in the field of chronic rhinosinusitis. Methods: A search of the PubMed database from 1st January 2011 to 31st December 2020 was conducted to include all RCTs that used p-value to determine the effects of an intervention. Data extracted included p-values, type of intervention, publishing journal with indexing, registration, funding, and multi- or single center status. The proportion of primary endpoints having p < 0.005 was determined first, followed by those with p > 0.005 but <0.05. Logistic regression analysis was used to determine if any trial characteristic was associated with reporting of significant p-values. Results: In total, 168 primary endpoints were identified from 123 RCTs. On analysis, 80 had a p-value <0.05, i.e., statistically significant on conventional parameter. Out of these, 53.75% had a p-value <0.005, which would retain significance under the proposed threshold, and the remaining 46.25% to be reclassified as ''suggestive''. None of the trial characteristics were contributing to reporting of conventional or proposed p-values on logistic regression analysis. Conclusion: Lowering the p-value threshold would render 46.25% of a decade of published RCTs results (in the field of CRS) to be reclassified as merely ''suggestive'' and not significant. Trial characteristics were not found contributing to reporting of p-value <0.005 or even <0.05. Level of evidence: II.

Susac Syndrome: A Rare cause of Bilateral Sensorineural hearing loss from North India-A Case Report with Review of literature.

Susac Syndrome (SS) is a rare unique autoimmune underdiagnosed disorder characterized by the clinical triad of central nervous system (CNS) dysfunction, sensorineural hearing impairment, and branch retinal artery occlusion (BRAO). Objectives The purpose of reporting the case is to succinctly highlight this enigmatic condition with focus on otological and audiological aspect of SS and also to augment awareness of this disease among otolaryngologists neurologists, psychiatrists and ophthalmologists. Additionally we reviewed the otological menifestations and audiological findings related to SS. Methods A case of 38 year old female is presented with bilateral SNHL as the initial symptom of SS. The review of otological and audiological findings of previous 10 year case reports was executed using the PRISMA protocol on 20 cases. Results It was seen that inspite of the ear being one of the main organs involved in the SS very few had undergone detailed audiological assessment. Our review of literature showed that only 40% cases had done audiological assessment other than PTA, out of which only 5% had undergone complete audiological workup. 30% of the patients were having auditory symptoms as presenting chief complaint. Conclusion Otolyryngologists should keep SS in differentials when a case of SNHL of unknown etiology is encountered.We emphasize the use newer noninvasive Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation diagnostic tools like Optical coherence tomography (OCT), MRI and detailed audiological tests for timely diagnosis of SS. Further multidisciplinary assessment protocols should be used to prevent the development of severe sequelae.

Potential effects of lowering the threshold of statistical significance in the field of chronic rhinosinusitis - A meta-research on published randomized controlled trials over last decade.

OBJECTIVE: To evaluate the impact of change in p-value threshold from 0.05 to 0.005, on published Randomized Controlled Trials (RCTs) over the last ten years in the field of chronic rhinosinusitis. METHODS: A search of the PubMed database from 1st January 2011 to 31st December 2020 was conducted to include all RCTs that used p-value to determine the effects of an intervention. Data extracted included p-values, type of intervention, publishing journal with indexing, registration, funding, and multi- or single center status. The proportion of primary endpoints having p < 0.005 was determined first, followed by those with p > 0.005 but <0.05. Logistic regression analysis was used to determine if any trial characteristic was associated with reporting of significant p-values. RESULTS: In total, 168 primary endpoints were identified from 123 RCTs. On analysis, 80 had a p-value <0.05, i.e., statistically significant on conventional parameter. Out of these, 53.75% had a p-value <0.005, which would retain significance under the proposed threshold, and the remaining 46.25% to be reclassified as "suggestive". None of the trial characteristics were contributing to reporting of conventional or proposed p-values on logistic regression analysis. CONCLUSION: Lowering the p-value threshold would render 46.25% of a decade of published RCTs results (in the field of CRS) to be reclassified as merely "suggestive" and not significant. Trial characteristics were not found contributing to reporting of p-value <0.005 or even <0.05. LEVEL OF EVIDENCE: II.

Dumbbell-Shaped Ternary Transition-Metal (Cu, Ni, Co) Phosphate Bundles: A Promising Catalyst for the Oxygen Evolution Reaction.

