Genetics of non syndromic hearing loss.

Non Syndromic Hearing Loss is an important cause for hearing loss. One in 1000 newborns have some hearing impairment. Over 400 genetic syndromes have been described. Non Syndromic Hearing Loss (NSHL) can be inherited in an Autosomal Dominant, Autosomal Recessive or a Sex Linked fashion. There are several reasons why genetic testing should be done in cases of NSHL, the main reasons being for genetic screening and for planning treatment. This review describes the genes involved in NSHL and the genetic mechanisms involved in the pathogenesis of the disease.

Evaluation of interactive teaching for undergraduate medical students using a classroom interactive response system in India.

BACKGROUND: The classical didactic lecture has been the cornerstone of the theoretical undergraduate medical education. Their efficacy however reduces due to reduced interaction and short attention span of the students. It is hypothesized that the interactive response pad obviates some of these drawbacks. The aim of this study was to evaluate the effectiveness of an interactive response system by comparing it with conventional classroom teaching. METHODS: A prospective comparative longitudinal study was conducted on 192 students who were exposed to either conventional or interactive teaching over 20 classes. Pre-test, Post-test and retentions test (post 8-12 weeks) scores were collated and statistically analysed. An independent observer measured number of student interactions in each class. RESULTS: Pre-test scores from both groups were similar (p = 0.71). There was significant improvement in both post test scores when compared to pre-test scores in either method (p < 0.001). The interactive post-test score was better than conventional post test score (p < 0.001) by 8-10% (95% CI-difference of means - 8.2%-9.24%-10.3%). The interactive retention test score was better than conventional retention test score (p < 0.001) by 15-18% (95% CI-difference of means - 15.0%-16.64%-18.2%). There were 51 participative events in the interactive group vs 25 in the conventional group. CONCLUSIONS: The Interactive Response Pad method was efficacious in teaching. Students taught with the interactive method were likely to score 8-10% higher (statistically significant) in the immediate post class time and 15-18% higher (statistically significant) after 8-12 weeks. The number of student-teacher interactions increases when using the interactive response pads.

Antimicrobial use and antimicrobial resistance in nosocomial pathogens at a tertiary care hospital in Pune.

BACKGROUND: Resistance to antimicrobial agents is emerging in wide variety of nosocomial and community acquired pathogens. Widespread and often inappropriate use of broad spectrum antimicrobial agents is recognized as a significant contributing factor to the development and spread of bacterial resistance. This study was conducted to gain insight into the prevalent antimicrobial prescribing practices, and antimicrobial resistance pattern in nosocomial pathogens at a tertiary care hospital in Pune, India. METHODS: Series of one day cross sectional point prevalence surveys were carried out on four days between March and August 2014. All eligible in patients were included in the study. A structured data entry form was used to collect the data for each patient. Relevant samples were collected for microbiological examination from all the clinically identified hospital acquired infection cases. RESULTS: 41.73% of the eligible patients (95% CI: 39.52-43.97) had been prescribed at least one antimicrobial during their stay in the hospital. Beta-lactams (38%) were the most prescribed antimicrobials, followed by Protein synthesis inhibitors (24%). Majority of the organisms isolated from Hospital acquired infection (HAI cases) were found to be resistant to the commonly used antimicrobials viz: Cefotaxime, Ceftriaxone, Amikacin, Gentamicin and Monobactams. CONCLUSION: There is need to have regular antimicrobial susceptibility surveillance and dissemination of this information to the clinicians. In addition, emphasis on the rational use of antimicrobials, antimicrobial rotation and strict adherence to the standard treatment guidelines is very essential.

Laryngopharyngeal Reflux : Larynx on Fire.

Laryngopharyngeal Reflux (LPR) is a commonly occurring and recently described clinical entity due to the retrograde flow of gastric contents into the pharynx. It accounts for many symptoms of upper airway including hoarseness, chronic throat irritation and globus sensation. The sensitive laryngeal mucosa is prone to damage by the combination of acid and pepsin. The inflammatory changes that follow are presumed to cause the symptoms and predispose the individual to laryngeal disorders. Diagnosis can usually be made clinically based on symptoms and laryngeal signs but a 24 hour pH metry is essential to establish diagnosis. Treatment centres on lifestyle modifications, vocal hygiene measures and long term use of proton pump inhibitors. Recent research in this field may lead to a better understanding of the pathophysiology of the disease and change the way LPR is managed.

Seasonal prevalence of blood parasitic diseases in crossbred cattle of Mysore and its surrounding districts of Karnataka.

The present study report the seasonal prevalence of blood parasitic diseases in cross bred cattle in Mysore and its surrounding districts of Karnataka such as Mandya, Chamaraj Nagar and Kodagu. The study was undertaken for a period of 2 years from August 2013 to July 2015. A total of 1655 blood samples were collected from clinically suspected cattle for blood parasitic diseases with clinical symptoms of anorexia, high fever, anaemia, salivation, enlargement of superficial lymphnodes, haemoglobinuria and sudden drop in milk yield. The blood samples were examined by giemsa's staining technique. Of the 1655 blood samples screened, 673 (40.22%) blood samples were found positive for blood parasites. Amid 673 positive samples, 609 (90.49%), 19 (2.82%) and 45 (6.68%) were found positive for Theileria annulata, Babesia bigemina and Anaplasma marginale respectively. The season wise prevalence revealed that, the highest prevalence was observed in summer months (March-June) (43.17%) followed by rainy (July-October) (39.53%) and winter season (November-February) (39.35%). Further, the month wise prevalence showed highest in August (77.64%) (Rainy month) followed by November (38.23%) and January (35.93%). During August-2013 to July 2014 and between August-2014 and July 2015, the highest was found in the month of May (85%) followed by July (70%) and April (69.81%). Theileriosis was most prevalent in summer (92.73%) followed by rainy (90.95%) and winter season (87.61%). Babesiosis was most prevalent in winter season (5.04%) followed by rainy (1.8%) and summer season (1.7%) whereas, Anaplasmosis was most prevalent in rainy season (7.23%) followed by winter (6.88%) and summer season (5.55%) during two years of study period.

