A randomized controlled trial on triamcinolone versus saline impregnated merocel post endoscopic sinus surgery: Our experience in a tertiary care centre.

Purpose: To assess the potential benefit of impregnating Merocel (a non-absorbable nasal dressing) with a topical steroid solution, for use as a direct and slow local delivery system of steroids after sinus surgery to improve postoperative wound healing. Methods: In this randomized controlled trial, 40 patients with bilateral chronic rhinosinusitis with nasal polyposis were subjected to functional endoscopic sinus surgery. Following the completion of the surgery, Merocel packs were inserted in the bilateral nasal cavities and infiltrated with 4 mL triamcinolone (40 mg/mL) in one nasal cavity (treatment group) and 4 mL normal saline in the other (control group). Nasal packs were removed on the third postoperative day and postoperative healing assessment was done on postoperative Weeks 1, 2, 4, and 12. The findings were noted as per Lund Kennedy (LKES) and perioperative sinus endoscopy (POSE) scores and compared on both sides. Results: Significant (P < 0.05) improvement was noted in Lund Kennedy score for crusting and polyp at Week 12, for edema at Week 1, and nasal discharge at Weeks 1 and 12, but there was no significant improvement in scarring at any week. Overall, the difference between the treatment and control arms was statistically significant at all postoperative visits except at Week 4. Also, there was a significant improvement in POSE scores at Weeks 1, 2, and 12 but not at Week 4. Conclusion: This study positively concludes that the nasal cavity packed with drug-soaked packs had less scarring and edema in the postoperative period and the overall wound healing was much better as compared to saline-soaked packs.

Diagnostic evaluation of nested PCR and microscopy for Cryptosporidiosis in goats: can COWP gene based qRT-PCR be useful in assessment of active Cryptosporidial infections?

The present research delved into the transmission patterns, diagnostic methods, molecular traits, and phylogenetic analysis of Cryptosporidium species. The research was undertaken to enhance comprehension of the epidemiology and the potential for zoonotic transmission. A total of 80 goat-kid samples were tested, 7 were confirmed positive by mZN microscopy and 12 by nested-PCR. By PCR, 18SSUrRNA, HSP70, and GP60 amplicons were tested for Cryptosporidium. The restriction enzymes viz., SspI, VspI and MboII were used to genotype 12 Cryptosporidium positive samples by which C. parvum and C. bovis mixed infections were detected. Quantitative reverse transcription real-time PCR was used to transcriptionally screen the COWP-subunit genes to assess the severity of the infection in goat-kids, which showed upregulation of COWP6 and COWP4, while COWP9 and COWP3 genes were downregulated. A silent mutation was found at the codon CCA→CCC, which is being reported for the first time in goat field isolates. Phylogenetic and sequencing analyses confirmed the presence of the anthropozoonotic IIe subtype.

Outcomes of Palisade Cartilage Tympanoplasty in Chronic Otitis Media: Our Experience at a Tertiary Care Centre.

To evaluate the anatomical and functional success rates of palisade cartilage tympanoplasty in chronic otitis media. Thirty patients with chronic otitis media with subtotal perforation underwent palisade cartilage tympanoplasty and were assessed prospectively. The outcomes evaluated were graft uptake and hearing gain. Overall graft uptake was 90% with failure in 3 cases. The preoperative mean air conduction threshold was 22.087 ± 6.120 dB which was improved to 13.387 ± 5.253 dB postoperatively at 12 weeks which was statistically significant. The mean postoperative ABG closure was 8.700 dB with a p value of 0.001 which was statistically significant. Palisade cartilage tympanoplasty demonstrates that subtotal perforations, which are at high risk for graft failure, can be treated efficiently and a durable and resistant reconstruction of the tympanic membrane with reasonable hearing can be achieved.

Evaluation of Pre and Post-operative Pulmonary Artery Pressures in Children with Adenotonsillar Hypertrophy and Correlation with Chronicity: A Prospective Study on 50 Children.