Development of economical and high-performance electrocatalysts for the oxygen evolution reaction (OER) is of tremendous interest for future applications as sustainable energy materials. Here, a unique member of efficient OER electrocatalysts has been developed based upon structurally versatile dumbbell-shaped ternary transition-metal (Cu, Ni, Co) phosphates with a three-dimensional (3D) (Cu2(OH)(PO4)/Ni3(PO4)2·8H2O/Co3(PO4)2·8H2O) (CNCP) structure. This structure is prepared using a simple aqueous stepwise addition of metal ion source approach. Various structural investigations demonstrate highly crystalline nature of the composite structure. Apart from the unique structural aspect, it is important that the CNCP composite structure has proved to be an excellent electrocatalyst for OER performance in comparison with its binary or constituent phosphate under alkaline and neutral conditions. Notably, the CNCP electrocatalyst displays a much lower overpotential of 224 mV at a current density of 10 mA cm-2 and a lower Tafel slope of 53 mV dec-1 with high stability in alkaline medium. In addition, X-ray photoelectron spectroscopy analysis suggested that the activity and long-term durability for the OER of the ternary 3D metal phosphate are due to the presence of electrochemically dynamic constituents such as Ni and Co and their resulting synergistic effects, which was further supported by theoretical studies. Theoretical calculations also reveal that the incredible OER execution was ascribed to the electron redistribution set off in the presence of Ni and Cu and the most favorable interaction between the *OOH intermediate and the active sites of CNCP. This work may attract the attention of researchers to construct efficient 3D ternary metal phosphate catalysts for various applications in the field of electrochemistry.

Sphenoid Sinus and Related Neurovascular Structures-Anatomical Relations and Variations on Radiology-A Retrospective Study.

The aim of this study was to evaluate sphenoid sinus pneumatisation and its anatomical relation with adjacent neurovascular structures in Indian population. We performed a retrospective cross-sectional study, in which the pattern of sphenoid sinus pneumatization was studied on high-resolution computed tomography scans (n = 400), and association of the optic nerve, vidian canal and foramen rotundum along with related morphometric measurements were studied. Out of 400 CT scans, 60.5% were males. Majority had sellar type of pneumatization (89.5%) and single intersinus septum (68%). The most common configuration of relation of optic nerve canal was DeLano type 2 (34.75%). Vidian canal (VC) and Foramen rotundum (FR) were found dehiscent in 40.5% and 6.38% respectively. Average distance of FR from midline on right and left side was 16.3 ± 2.19 mm and 16.7 ± 2.23 mm respectively. Average distance of VC from midline on right and left side was 12.4 ± 5.84 mm and 12.4 ± 4.18 mm respectively. Average right FR to VC distance was 4.17 ± 2.16 mm and left FR to VC was 4.44 ± 2.20 mm. Anatomical variations of the sphenoid sinus are well known. In the present study, we have tried to highlight the importance of knowledge of various anatomical variations in relations to sphenoid sinus as they are critical in planning of surgery. Pre-operative radiological study and correlation is inevitable to assess type and extent of sinus pneumatisation, bony dehiscence and septal terminations to avoid injury to vital structures.

Pretreatment of low-grade shredded dust e-waste to enhance silver recovery through biocyanidation by Pseudomonas balearica SAE1.

Shredded dust originated during mechanical dismantling of waste electrical and electronic equipments (WEEEs) is enriched source of some valuable metals which might be lost as unworthy waste. Composition analysis of shredded dust printed circuit boards (PCBs) revealed the presence of 12.75 mg g-1  copper (Cu) and 10.34 mg g-1 silver (Ag) along with some other metals (Fe, Ni, and Au). Low concentration of precious metal, such as gold (Au i.e., 0.04 mg g-1) classified this shredded dust as low-grade scrap. Despite low concentration of Au this e-waste can be considered as potential "secondary ore" to recover other valuable metals like Ag. To improve the efficiency of Ag bioleaching using Pseudomonas balearica SAE1, pretreatment of e-waste was done using cost-effective ferric chloride (FeCl3) chemical lixiviant. The concentration of FeCl3 lixiviant was optimized to recover Cu metal prior to bioleaching process. Bioleaching of Ag was done under optimized conditions by Pseudomonas balearica SAE1 using 100 mL Luria Broth (LB) medium, 5 g L-1 glycine, pH 9, temperature 30 °C and 150 rpm. 95% Cu was recovered with 1% FeCl3 prior to bioleaching. Ag solubilization was increased for treated e-waste (36%) as compared to untreated e-waste PCBs (25%). Prerecovery of Cu enhanced Ag bioleaching, as available cyanide was utilized by Ag metal. Therefore, this study provides an economical hybrid method to enhance retrieval of precious metal (Ag) by Pseudomonas balearica SAE1 with economic and ecofriendly redox lixiviant even from low-grade e-scrap. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13205-021-02977-4.

