Self Directed Learning: A More Impactful Tool for Learning Tracheostomy by Medical Undergraduate?!

An educational project in medical undergraduate otorhinolaryngology teaching-learningmethodology was designed with the aimof objectively studying the impact of self-directed learning on the topic of tracheostomy, since the latter has been included by the National Medical Commission as a core-competence for students. 150 third-year medical undergraduates participated in the study. They were divided into two groups, namely A and B. Group A was guided to undertake self-directed learning on tracheostomy while Group B underwent a lecture on the sametopic. Thereafter, both the groups responded to a validated feedback performa. Both the groups were assessed before and after the teaching-learning sessions by way of validated multiple-choice questions. Seventy-eight percent of participants from Group A agreed with the fact that they had acquired adequate knowledge on tracheostomy following the self-directed learning session as compared to 93.3% of those in Group B. Lacunae in the knowledge at the end of the teaching sessions were found to be more (27.4%) in Group B as compared to Group A (22%). The results obtained through the preand post-tests found Group A students to be performing significantly better than those in Group B, indicating that self-directed learning had been a more effective method for teaching the skills of tracheostomy as compared to the conventional lecture involving a large group. Self-directed learning, when used alone for a topic like tracheostomy, is more effective than a lecture in terms of reduced lacunae in knowledge and students performance in examinations.

Septal plasmacytoma: Dilemma of diagnosis.

Plasmacytomas are malignant tumours characterised by abnormal monoclonal proliferation of plasma cells. They may be osseous or may arise from soft tissues. Extramedullary plasmacytoma (EMP) accounts for only 1% of all head and neck malignancies. Septal plasmacytomas are extremely rare. Here, we report a case of an 80-year-old male patient with alocalised plasmacytoma arising from the nasal septum, which was resected endoscopically, with post-op radiotherapy and no recurrence in 1 year of follow-up. A multidisciplinary approach is required for the optimal diagnosis and management. It is essential to exclude any systemic involvement before arriving at a diagnosis of solitary plasmacytoma. Depending on lesion resectability, a combined therapy is the treatment of choice.

Image analysis in laryngopharyngeal reflux disease: A road less traveled.

Background: Laryngopharyngeal reflux disease (LPRD) is a common condition affecting patients reporting to an otolaryngologist. However, the diagnosis of this condition is usually hinged on the combination of largely non-specific symptoms, and clinical findings on laryngoscopy. This study aimed at evaluating the utility of digital image analysis to quantitatively evaluate the severity of signs as recorded with laryngoscopy in patients of LPRD. Methods: The study group included individuals who were aged between 18 and 65 years and reported to the ENT OPD. These were then divided into two groups depending on symptoms and laryngoscopic findings. The LPRD group had symptomatic patients with an Reflux finding score (RFS) score >7. Those with an RFS of <6 were designated as the 'Normal group'. The Laryngoscopic images were recorded and analyzed using Image J software as per the set protocol. The Red Green Blue (RGB) values of the laryngoscopic images of each group were obtained and subjected to statistical analysis. Results: 200 participants were enrolled in the study with 100 participants in the LPRD group (mean age = 46.2, 40 males, 60 females) and 100 in the control group (mean age = 43.6, 55 males, 45 females). The measured RGB values were more in the LPRD group as compared to the control group and the results were statistically significant (P < 0.001). Conclusion: By providing an objective value to the degree of inflammation, RGB value measurement provides a quick, economical, adaptable tool for auxiliary and corroborative information for the diagnosis of LPRD.

To compare the recovery rates of modified Epley's against Semont's manoeuvres in patients with posterior canal benign paroxysmal positional vertigo: a randomized clinical trial.

INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is one of the commonest causes of peripheral vertigo. It is treated with various canalolith repositioning manoeuvres by changing the head positions to allow the otoconial debris to fall back from the affected canal back to the utricle. The present study has compared the rate of recovery of vertigo with modified Epley's manoeuvres as compared to Semont's manoeuvre in patients with posterior canal BPPV. MATERIALS AND METHODS: One hundred and seventy patients diagnosed by positive Dix-Hallpike test as posterior canal BPPV were included in this clinical trial. Subjective analysis of vertigo was done using visual analogue scale. 85 patients each were recruited in two arms by simple randomization using lottery method. Modified Epley's manoeuvre was administered to one group and Semont's manoeuvre to the other. They were recalled after 2 weeks for clinical assessment with repeat Dix-Hallpike and VAS. RESULTS: Repeat Dix-Hallpike manoeuvres after two weeks revealed that 95.3 and 90.6% patients improved in Modified Epley's and Semont's group, respectively. After the second manoeuvre, the resolution rate was significantly higher in Semont's manoeuvre 100% (8 out of 8 patients), as compared to 25% (1 out of 4 patients) in Modified Epley's manoeuvre. Comparison of the mean values of VAS day 0 and VAS 2 weeks has been found to be statistically significant (p value of < 0.001). CONCLUSION: Both Epley's and Semont's manoeuvre are equally efficacious in treatment of BPPV. However, use of Semont's manoeuvre required fewer repeat manoeuvres for complete resolution of symptoms in patients. The Semont's manoeuvre is also comparatively easier to perform with less number of position changes, takes less time, and has no requirement of post-manoeuvre mobility restrictions. Hence, it is recommended that Semont's manoeuvre can be routinely used for the management of PC BPPV especially in older population and patients with spinal problems.

A Comparative Study of Computed Tomography Findings versus Intraoperative Findings of Level of Tegmen Plate in Chronic Otitis Media: An Observational Study.

OBJECTIVE: To compare the computed tomography findings with intraoperative findings of the level of tegmen plate with respect to the superior most part of the lateral semicircular canal in patients with Chronic Otitis Media. This study was attemptted to provide an objective assessment of the level of tegmen mastoideum. MATERIALS AND METHODS: The level of tegmen plate with respect to the superior most part of the lateral semi-circular canal was measured preoperatively using HRCT scan of slice thickness of 0.6 mm with a software - RadiAnt DICOM Viewer 64-bit version in sagittal plane. The distance between these two planes was measured intraoperatively using micro ear straight pick and Vernier Calipers. RESULTS: 75 participants (thirty-three male & forty-two female) with chronic otitis media underwent computed tomography preoperatively and surgery. No significant difference was found in the height of tegmen measured preoperatively using HRCT temporal bone and intraoperatively (p value - 0.16). The tegmen plates were classified as low lying (2.0 -2.49 mm), intermediate lying (2.49-2.99 mm) and high lying (3.0 -3.49 mm). CONCLUSION: Computed tomography findings of tegmen height correlates well with the intraoperative findings. An objective assessment of the level of tegmen mastoideum can provide the surgeon an idea of the severity of low lying level of tegmen to be expected and hence likely surgical problems. Based on this study, a classification system of level of tegmen plate has also been proposed.

Kimura Disease Masquerading as Vascular Malformation - An Interesting Report.

Kimura disease is a chronic inflammatory disorder which is rare, cause is unknown and primarily seen in young Asian males. The disease is characterized by painless subcutaneous swelling in head and neck, blood and tissue eosinophilia and raised IgE levels. The etiology is thought to be manifestation of an aberrant allergic response. The main modalities of treatment are corticosteroids/ surgery or both. Here we report a case of 16 years old male who presented to our hospital with fluctuant swelling over the post auricular region of 06 months duration. Imaging suggested vascular malformation, however the final diagnosis was found to be Kimura disease.

Novel Approach for Management of Extremely Rare Pleomorphic Adenoma of Soft Palate (Minor Salivary Glands).

Salivary gland tumours account for 2-3% of tumours occurring in head and neck region, majority of them being benign. Pleomorphic Adenoma present mainly in Parotid gland and Sub-mandibular gland and rarely in minor salivary glands. The tumours of minor salivary glands are generally malignant. The commonest sites of intra oral Pleomorphic adenoma are palate, lip and buccal mucosa. Here I describe a very rare case of Pleomorphic Adenoma in minor salivary glands and its novel management using CO2 Laser. There was no recurrence seen after a follow-up period of around one year.

Enigma of otologic immunoglobulin G4-related disease, COVID-19, and uncontrolled diabetes: The unholy trinity.