Children with grade III or IV of adenotonsillar hypertrophy especially of a longer duration, may show cardiovascular changes due to mouth breathing. These changes can be detected on doppler echocardiocardiography which can be used as a screening tool. Fifty paediatric patients of grade 3 and 4 adenotonsillar hypertrophy underwent adenotonsillar resection after a pre-operative work up which included doppler echocardiography to measure pulmonary artery pressures. A post-operative doppler echocardiography was done after three months. 11 children (22%) showed deranged pulmonary artery pressure values with increased mean pulmonary artery pressure (MPAP) and pulmonary artery systolic pressure (PSAP) on preoperative doppler echocardiography, and 2 out of these 11 children had Pulmonary Artery Hypertension. A significant (p < 0.001) improvement was noted in pulmonary artery pressure values (MPAP and PSAP returned to normal) after adenotonsillectomy in 3-month postoperative echocardiography. Also, a statistically significant correlation was obtained between chronicity of symptoms and raised pulmonary artery pressures. Our study concluded that these children with chronic untreated upper airway obstructive symptoms get predisposed to potential cardiac complications. And these grave consequences can be easily prevented by a timely intervention.

Surgical Outcomes of Type 1 Tympanoplasty in Chronic Otitis Media in Paediatric Patients: A Prospective Study.

Objectives: To observe the surgical outcome of type 1 tympanoplasty in paediatric patients in the form of graft uptake and audiological improvement. Materials and methods: A prospective study was done in which 40 paediatric patients in age group 6-16 years, diagnosed of chronic otitis media, were taken up for tympanoplasty under general anaesthesia. Patients were followed in post operative period at 4, 6 and 12 weeks for assessment of graft status and audiological evaluation. Results: In this study, we found surgical success rate in the form of graft uptake in 80% of the cases and audiological improvement in 75% of the cases. Conclusion: Tympanoplasty is safe and effective in children with adequate graft uptake and audiological outcome. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03965-1.

Recent developments in nanoparticles for the treatment of diabetes.

Changes in the homeostasis of blood sugar levels are a hallmark of diabetes mellitus, an incurable metabolic condition, for which the first-line treatment is the subcutaneous injection of insulin. However, this method of administration is linked to low patient compliance because of the possibility of local infection, discomfort and pain. To enable the administration of the peptide through more palatable paths without requiring an injection, like by oral routes, the use of nanoparticles as insulin carriers has been suggested. The use of nanoparticles usually improves the bioavailability and physicochemical stability of the loaded medicine. The utilisation of several forms of nanoparticles (like lipid and polymeric nanoparticles, micelles, dendrimers, liposomes, niosomes, nanoemulsions and drug nanosuspensions) is discussed in this article as a way to improve the administration of various oral hypoglycaemic medications when compared to conventional treatments.

Effect of Chronic Suppurative Otitis Media on Gustatory Function of chorda Tympani Nerve : A Prospective Study.

Introduction the ability to taste is among the life's finest pleasures and perception of taste can be altered by various disorders or therapeutic regimens as colds or dental procedures. Head trauma patients, patients on certain drugs such as phenylbutanone, carbamazepine and baclofen and patients with inflammatory diseases of the middle ear frequently complain about alterations in their ability to taste. So, assessment of gustatory sensitivity is the prerequisite for the correct diagnosis of taste dysfunction which uses taste strips impregnated with taste stimulants. Material and method in this prospective study, 40 patients were enrolled after assessment of history, general and local examination of ear and finally assessment of gustatory function was done according to Muller technique using taste strips. Results in present study out of 40 patients, 16 (40%) patients had COM squamous, 24 patients (60%) had COM mucosal. In the ipsilateral diseased ear (both COM squamous & mucosal) the mean taste score for various taste sensation was 11.65 ± 2.59. In the contralateral normal ear, the mean taste score was 15.42 ± 0.78. The difference between the two was found to be statistically significant (p < 0.0001). Conclusion a significant difference was obtained in taste scores between diseased (ipsilateral) and normal (contralateral) ears both overall and also when subtypes were compared. Thus, the present prospective study indicates that COM squamous as well as mucosal can induce taste dysfunction. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03703-7.

