A Perception-Based Survey on Practice Patterns Pertaining to the Diagnosis and Management of Allergic Rhinitis in India.

INTRODUCTION: Allergic rhinitis (AR) is increasingly prevalent in India, affecting a significant portion of the population and adversely impacting their quality of life. This nationwide survey aimed to explore the perceptions and clinical preferences of Indian physicians regarding the perceived prevalence, common symptoms, and various available treatments for AR. METHODS: This cross-sectional, observational, digital questionnaire-based survey was conducted from September 2022 to March 2023, involving physicians sharing insights on prevalence rates, diagnostic approaches, medication preferences, and immunotherapy practices in AR management. RESULTS: A total of 1608 physicians participated in this survey. The majority of physicians (n=684, 42.5%) reported that the prevalence of AR in routine clinical practice is between 21 and 40%. Physicians also noted a substantial burden of AR with asthma (n=626, around 40%). Total IgE count was reported as a mandatory test for the diagnosis of AR by 47.5% of physicians (n=764). For the management of mild cases of seasonal or perennial AR, 980 (60.9%) physicians preferred fexofenadine as an oral antihistamine of choice. Fluticasone furoate was the preferred intranasal corticosteroid (INCS) option (67.1% of physicians (n=1079)), for the management of patients with moderate to severe AR, the most recommended duration of INCS therapy was two to four months (40.9% of physicians). Doctors recommended a montelukast and antihistamine combination in mild AR (n=152, 9.5%), mild AR not responding to antihistamine alone (n=291, 18.1%), moderate to severe AR along with INCS (n=252, 15.7%), and AR with mild asthma (n=74, 4.6%). The majority of physicians (n=1512, 75.6%) preferred using fexofenadine in combination with montelukast for the management of AR. The majority of physicians (n=839, 52.2%) opined that the efficacy rate of oral montelukast-fexofenadine was 60-90% in the management of mild-moderate AR. Around 55.3% of physicians (n=889) had not used immunotherapy in their clinical practice. CONCLUSION: These observations offer a holistic view of how Indian physicians perceive the management of AR, a condition highly prevalent in India and often associated with asthma. It also highlights the treatment strategies employed in their day-to-day clinical practice.

Designing and evaluating a Nutritional Assessment and Intervention Kiosk for mother-child dyad to combat double burden of malnutrition.

The study protocol focuses on DBM, proposing a preventive strategy for mother-child pairs that would be accessible, affordable, sustainable, and human-centred. The aim is to guide the development of tools and technologies, passing through stages for gathering a process and presenting health data. The initial stage identifies the rules and models synthesising existing digital interventions combating forms of malnourishment, followed by designing and developing a Nutrition Informatics Intervention, i.e. NAIK. The last stage includes evaluation of the effectiveness and utility of NAIK. The system aims to address malnutrition by assessing different associated elements, with the participants. An SMS system will provide follow-up assistance. Overall, this study is an amalgamation of technology, data collection, personalised interventions, growth monitoring, and education to address malnutrition effectively by promoting positive health-behaviours within the community. So, a computerised health kiosk will help provide preventive strategies from the healthcare professional, especially in circumstances requiring immediate attention.

Management of Recurrent Aphthous Stomatitis: An Indian Expert Consensus.

Recurrent aphthous stomatitis (RAS) is characterized by painful, oral mucosal ulcers with wide range of prevalence ranging from 2 to 78%. Etiology of RAS is idiopathic and multifactorial. There are numerous gaps in assessment and management of RAS and the absence of guidelines or a consensus document makes the treatment further difficult. The aim of this document is to provide an Indian expert consensus for management of RAS. Experts from different specialties such as Otorhinolaryngology, Oral Medicine/Dentistry and Internal Medicine from India were invited for face to face and online meetings. After a deliberate discussion of current literature, evidence and clinical practice during advisory meetings, experts developed a consensus for management of RAS. We identify that the prevalence of RAS may lie between 2 and 5%. In defining RAS, we advocate three or more recurrences of aphthous ulcers per year as criterion for RAS. Investigation should include basic hematological (complete blood count) and nutritional (serum vitamin B12, and iron studies) parameters. Primary aim of treatment is to reduce the pain, accelerate ulcer healing, reduce the recurrences and improve the quality of life. In treating RAS, initial choice of medications is determined by pain intensity, number and size of ulcers and previous number of recurrences. Topical and systemic agents can be used in combination for effective relief. In conclusion, this consensus will help physicians and may harmonize effective diagnosis and treatment of RAS.