Interfacial Engineering of CuCo2S4/g-C3N4 Hybrid Nanorods for Efficient Oxygen Evolution Reaction.

Altering the morphology of electrochemically active nanostructured materials could fundamentally influence their subsequent catalytic as well as oxygen evolution reaction (OER) performance. Enhanced OER activity for mixed-metal spinel-type sulfide (CuCo2S4) nanorods is generally done by blending the material that has high conductive supports together with those having a high surface volume ratio, for example, graphitic carbon nitrides (g-C3N4). Here, we report a noble-metal-free CuCo2S4 nanorod-based electrocatalyst appropriate for basic OER and neutral media, through a simple one-step thermal decomposition approach from its molecular precursors pyrrolidine dithiocarbamate-copper(II), Cu[PDTC]2, and pyrrolidine dithiocarbamate-cobalt(II), Co[PDTC]2 complexes. Transmission electron microscopy (TEM) images as well as X-ray diffraction (XRD) patterns suggest that as-synthesized CuCo2S4 nanorods are highly crystalline in nature and are connected on the g-C3N4 support. Attenuated total reflectance-Fourier-transform infrared (ATR-FTIR), X-ray photoelectron spectroscopy (XPS), and Raman spectroscopy studies affirm the successful formation of bonds that bridge (Co-N/S-C) at the interface of CuCo2S4 nanorods and g-C3N4. The kinetics of the reaction are expedited, as these bridging bonds function as an electron transport chain, empowering OER electrocatalytically under a low overpotential (242 mV) of a current density at 10 mA cm-2 under basic conditions, resulting in very high durability. Moreover, CuCo2S4/g-C3N4 composite nanorods exhibit a high catalytic activity of OER under a neutral medium at an overpotential of 406 mV and a current density of 10 mA cm-2.

Association of serum vitamin D with Chronic RhinoSinusitis in adults residing at high altitudes.

PURPOSE: To evaluate the association of serum vitamin D levels with chronic rhinosinusitis (CRS) in population residing at high altitudes and to assess its correlation with severity of CRS. METHODS: A prospective case-control study comparing vitamin D in 60 cases (30 with nasal polyposis and 30 without) and 31 controls was carried out. Correlation of vitamin D with severity of disease (Lund Mackay CT/LMS and endoscopic Lund Kennedy scores/LKS) was assessed using Spearman's correlation (rs). Logistic regression analysis using vitamin D and confounding factors (Age and gender only, as other variables like smoking, bronchial asthma were exclusion criteria) as dependent and CRS (presence/absence) as independent variable, was also conducted. RESULTS: A significantly lower vitamin D levels were found in CRS (14.60 ± 7.68 ng/ml), CRSwNP (13.70 ± 7.88 ng/ml) and CRSsNP (15.49 ± 7.50 ng/ml), when compared to controls (29.36 ± 7.49 ng/ml). Non allergic cases when compared with controls, showed significantly lower vitamin D levels (13.91 ± 6.78 compared to 29.36 ± 7.49 ng/ml). LMS and LKS in CRS showed a moderate correlation with vitamin D (rs: - 0.604 for LMS, rs: - 0.595 for LKS). Logistic regression analysis showed vitamin D levels (Odds-Ratio 0.783) to be an independent predictive factor of CRS. CONCLUSION: A significantly lower vitamin D level is associated with CRS, irrespective of presence or absence of nasal polyposis in adults residing at high altitudes. Vitamin D is an independent predictive factor for CRS. There is an inverse moderate correlation of severity of CRS with vitamin D.

Metallurgical processes unveil the unexplored "sleeping mines" e- waste: a review.