Otologic immunoglobulin G4-related disease (IgG4-RD) is a rare and a relatively newer pathology. COVID-19, IgG4-RD, and type 2 diabetes, all have independent capabilities to considerably affect the immune system. The immunological effects of COVID are a global conundrum; consequently, the association of this trio (otologic IgG4-RD, COVID-19, and type 2 diabetes), the only reported case in literature, paves the way for a fascinating interplay to explore the knowledge of which would help optimize treatment and improve disease outcomes.

A Comparative Prospective Study to Evaluate Outcomes of Ossiculoplasty using Autograft Versus Synthetic Graft.

Chronic Otitis Media is the most common cause of hearing impairment with ear discharge with which patients report to any otologist. The aim of management in such cases is to provide a safe ear and restore the hearing by Tympanoplasty. Many materials have been used for ossicular reconstruction, including both biological and synthetic materials. Minimally destroyed ossicle can be utilized for Ossiculoplasty while in case of complete destruction of ossicles, synthetic materials may be used such as teflon, titanium, hydroxyapatite etc. To evaluate the outcome of Ossiculoplasty using autograft versus synthetic graft. A prospective study done using non-probability convenience method of sampling involving a group of 50 patients were subjected to Tympanoplasty with Ossiculoplasty. Intra operative decision was taken on the type of graft to be used for Ossiculoplasty and the patients were divided into two equal groups, A (autograft) and B (synthetic graft) of 25 each. The patients were thereafter evaluated post surgery at periodic intervals of 3, 6 and 12 months. The improvement in hearing following surgery was significant (AB gap < 20 dB) in the range of 72% in Group A to 84% in Group B of patients 12 months after surgery. Also there was a 37% change in AC in Group A as compared to 40% in Group B, demonstrating marginally better improvement in hearing with synthetic graft as compared to autograft. The patients have significant improvement in hearing thresholds after ossiculoplasty with both autograft and synthetic graft. Teflon is an excellent alternative for ossiculoplasty when autologous incus is not available for use due to disease.

High-Throughput Evaluation of Emission and Structure in Reduced-Dimensional Perovskites.

High-throughput experimentation (HTE) seeks to accelerate the exploration of materials space by uniting robotics, combinatorial methods, and parallel processing. HTE is particularly relevant to metal halide perovskites (MHPs), a diverse class of optoelectronic materials with a large chemical space. Here we develop an HTE workflow to synthesize and characterize light-emitting MHP single crystals, allowing us to generate the first reported data set of experimentally derived photoluminescence spectra for low-dimensional MHPs. We leverage the accelerated workflow to optimize the synthesis and emission of a new MHP, methoxy-phenethylammonium lead iodide ((4-MeO-PEAI)2-PbI2). We then synthesize 16 000 MHP single crystals and measure their photoluminescence to study the effects of synthesis parameters and compositional engineering on the emission intensity of 54 distinct MHPs: we achieve an acceleration factor of more than 100 times over previously reported HTE MHP synthesis and characterization methods. Using insights derived from this analysis, we screen an existing database for new, potentially emissive MHPs. On the basis of the Tanimoto similarity of the bright available emitters, we present our top candidates for future exploration. As a proof of concept, we use one of these (3,4-difluorophenylmethanamine) to synthesize an MHP which we find has a photoluminescence quantum yield of 10%.

In Situ Inorganic Ligand Replenishment Enables Bandgap Stability in Mixed-Halide Perovskite Quantum Dot Solids.

Instability in mixed-halide perovskites (MHPs) is a key issue limiting perovskite solar cells and light-emitting diodes (LEDs). One form of instability arises during the processing of MHP quantum dots using an antisolvent to precipitate and purify the dots forming surface traps that lead to decreased luminescence, compromised colloidal stability, and emission broadening. Here, the introduction of inorganic ligands in the antisolvents used in dot purification is reported in order to overcome this problem. MHPs that are colloidally stable for over 1 year at 25 °C and 40% humidity are demonstrated and films that are stable under 100 W cm-2 photoirradiation, 4× longer than the best previously reported MHPs, are reported. In LEDs, the materials enable an EQE of 24.4% (average 22.5 ± 1.3%) and narrow emission (full-width at half maximum of 30 nm). Sixfold-enhanced operating stability relative to the most stable prior red perovskite LEDs having external quantum efficiency >20% is reported.

A Prospective Study to Elucidate the Efficacy of 4 Oral Prednisolone Regimens in Acute Acoustic Trauma.

