Application of Belfast 15/30 dB Rule of Thumb in Assessing Hearing Benefit in Middle Ear Reconstructive Surgery.

The objective of this study is to assess the concordance between Belfast 15/30 dB rule of thumb and subjective hearing benefit in middle ear reconstruction surgery. A total of 105 cases of chronic otitis media (COM) (both mucosal and squamosal type) with conductive hearing loss and who underwent middle ear reconstructive surgery during the study period from January 2019 to January 2022 were included. All cases were followed up at 6 week and at 3 months of postoperative duration for subjective assessment of hearing with questionnaire and pure tone audiometry as per standard of care and correlated with Belfast 15/30 dB rule of thumb. Concordance with Belfast rule of thumb was seen in 73.4% cases of both mucosal and squamosal type of COM. Belfast 15/30 dB rule of thumb is a valuable and useful tool to predict hearing benefit following middle ear reconstructive surgery, but, it suffers from the disadvantages of all or none phenomenon and it does not grade the level of hearing improvement. The prediction of postoperative subjective hearing with this Belfast rule of thumb is more reliable in mucosal type of COM than in squamosal type of COM.

Predictive markers in chronic kidney disease.

Chronic kidney disease (CKD) is defined by gradual deterioration of the renal parenchyma and decline of functioning nephrons. CKD is now recognized as a distinct risk factor for cardiovascular disease (CVD). This risk rises in tandem with the decline in kidney function and peaks at the end-stage. It is important to identify individuals with CKD who are at a higher risk of advancing to end-stage renal disease (ESRD) and the beginning of CVD. This will enhance the clinical benefits and so that evidence-based therapy may be started at the initial stages for those individuals. A promising biomarker must represent tissue damage, and be easy to detect using non-invasive methods. Current CKD progression indicators have difficulties in reaching this aim. Hence this review presents an update on markers studied in the last decade, which help in the prediction of CKD progression such as neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, urinary liver-type fatty acid-binding protein, cystatin-C, asymmetric dimethylarginine, symmetric dimethylarginine, endotrophin, methylglyoxal, sclerostin, uric acid, and miRNA-196a. Additional research is needed to determine the predictive usefulness of these indicators in clinical samples for disease development. Their utility as surrogate markers need to be explored further for the early identification of CKD progression.

"A Systematic Review on Guidelines and Recommendations for Tracheostomy During COVID-19 Pandemic".

World is under threat of COVID-19 pandemic, associated with many numbers of critically ill patients. To manage these intubated patients there are need of more ventilators but world is not prepared for this type of situation and there are lacunae of such arrangements in most of the countries. As we know patients cannot be intubated for long time and they should be given preference to alternative airway in the form of tracheostomy. COVID-19 is aerosol transmitted disease which lead to indeed challenge to health care providers to safely perform tracheostomy and provide post tracheostomy care to these patients with minimising risks of nosocomial transmission to themselves and accompanying nursing staff. There are so many guidelines and recommendations for the timing, desired place of tracheostomy, change in tracheostomy steps related to conventional method and the subsequent management of patients. So, the aim of this systematic review is to give a brief review of available data on COVID-19 related to the timing, personal protections, operative steps modifications, and subsequent post tracheostomy care during this pandemic.

Evaluation of the Synthesized Novel Iridium (III) Complexes Against HeLa Cell Lines Through In-Silico, In-Vitro and DNA Nicking.

Globally, the pharmaceutical industry is continuously driven in search of new anticancer drugs due to increasing rate of cancer patients. Clinical trials of Cisplatin has been explored, however, usage of Cisplatin as a drug is limited due to its various side effects, hence, alternative to platinum based complex drugs and its analogues are needed. Iridium complexes have been attracted widespread interests by virtue of their pharmacological and photo-physical properties; however the less number of complexes was reported in the literature. In this article, a new series of novel Iridium (III) complexes were synthesized using substituted quinoline Schiff Base (SB) ligands and characterized by spectroscopic techniques. The in- vitro cyto-toxicity assay showed that the Iridium (III) complex activity is equal to standard Cisplatin. In addition, computational docking studies have shown that the prominent binding sites for synthesized complexes against HeLa cell lines, which is comparable with standard Cisplatin drugs and other Ruthenium complexes.
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Interleukin-9 serves as a key link between systemic inflammation and angiogenesis in psoriasis.