The aim of this review paper is to critically analyze the existing studies on waste electric and electronic equipment (WEEE), which is one of the most increasing solid waste streams. This complex solid waste stream has pushed many scientific communities to develop novel technologies with minimum ecological disturbance. Noteworthy amount of valuable metals makes e-waste to a core of "urban mining"; therefore, it warrants special attention. Present study is focused on all the basic conceptual knowledge of WEEE ranging from compositional analysis, global statistics of e-waste generation, and metallurgical processes applied for metals extraction from e-waste. This review critically analyses the existing studies to emphasize on the heterogeneity nature of e-waste, which has not been focused much in any of the existing review articles. Comprehensive analysis of conventional approaches such as pyrometallurgy and hydrometallurgy reveals that high costs and secondary pollution possibilities limit the industrial feasibilities of these processes. Therefore biohydrometallurgy, a green technology, has been attracting researchers to focus on this novel technique to implement it for metal extraction from WEEE.

Manoeuvres to Improve Endoscopic Visualization of Hypopharynx.

The more progress achieved in endoscopy, the more superficial cancers in head and neck region have been diagnosed. There are, however, some areas difficult to observe, particularly the hypopharynx, due to closure of this space. Examination of hypopharynx form an essential part of head and neck examination especially in the suspected malignancies as well as in the cases with unknown primary. As the flexible fiber-optic nasopharyngolaryngoscopy forms an essential part of examination of hypopharynx, the present study aims to evaluate the effectiveness of various manoeuvres devised to aid in better visualization of the hypopharynx. The present prospective study is an observation carried out on 30 patients, which had been followed up for hypopharyngeal or laryngeal disease, in the OPD of the department of Otorhinolaryngology and head and neck surgery in Gandhi Medical College and associated hospital, Bhopal, M.P. In the present study, authors compared the visibility of subsites of hypopharynx in 30 patients undergoing trans nasal flexible fibre optic endoscopy in normal seated position and with head torsion, valsalva manoeuvre and the Killian position. The authors concluded that the above mentioned manoeuvres facilitated the visualization of the entire circumference of the hypopharynx during endoscopic examination, are non invasive and easy to perform and so should be included as a part of routine examination while performing flexible fibre optic endoscopy.

Alteration of Lipid Profile in Patients with Head and Neck Malignancy.

Lipids are the major cell membrane components, essential for various biological functions including cell growth and division for the maintenance of cell integrity of normal and malignant tissues. The changes in lipid profile have been associated since long with cancer and hypocholesterolemia has been observed in patients with cancers of various organs. The objective of the present study is to evaluate the alterations and clinical significance of plasma lipid profiles in untreated head and neck malignancies. The present case-control study comprises of newly diagnosed and histologically confirmed, 100 head and neck malignancy cases diagnosed between 1st July 2013 and 30th June 2014 in the Department of Otorhinolaryngology and Head and Neck Surgery, Gandhi Medical College, Bhopal. Fasting blood samples were collected and the lipid profile studied. In present study, the authors found that there is a preponderance of head and neck malignancy in the age group of 41-60 years, males having the higher incidence. Malignancy involving oral cavity were the commonest and majority were well differentiated. Statistically, there was a highly significant reduction of mean serum total cholesterol (TC), triglycerides and high density lipoproteins (HDL) in the subjects of head and neck malignancy as compared to the control group. TC and HDL were also found significantly lower among those with habit of tobacco consumption.

Effect of Nasal Allergy Over Spirometric Parameters: A Prospective Study.

Nasal allergy is characterized by an IgE mediated inflammatory response of nasal mucosa to allergens and it has a close association with Asthma. Nasal allergy has been demonstrated to be a strong risk factor for the onset of asthma in adults. Spirometric parameters like Forced expiratory volume at timed interval of 1 s (FEV1) and forced expiratory flow (FEF25-75 %) are impaired in patients with nasal allergy or allergic rhinitis. The FEF25-75 % has been evidenced to be a reliable marker of early bronchial impairment in nasal allergy. Nasal allergy may be considered as the first step of the progression of respiratory allergy towards asthma. It has been demonstrated that FEF25-75 % is useful in predicting the presence of airway hyper responsiveness.It may be a more sensitive indicator of chronic airway obstruction than FEV1 and is considered as a risk factor for the persistence of respiratory symptoms in asthmatic patients. The impact of allergic rhinitis or nasal allergy on asthma (ARIA) guidelines, clearly underlined the role of allergic rhinitis as risk factor for asthma development. The possible presence of spirometric abnormalities in patient with allergic rhinitis has been well documented. So keeping this in mind, present study is undertaken to evaluate the impairment of spirometric parameters, like FEV1, FEF25-75 %, and forced vital capacity, in patients with nasal allergy and to predict the presence of airway hyper responsiveness.