High resolution multi detector computed tomography of temporal bone: our experience in a tertiary care service hospital.

High resolution multi detector computed tomography (HRMDCT) is an excellent tool for evaluation of a variety of congenital and acquired conditions affecting the temporal bones. We describe our experience of HRMDCT of temporal bones of 145 patients in a tertiary care and teaching hospital of Armed Forces Medical Services of India over a period of three and half years. Hearing loss was the most frequent indication for HRMDCT and congenital bilateral profound sensorineural hearing loss for evaluation prior to possible cochlear implant formed the single largest group (62, 42%) among all indications for HRMDCT of temporal bones. Major vestibule-cochlear and semicircular canal anomalies were noted in 11 such cases. Seven patients of microtia were studied and all had positive CT scan findings. All patients of vertigo had normal HRCT study. Extent of temporal bone injuries and inflammatory conditions were clearly delineated in all cases. Thinner collimations allowing image reconstructions in planes of anatomical interest with near isotropic resolution has been a major advantage of HRMDCT of temporal bones.

Lateral temporal bone resection for malignancy of external auditory meatus: our approach.

OBJECTIVE: Surgical management of tumors of the external ear remains controversial with regard to the extent of resection and the efficacy of piecemeal resection compared to standard en bloc resection. The objective was to study the results of lateral temporal bone resection with soft tissue resection used at our centre in managing a series of such cases. SETTING: Tertiary referral centre PATIENTS: A retrospective study was carried out on seven cases of temporal bone malignancies treated at our center, with lateral temporal bone resection by the otologic microsurgical technique and superficial parotidectomy, with adjuvant radiotherapy where indicated. The mode of presentation, clinical and pathological staging, extent of surgical resection, reconstructive methods used and adjuvant therapy given were evaluated. The disease free survival on follow-up was noted. RESULTS: Disease free survival achieved was comparable with other published series, with acceptable morbidity patterns. CONCLUSION: Lateral temporal bone resection using otologic microsurgical technique with soft tissue resection is an effective way of achieving control of temporal bone malignancies.

Management of the node negative early carcinoma tongue.

OBJECTIVE: To determine the role of thickness of the primary lesion in early Squamous Cell Carcinoma (SCC) of the oral tongue for decision-making regarding the management of possible occult cervical node metastases. SETTING: Tertiary referral centre PATIENTS: Patients who were treated by the authors for early (T1, T2) primary lesions in the oral tongue in two malignancy treatment centres of the Armed Forces Medical Services were included in this prospective study. Where the primary lesion was less than 04 mm in depth, the neck was not addressed electively. Those who developed nodal disease in the neck on follow up were subjected to comprehensive neck dissection. In those patients where the tumour thickness was more than 04 mm, the neck was addressed with at least a supra-omohyoid neck dissection. Postoperative radiotherapy was given as per standard indications. The patients were followed up as per standard protocol. RESULTS: Disease free survival rate achieved was 86% and this compares well with survival rates achieved by other workers. CONCLUSION: Treatment of neck nodes in early (T1,T2) SCC of the oral tongue can be expectant in cases where tumour thickness is less than 04 mm, but where it is more than 04 mm elective treatment of the neck is recommended.

Ultrasonography: Its role in nodular thyroid disease.

OBJECTIVE: The objective was to correlate the number, size and extent of the nodules as determined during the preoperative clinical examination of the thyroid gland, USG, intra-operative examination and histopathology. Also, FNAC (with or without USG guidance) and USG findings suggestive of malignancy were correlated with the final histopathology. SETTING: Tertiary referral centre PATIENTS: A retrospective chart review was done for 106 patients who underwent surgery for benign or malignant nodular thyroid disease in our center, between Jan 2004-Dec 2006. RESULTS: USG has 7 times higher predictive value than clinical examination in detecting number of nodules and determining size of nodules. USG guided FNAC has a sensitivity of 85.71% and specificity of 90.0% in detecting malignancy in nodular thyroid disease. However for predicting malignancy in thryoid nodules, this study shows that USG has a sensitivity of 20.0% and specificity of 97.67%. CONCLUSION: In patients with nodular thyroid disease, USG can accurately determine the number and the size of the nodules. It is extremely useful in guiding FNAC; However its role in predicting malignancy is doubtful. We therefore recommend that USG guided FNAC be carried out as a routine in the evaluation of thyroid nodules.

Study of the effects of chemotherapy on auditory function.

Chemotherapeutic agents are known to cause multiple toxicities such as myelotoxicity, nephrotoxicity and ototoxicity. A prospective study was carried out on 60 patients receiving Cisplatin based chemotherapy in a tertiary care centre. The effects of Cisplatin on auditory function were studied using metabolic, biochemical and audiological parameters. The auditory effects were correlated with the dose and duration of chemotherapy. The study concluded that a significant percentage (15%) of patients who were subjected to chemotherapy based on Cisplatin developed high frequency sensorineural hearing loss which was permanent and irreversible in nature.