BACKGROUND: Psoriasis is a T helper cell-mediated chronic immune-mediated inflammatory disease affecting mainly the skin, although systemic pathological effects are also observed. Cytokine-mediated interaction between T lymphocytes and keratinocytes lead to excessive proliferation of keratinocytes, which in turn leads to formation of a proinflammatory milieu and finally to psoriatic plaque formation. AIM: To measure interleukin (IL)-9, IL-17 and vascular endothelial growth factor (VEGF) levels in patients with psoriasis compared with controls, and to evaluate the effect of methotrexate (MTX) monotherapy on the aforesaid cytokine levels in psoriasis. METHODS: This cohort study included 54 patients with psoriasis and 54 age- and sex-matched healthy controls (HCs). IL-9, IL-17 and VEGF levels were measured by using commercially available ELISA kits. Patients with psoriasis who were on MTX monotherapy were followed up for a period of 3 months. RESULTS: Patients with psoriasis had increased levels of IL-9, IL-17 and VEGF at baseline, compared with the HC group. After 3 months of MTX monotherapy, Psoriasis Area Severity Index (PASI), Dermatology Life Quality Index (DLQI) and levels of cytokines (IL-9, IL-17 and VEGF) were significantly decreased compared with baseline. PASI and DLQI at baseline also showed a positive correlation with IL-9, IL-17 and VEGF. CONCLUSION: Our results suggest the existence of a proinflammatory milieu in psoriasis, with increased levels of IL-9, IL-17 and the proangiogenic growth factor VEGF, showing an increasing trend with increasing disease severity and impaired quality of life (QoL). MTX treatment helps to reduce levels of IL-9, IL-17 and VEGF, thereby limiting disease progression and improving QoL in psoriasis.

Effectiveness of symptom screening and incidence of tuberculosis among adults and children living with HIV infection in India.

BACKGROUND: WHO recommends the use of a simplified symptom-based algorithm for screening for tuberculosis (TB) among people living with HIV (PLHIV). We assessed the feasibility and effectiveness of this algorithm and determined the prevalence and incidence of TB among PLHIV attending antiretroviral treatment (ART) centres in India. METHODS: We did a prospective multicentric implementation research study in four states of India. To rule out TB, we administered the WHO symptom-screen algorithm to all PLHIV every month for 6 months. If they were found to be symptomatic any time during this period, they were referred for investigations for TB. A case of TB diagnosed during the first month of screening was taken as a prevalent case while those detected TB in the subsequent 5 months were considered cases of incident TB. We calculated the incidence rate using the person-years method. Results . Between May 2012 and October 2013, a total of 6099 adults and 1662 children living with HIV were screened for TB at the ART centres of four states. Of the 6099 adult PLHIV, 1815 (30%) had at least one symptom suggestive of TB, of whom only 634 (35%) were referred for investigations of TB. Of those referred, 97 (15%) PLHIV were diagnosed with TB. Overall, the prevalence of undiagnosed TB was 0.84 person-years and in the subsequent period, the incidence of TB was 2.4/100 person-years (95% CI 1.90-3.10). Among 1662 children, 434 (26%) had at least one symptom suggestive of TB. But only 57 (13%) children were referred for investigations of TB and 13 (23%) of them were diagnosed with TB. The prevalence of TB among children was 0.5% and its incidence among them was 2.7/100 person-years (95% CI 1.60-4.30). CONCLUSION: Prevalence and incidence of TB is high among PLHIV attending ART centres. This emphasizes the need to strengthen regular screening for symptoms of TB and further referral of those symptomatic for diagnosis of TB.