INDIan Consensus on the mAnagemenT of cOugh at pRimary care setting (INDICATOR).

BACKGROUND: Cough has a prevalence of 9.6% globally and 5-10% in India. Though it is a reflex action, it affects an individual's quality of life (QoL) when uncontrolled. There was a need to create an integrated guidance document on managing cough focused on primary care physicians in the Indian setting. This consensus intends to bridge this gap by providing clinical recommendations to diagnose and manage cough in primary healthcare in India. MATERIALS AND METHODS: The modified Delphi method was used to arrive at a consensus on clinical statements. The panel comprised 10 experts, including pulmonologists, otolaryngologists, a pediatrician, and a general physician. The statements were discussed under the following domains: definition, etiology, diagnosis, and treatment. RESULTS: A total of 109 clinical statements were framed, with 75 reaching consensus, 13 reaching near consensus, and 21 reaching no consensus. The experts recommended empiric use of nonopioid antitussive agents for symptomatic relief of acute dry cough. The use of oral antihistamines, oral decongestants, or mucoactive agents as a part of fixed-dose combinations (FDCs) in cough associated with rhinitis or upper airway cough syndrome (UACS) can be considered for symptomatic relief. Maintaining good hydration is important to manage a productive cough. Codeine-based preparations are to be considered as a last resort in patients with an unexplained chronic cough when other treatments have failed. Additionally, insights were captured on red flag signs, nonpharmacologic therapy, special populations, and referral to higher centers. Experts have also proposed a management algorithm with an integrated care pathway approach for acute, subacute, and chronic coughs. CONCLUSION: The present consensus fills the existing need and may guide the physician to successfully diagnose and manage cough in the primary healthcare setting in India.

Smart Advancements for Targeting Solid Tumors via Protein and Peptide Drug Delivery (PPD).

Proteins and peptides possess considerable potential in treating solid tumors because of their unique properties. At present, there are over 100 peptide-based formulations on the market. Today, peptides and proteins are in more demand due to their selective nature and high target-binding efficiency. Targeting solid tumors with compounds of molecular weight less than 10 kDa are much more desirable because they undergo excessive penetration in view of the fact that they are small sized. The solid tumors have thick tissues and possess excessive interstitial fluid pressure, because of which high molecular compounds cannot enter. The properties of proteins and peptides induce low toxic effects and lessen the major side effects caused by chemical-based drugs. However, their delivery is quite challenging as most proteins and peptides stop functioning therapeutically when following a parenteral route of administration. This paper elaborates on the importance of new age formulations of peptides and proteins followed by their recently documented advancements that increase their stability and delay their metabolism, which helps to target solid tumors.

S-100 Immuno-Positive Low Grade Myofibroblastic Sarcoma of Nasal Cavity: A Rare Case Presentation and Review of Literature.

Introduction: Myofibroblastic neoplasms comprise a spectrum of benign/malignant neoplasms. Only low-grade malignant forms have been reproducibly characterized as a diagnostic entity in the WHO classification. Low grade myofibroblastic sarcoma (LGMFS) confined to the nasal cavity is extremely rare. Objective: To review previously reported cases of nasal cavity LGMFS and provide a better insight regarding its clinical and immunohistochemical features. Data synthesis: A review was performed involving two databases (PubMed and Google Scholar). Four cases of nasal cavity LGMFS were included. The lesion showed no gender or nasal-side predilection. All cases underwent wide excision. None showed distant metastasis while half recurred locally. Histologically, mitotic rate ranged from 1 to 3/10 high-power-field (HPF) and none exhibited spontaneous necrosis. Immuno-expression of calponin, smooth muscle actin (SMA) and vimentin were seen in either all four or three-fourth of cases. Diffuse S-100 expression was a unique finding in present case and not reported previously, that caused a diagnostic dilemma with schwannomas. Conclusion: LGMFS of nasal cavity is extremely rare. A wide resection is the primary treatment of choice. Adjuvant therapies (chemotherapy or radiotherapy) are of uncertain significance. Distant metastasis is rather unusual. Calponin, SMA and vimentin are highly sensitive immuno-markers. Diffuse S-100 expression is a possible finding. Mitotic rate < 6/10 HPF and absence of spontaneous necrosis are characteristic indolent features differentiating from high grade lesions. Trifecta of clinical and morphological features plus immunohistological phenotype, are sufficient for a definitive diagnosis. Electron microscopy is the most definitive confirmation test, however, should be reserved only for equivocal/atypical immunostaining pattern.