Noise induced hearing loss affects around 5% of the population and acoustic trauma to military personnel accounts for 30% of all injuries inflicted during active service. Initial treatment for acoustic trauma involves administration of steroids, however there are no studies regarding oral steroid regimens for best outcomes. Comparing and elucidating the benefits of four oral steroid regimens on hearing gain in patients with acute acoustic trauma. A prospective study of 4 different steroid regimens was done in 200 soldiers from July 2014 - July 2020. In the first group, oral Prednisolone 60 mg was administered for 6 days, in the second group for 8 days, in the third group for 10 days and in the fourth group for 12 days. Medication was tapered over the next 5 days in all the groups. Data analysed included demographics, Pure Tone Audiograms at admission and at 4 weeks, time of reporting to hospital, onset of treatment and type of treatment given. Multivariate linear regression model was done to consider the risk factors responsible for average hearing gain at all pure tones. Box-and-whisker plot, Mann-Whitney-Wilcoxon test, Kruskal Wallis test, Reciever Operating Characteristic curve were used to analyse the independent samples. p value of < 0.05 was considered statistically significant. Age, time of onset of prednisolone therapy and acoustic trauma due to blast or gunshot injury did not show correlation (R2 = 0.01, 0.01 and 0.35 respectively and p = 0.09, 0.71, 0.80 respectively). Prednisolone therapy, average initial hearing at pure tones were considered as factors responsible for hearing gain as they showed correlation (R2 = 0.22, and 0.34 respectively and p < 0.001 and < 0.01 respectively). Significant hearing gain was found in all groups. The hearing gain was statistically better in group 3 and 4 as compared to group 1 and 2. There was no statistically significant difference in hearing gain between groups 3 and 4. So there was no additional advantage of giving 60 mg oral prednisolone for more than 10 days. The best oral prednisolone regimen recommended is 60 mg/day for 10 days which is tapered over the next 5 days.

Bright and Stable Light-Emitting Diodes Based on Perovskite Quantum Dots in Perovskite Matrix.

Light-emitting diodes (LEDs) based on metal halide perovskite quantum dots (QDs) have achieved impressive external quantum efficiencies; however, the lack of surface protection of QDs, combined with efficiency droop, decreases device operating lifetime at brightnesses of interest. The epitaxial incorporation of QDs within a semiconducting shell provides surface passivation and exciton confinement. Achieving this goal in the case of perovskite QDs remains an unsolved challenge in view of the materials' chemical instability. Here, we report perovskite QDs that remain stable in a thin layer of precursor solution of perovskite, and we use strained QDs as nucleation centers to drive the homogeneous crystallization of a perovskite matrix. Type-I band alignment ensures that the QDs are charge acceptors and radiative emitters. The new materials show suppressed Auger bi-excition recombination and bright luminescence at high excitation (600 W cm-2), whereas control materials exhibit severe bleaching. Primary red LEDs based on the new materials show an external quantum efficiency of 18%, and these retain high performance to brightnesses exceeding 4700 cd m-2. The new materials enable LEDs having an operating half-life of 2400 h at an initial luminance of 100 cd m-2, representing a 100-fold enhancement relative to the best primary red perovskite LEDs.

An innovative method of retrieval of the broken suction cannula tip during medical termination of pregnancy using a fibrobronchoscope during the coronavirus disease 2019 pandemic.

The breaking of the tip of the 'Karman cannula' inside the uterine cavity while performing suction curettage for missed abortion is an extremely rare phenomenon. Ideally, such foreign bodies should be removed using a hysteroscope under direct vision. In the absence of a hysteroscope, retrieval may be attempted using retrieving forceps either under ultrasonographic guidance or blindly. A 26-year-old female patient presented as a case of missed abortion at 6 weeks of gestation and underwent suction and evacuation. The tip of the cannula broke during the procedure. Multiple attempts were made to retrieve the cannula tip using forceps under ultrasound guidance without success. The patient was planned to be shifted to a higher centre as the hysteroscope was not available at this centre. However, owing to travel restrictions and lockdown imposed for the coronavirus disease 2019 (COVID 2019) pandemic, the patient could not be transferred. An innovative method using the fibre optic bronchoscope was devised by the otorhinolaryngologist and gynaecologist, and the retained impacted cannula was safely removed from the left uterine cornu under vision.