Pyrazole; A Privileged Scaffold of Medicinal Chemistry: A Comprehensive Review.

Pyrazole is considered an important active scaffold that possesses various types of pharmacological activities. The overwhelming literature reported earlier reflects the immense biological potential of pyrazole derivatives. The presence of this moiety in various FDA-approved drugs, including celecoxib (anti-inflammatory), apixaban (anticoagulant), rimonabant (anti-obesity), difenamizole (analgesic), and sildenafil (for erectile dysfunction), has proved its pharmacological potential. Owing to its diversity in the biological field, this nucleus has attracted the attention of many researchers to study its skeleton chemically and biologically. This review highlights the literature supporting the research of the past 10 years related to the structures of pyrazole derivatives with their corresponding biological activities. The findings of this review may open new avenues for an upcoming scientific breakthrough.

Endoscopic Push-Through Cartilage Myringoplasty for Anterior Perforations.

Introduction: The study aims to evaluate the anatomical and functional success rates of endoscopic push-through cartilage myringoplasty for anterior tympanic membrane (TM) perforations. Materials and Methods: Thirty patients with TM perforations in the anterior quadrant underwent endoscopic push-through cartilage tympanoplasty and underwent prospective evaluation. The graft uptake rate and hearing gain were the outcomes evaluated. Results: Out of the 30 patients, 15 were male, and 15 were female. The mean age was 32.60 ± 13.66 years (from 18-60 years). The overall graft uptake rate was 90%, with failure observed in three cases. The mean preoperative air conduction threshold was 37.9 ± 5.83 dB which improved to 27.66 ± 4.88 dB at 16 weeks post-operation. The mean postoperative ABG closure was 7.28 dB with a p-value of 0.001 which was statistically significant. Conclusions: Endoscopic push-through cartilage myringoplasty is the least invasive, safe, simple, and advantageous for healing TM perforation and hearing restoration.

Conservation Tillage and Waste Crop Residue Based Zinc Fortification in Rice and Wheat under Reclaimed Sodic Soils: Progress toward Nutrient Circularity and Sustainability.

Nearly 50% of the population across the globe is at risk of malnutrition with respect to zinc (Zn) in areas where a cereal based dietary system dominates. The present study estimated daily Zn intake in humans through field experiments in reclaimed sodic soil, utilizing waste crop residue (CR) in conservation tillage where CR played a vital role in enhancing Zn uptake in rice and wheat grains. Zn dynamics, its bioavailability, interaction with soil properties, and plausible contribution in dietary intake were studied extensively to supplement the research. A higher mobility factor (2.70%) and plant available Zn resulted in its higher uptake in rice (58.2 mg kg-1) and wheat (67.2 mg kg-1) under zero tillage in rice followed by zero tillage in wheat where CR was retained on the surface (ZTR-ZTW+CR). Daily Zn intake was found to be maximum (0.651 mg kg-1 day-1) under ZTR-ZTW+CR, demonstrating zinc sufficiency. Thus, this study may help in formulating actionable policies for combating both nutritional security and environmental hazards due to CR burning.

Development of duplex real-time PCR for quick detection of cryptosporidiosis in goats.