Asia-Pacific survey of physicians' perceptions and managements of chronic rhinosinusitis.

BACKGROUND: The diagnosis and management of patients with chronic rhinosinusitis (CRS) may vary between otolaryngologists and allergists. Moreover, the adherence of different practitioners to European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020 guideline recommendations has not been previously ascertained in Asia-Pacific regions. OBJECTIVE: Different specialists' perceptions and managements of CRS in Asia-Pacific regions were assessed in an attempt to gauge these practices against EPOS 2020 guidelines. METHODS: A transregional, cross-sectional survey was conducted to assess otolaryngologists' and allergists' perceptions and managements of CRS with regard to diagnosis, management and adherence to EPOS 2020 guidelines. RESULTS: Sixteen physicians in Asia-Pacific regions responded to the questionnaire. A total of 71.4% of otolaryngologists preferred to diagnose CRS with a combination of positive nasal symptoms and nasal endoscopy plus sinus CT, whereas 22.2% of allergists took such criterion to diagnose CRS. Compared to allergists, otolaryngologists more often considered the endotype classification (85.8% versus 55.5%). For the preferred first-line treatment, in addition to intranasal corticosteroids recommended by all respondents, 66.7% of allergists preferred antihistamines, whereas 71.4% of otolaryngologists preferred nasal saline irrigation. Regarding the proper timing of surgery, 71.5% of otolaryngologists reported 8-12 weeks of treatment after the initiation of medication, while more than half of the allergists recommended 4-6 weeks of medical treatment. CONCLUSIONS: This survey shows that variable perceptions and practices for CRS may exist between physicians with different specialties and highlights the need for increased communication and awareness between otolaryngologists and allergists to improve the diagnosis and treatment of CRS.

Auricle Schwannoma: Presentation of a Rare Case and Review of Existing Literature.

Schwannomas are extremely rare over auricle. Despite the extensive somatogenic neural innervations of the pinna, schwannomas are never amongst the differentials for a benign auricular mass. Previously published articles have all agreed on the rarity of this lesion occurring over the auricle. However, none of the articles have tackled and extensively reviewed the auricle schwannomas (AS) as an individual entity. The article aim to review previously published cases of AS along with an illustrative case, and provide a better insight regarding demographic, clinicopathological and immunohistochemical features of this neural tumor in a rare site. A systemic review of English literature was performed after using a sensitive search strategy involving three different databases (PubMed, Google Scholar and Embase). A total of nine cases were included. They mostly presented in young adults as a slow growing tumor (mean duration: 3.17 years) and showed a slightly higher male predominance (male/female ratio 1.25:1). They were mostly located over lateral surface (66.67%) with a predilection for left ear (77.78%). Conventional histological variant has only been reported. Complete surgical excision was performed for all the cases without any reports of recurrence or malignant transformation. AS present as a solitary, painless, firm and well-encapsulated lesion, mostly over the lateral auricle surface. Preoperative clinical diagnosis is difficult and radiological investigations do not hold much importance. FNAC is inconclusive and diagnosis mandates histopathologic examination. The nerve of tumor origin is difficult to precisely identify. Complete surgical excision is the treatment of choice. Post-operative prognosis is excellent.

Risk Indicators for Hearing Impairment in Neonates.

To identify relation between prevalence of hearing impairment and risk factors at the time of birth in high risk neonates. A year-long study is performed at HBT Medical College and Dr. R. N. Cooper Municipal General Hospital, Vile Parle (west), Mumbai. The Study comprised of 478 high risk babies born between March 2016 and February 2017 and admitted in NICU of the hospital. Out of these 68 babies were either transferred to higher centre or took discharge against medical advice. A total of 410 babies completed the study. Additional 21 eligible babies died in NICU during the study. A Prospective Observational Study is used to analyse the findings of the study. Skew analysis of spread of prevalence across risk factors is used to establish higher prevalence of hearing impairment in high risk neonates. Cramer's Moment Coefficient of Skewness and Corresponding Test Statistics are used for studying the skewness. Out of 410 babies screened during the study 5 babies were diagnosed with profound SNHL. The risk factors associated with babies is plotted against frequency of babies with Profound SNHL. The plot is found to be un-uniformly distributed and shows inclination towards higher prevalence with high risk babies. Sample skewness (G1) value - 0.81 indicates moderately negative skewed sample. This means the number of babies with profound SNHL found by 3 stage screening is moderately concentrated at high risk weightage.