The Impact of COVID-19 Pandemic on Orthopedic Trauma Practice: An Experience at a Tertiary Care Center in Northern India.

The Impact of Covid -19 Pandemic on Orthopedic trauma practice: An experience at a tertiary care center in Northern India Introduction: COVID-19 pandemic and associated lockdown have had drastic effects on the health care system. To dedicate all the staff, residents, interns to covid care and accommodate the escalated inflow of infected persons, most hospitals had to restructure their departments. The orthopedic department was no exception. The present study aimed to evaluate trends in orthopedic trauma cases during two waves of the Covid -19 pandemic. MATERIAL AND METHODS: In this retrospective observational study, the period of lockdown during the first wave of Covid (March 24, 2020, to May 31, 2020 (Period 2)) and the second wave in 2021 was compared with a similar nine weeks interval in 2019 before COVID -19 (Period 1). Demographic details and epidemiological parameters of trauma were collected and compared. OBSERVATIONS: The number of admissions declined from 8.2 admissions/day to 2.3/day and 2.71/day in periods 2 and 3, respectively. Roadside accidents in 73.37% of patients in period 1 reduced to 30.43% and 59 36.2% in period 2 and 3, respectively. After soft tissue injuries, fractures around the hip joint dominated the pattern of injury during the lockdown, while polytrauma significantly decreased compared to the pre-covid era. More than 80% of patients during lockdown were treated conservatively. CONCLUSION: Evaluation of differences in injury patterns and method of treatment during distinctive situations arising due to the COVID-19 pandemic will help to judicially plan and formulate protocols for more effective management of patients if similar events arise again.

A comparative analysis of control measures on-board ship against COVID-19 and similar novel viral respiratory disease outbreak: Quarantine ship or disembark suspects?

BACKGROUND: Management of novel viral respiratory disease outbreak on-board a ship with person-to-person transmission can be a public health challenge because of close proximity of inhabitants due to confined space and air-conditioned environment. It has a potential to be explosive, with high secondary attack rate (SAR) and cause significant morbidity and mortality. This study compares control measures instituted on-board two ships with similar outbreaks and recommends a standardized evidence-based outbreak response against them. METHODS: This is a descriptive study, showing comparative analysis of control measures instituted on-board two ships, a cruise ship in case of COVID-19 and a warship in case of H1N1 influenza, with novel viral respiratory disease outbreak, at different span of time. Data of the date of onset, clinical details, laboratory results, history of travel, history of contact with positive case and control measures initiated were collected, analysed and compared. RESULTS: Of the two ships compared, one was a cruise ship with 712 COVID-19 cases, with an attack rate (AR) of 19.2% and 13 deaths, and other a warship with 14 cases of H1N1 influenza and an AR of 4.83%. The epidemic curve for both the outbreaks was plotted to study time distribution. CONCLUSION: Active surveillance, early self-reporting and immediate disembarkation of the suspects, along with strict compliance of hand hygiene, cough etiquettes and disinfection enhancement, will help in early mitigation of the outbreak. Health education should be undertaken to impart evidence-based knowledge and alleviate fear of the unknown. Vaccination may not be present but if available should only be administered after strict risk-benefit, cost-benefit and effectiveness analysis.

Chelating-agent-assisted control of CsPbBr3 quantum well growth enables stable blue perovskite emitters.

Metal halide perovskites have emerged as promising candidates for solution-processed blue light-emitting diodes (LEDs). However, halide phase segregation - and the resultant spectral shift - at LED operating voltages hinders their application. Here we report true-blue LEDs employing quasi-two-dimensional cesium lead bromide with a narrow size distribution of quantum wells, achieved through the incorporation of a chelating additive. Ultrafast transient absorption spectroscopy measurements reveal that the chelating agent helps to control the quantum well thickness distribution. Density functional theory calculations show that the chelating molecule destabilizes the lead species on the quantum well surface and that this in turn suppresses the growth of thicker quantum wells. Treatment with γ-aminobutyric acid passivates electronic traps and enables films to withstand 100 °C for 24 h without changes to their emission spectrum. LEDs incorporating γ-aminobutyric acid-treated perovskites exhibit blue emission with Commission Internationale de l'Éclairage coordinates of (0.12, 0.14) at an external quantum efficiency of 6.3%.

Antibiotic Resistance in Microbes from Street Fruit Drinks and Hygiene Behavior of the Vendors in Delhi, India.

Microbial contamination of fruit juices has caused major outbreaks, leading to significant morbidity and mortality in developing countries. The inept hygiene and safety practices followed by the juice vendors are the leading risk factors of the microbial contamination of juices. In this pilot study, the five most crowded markets in urban Delhi, including Kamla Nagar, University of Delhi (north campus), Tilak Nagar, Chandni Chowk, and Rohini, were selected for a questionnaire survey on the fruit juice vendors and the sampling of water used for juice preparation as well as sugarcane, orange, and mix fruit juices collected from these markets for the enumeration of total bacterial count (TBC), Escherichia coli, Salmonella, and Vibrio. Antibiotic susceptibility tests were performed using ampicillin, cefotaxime, chloramphenicol, ciprofloxacin, and imipenem. The results indicated that the majority of the vendors were not following hygiene and safety practices when compared with the recommended standard safety practices. The use of municipal water by 95% of vendors with high TBC counts might have been the major source of microbial contamination in all types of fruit juices. E. coli and Salmonella contaminations were high in sugarcane (2 × 105 colony forming units (CFU)/mL) and mix fruit (2.2 × 105 CFU/mL) juice samples, respectively. On the other hand, Vibrio was found to be absent in almost all juice samples except for orange juice. All strains were found to be susceptible to chloramphenicol, but resistant to ampicillin and cefotaxime. Only a few strains were resistant to ciprofloxacin, and only E. coli strains were resistant to imipenem. Taken together, the overall microbiological standards of fruit juices served by street vendors were not within the acceptable limits, perhaps due to the poor quality of water used to prepare juices and poor hygiene and safety practices followed by the vendors. More importantly, the isolated microbes demonstrated resistance to ampicillin and cefotaxime, which may have pressing public health implications. Post hoc power analyses identified the minimum sample size required for 80% power.

A disintegrin and metalloproteinase domain 17-epidermal growth factor receptor signaling contributes to oral cancer pain.

Cancer cells secrete pronociceptive mediators that sensitize adjacent sensory neurons and cause pain. Identification and characterization of these mediators could pinpoint novel targets for cancer pain treatment. In this study, we identified candidate genes in cancer cell lines that encode for secreted or cell surface proteins that may drive nociception. To undertake this work, we used an acute cancer pain mouse model, transcriptomic analysis of publicly available human tumor-derived cell line data, and a literature review. Cancer cell line supernatants were assigned a phenotype based on evoked nociceptive behavior in an acute cancer pain mouse model. We compared gene expression data from nociceptive and nonnociceptive cell lines. Our analyses revealed differentially expressed genes and pathways; many of the identified genes were not previously associated with cancer pain signaling. Epidermal growth factor receptor (EGFR) and disintegrin metalloprotease domain 17 (ADAM17) were identified as potential targets among the differentially expressed genes. We found that the nociceptive cell lines contained significantly more ADAM17 protein in the cell culture supernatant compared to nonnociceptive cell lines. Cytoplasmic EGFR was present in almost all (>90%) tongue primary afferent neurons in mice. Monoclonal antibody against EGFR, cetuximab, inhibited cell line supernatant-induced nociceptive behavior in an acute oral cancer pain mouse model. We infer from these data that ADAM17-EGFR signaling is involved in cancer mediator-induced nociception. The differentially expressed genes and their secreted protein products may serve as candidate therapeutic targets for oral cancer pain and warrant further evaluation.

Fluorescent Chemosensors as Future Tools for Cancer Biology.

It is well established that aberrant cellular biochemical activity is strongly linked to the formation and progression of various cancers. Assays that could aid in cancer diagnostics, assessing anticancer drug resistance, and in the discovery of new anticancer drugs are highly warranted. In recent years, a large number of small molecule-based fluorescent chemosensors have been developed for monitoring the activity of enzymes and small biomolecular constituents. These probes have shown several advantages over traditional methods, such as the ability to directly and selectively measure activity of their targets within complex cellular environments. This review will summarize recently developed fluorescent chemosensors that have potential applications in the field of cancer biology.