Formulation and optimization for DPP-4 inhibitor nanomicelles using response surface methodology.

Objective: Dipeptidyl peptidase-4 (DPP-4) inhibitors are the oral antidiabetics that inhibits the enzyme DPP-4. The main aim of study was to formulate, statistically optimize and characterize the polymeric nanomicellar (PNM) formulation of DPP-4 inhibitor (sitagliptin) using natural polymer and a nonionic surfactant.Method: Response surface methodology (RSM) an experimental design was applied for optimization of nanomicelles using full central composite design. Drug and polymer concentration are independent variables (each at two factor three level) whereas drug loading (% DL) (R1), entrapment efficiency (% EE) (R2) and % drug release (R3) were identified as dependent variables. The polymeric nanomicelles were prepared by direct dissolution method and characterized for surface morphology, particle size, polydispersity index, zeta potential, entrapment efficiency, drug loading, and % drug release.Results: The optimized formulation of sitagliptin loaded polymeric nanomicelles (PNM 10) was found to be clear, homogenous nanomiceller solution with round spherical structures with a low poly dispersity index of 0.564. PNM 10 has particle size of 368.2 nm. PNM 10 showed drug loading of 38.67 ± 0.23%, entrapment efficiency of 79.67 ± 0.54% and % drug release (R3) of 82.34 ± 0.78%.Conclusion: Design-Expert (DOE) version 11.0.5.0 software (Stat-Ease Inc, USA) was used for statistically optimization of formulations. PNM 10 was considered best optimized formulation and highly stable for prolonged use and found to be safe for application. Thus this can be a futuristic approach for developing nanomicelles, which can minimize the possible side effects of drug.

Data on Spectroscopic, Rheological characterization of neem oil and its isolated fractions.

In this article a medicinal oil (neem oil) is fractionated and compared with original oil. The fractions were separated at low temperature using chloroform and methanol. The uniphase mixture of solvents and neem oil at room temperature was transformed to a bi-phasic system at low temperature. The isolated fractions (NOC - isolated using chloroform; NOM - isolated using methanol) were characterized and differentiated by GC, FT-IR and Rheometer. GC and FTIR have well revealed the difference in composition of fatty acids in fractions - NOC; NOM and neem oil (NO). Rheologically all the oils are different in viscosity from parent oil. The NOM fraction of neem oil showed newtonian behavior while NOC shows a non-newtonian behavior. It can be concluded from data that fractions NOC, NOM can be used for targeting drugs using various formulation approaches.

Pharmacotherapy of Chronic Rhinosinusitis with a Focus on Clarithromycin: An Expert Opinion.

Chronic Rhinosinusitis (CRS) is frequently distinguished as persistent symptomatic inflammation of the nasal and sinus mucosa and is recognized as one of the most common chronic diseases, with high incidence rate. It has a major impact on overall quality of life. Although, the etiology and pathogenesis of CRS are not clearly understood, there are several hypotheses on CRS etiology and pathogenesis. The presence of biofilms and bacterial infection, as well as fungal infection, allergy, environmental pollutants, and smoking are considered as a possible environmental factors which are involved in etiology of CRS. Over the past few years, the presence of biofilms is indicated in more than 65% of chronic infections in humans. The most important goals of treatment in CRS include suppression of the infection, reduction of sinonasal inflammation, and maintenance of patent sinonasal passage drainage. CRS is generally treated with medical and surgical therapy. Antibiotics play a major role in the treatment of CRS and are often used to reduce the infectious component of CRS. Macrolide antibiotics are considered as a choice of treatment option as they have anti-inflammatory and immunomodulatory properties in addition to usual antimicrobial effects. Clarithromycin is one of the macrolide which has shown beneficial effects for treating CRS. Various studies indicated that long term use of clarithromycin is effective in the treatment of CRS with good tolerability profile The present review suggests that clarithromycin can be used as treatment of choice in the treatment of CRS.