Cryptosporidium spp. is the most important foodborne and waterborne pathogens and a leading cause of mortality from foodborne and waterborne gastrointestinal diseases. In neonates of domestic animals, it is associated with consistent diarrhea and dehydration. Cryptosporidium infection begins with the ingestion of sporulated oocytes disseminated by carrier animals that consistently contaminate the environment. Many diagnostic tests are available including microscopy and antigen trap-ELISA, but none of the diagnostic tests available currently cannot differentiate between active and passive infection in the host. In the current study, to address this challenge an mRNA-based duplex TaqMan® probe PCR was developed to target the Cryptosporidium oocyst wall protein gene and 18SSU rRNA gene in a single tube that can detect metabolically active cryptosporidial oocysts. The mRNA transcripts are the direct indicator of any actively replicating cell and they will help decipher the active stages of its lifecycle in a host. This diagnostic assay was standardized by computing transcript copy number-based limit of detection (LOD). For COWP and 18SSU rRNA genes, the LOD was 7.08 × 1004 and 5.95 × 1005 , respectively. During active infections, the oocyst wall protein will be active and so its COWP gene transcripts will act as a marker for active infection. While transcripts for 18SSU rRNA are constitutively expressed in cryptosporidial life cycle. This current diagnostic assay will be a quantitative marker that will help assess the active stages of Cryptosporidium infection in neonates. The disease dynamics will help better understand to formulate the control strategies and contain infection among healthy animals.

Characterization of homogenous acid catalyzed biodiesel production from palm oil: experimental investigation and numerical simulation.

Biodiesel is a biological renewable source produced from the conversion of triglycerides to alkyl esters. Palm oil is one of the most used lipid feedstocks for biodiesel production. It becomes necessary to optimize the transesterification reaction parameters to reduce the cost and enhance the quality of biodiesel. This study focuses on the use of homogenous sulfuric acid as a catalyst for the transesterification of palm fatty acids to methyl esters in a batch-scale reactor. A novel examination of transesterification reaction input parameters using the technique for order performance by similarity to ideal solution optimization technique and the effect of these parameters on yield, viscosity, and density of palm biodiesel using 3D surface graphs is investigated in this research. The present optimization approach is implemented to find out the optimum ranking of biodiesel production. From the experimental and numerical simulation, optimum results were observed at the catalyst concentration of 6% (w/w), reaction temperature of 70 °C, the reaction time of 120 min, and alcohol to oil molar ratio of 30:1 at which yield of 95.35%, viscosity of 5.0 cSt, and density of 880 kg/m3 of palm biodiesel were obtained. The different physicochemical properties of produced palm methyl esters are obtained within standards set by international authorities. Selected optimized process parameters can be used for commercial-scale biodiesel production.

The effect of geometry dependent Chamber Spatial Response Function in small field profile measurements.

The effect of Chamber-Spatial Response Function (CSRF) on beam profile measurements has been studied for Standard Ionization Chamber-Radiation Field Analyzer setup. The Chamber-Spatial Response Function is assumed to be Gaussian and parameterized through the projected geometry of the chamber along the measurement axis. CSRF widths was measured by constructing chamber diameter-FWHM correlation for a set of ionization chambers. The results were analyzed through Geant4 simulations. The geometrical parameters for the chamber, used in Geant4 simulation, have been derived from the CT scan images of the chamber. An excellent agreement between measurement and simulation is obtained. Various factors effecting the CSRF, such as chamber width and Compton current are analyzed. The analysis shows that the Compton current has significant role in broadening the CSRF. Further, it is also observed that a spherical chamber geometry provides better and compact CSRF.

Energy, exergy, environmental impact, and economic analyses of evacuated tube compound parabolic concentrator-powered solar thermal domestic water heating system.

In the reported study, a dynamic analytical model is developed to propose the energy, exergy, environmental impact, and economic analyses of the water heating system at Jaipur (India) with an evacuated tube compound parabolic concentrator field of a total area of 81 m2. Consequently, the model is used to perform parametric studies to report the effect of operating and meteorological parameters on the productivity and performance of the system. Moreover, the system's performance, environmental impact, and economic aspects have been investigated and compared under different meteorological conditions at four different Rajasthan (India) locations using TMY2 weather data files. Results clarified that Jodhpur receives the highest solar radiation intensity from these four locations. The model results were validated with the experimental data, and a good agreement has prevailed. Consequently, the results indicate the highest annual energy and exergy gain for Jodhpur with 79.72 MWh and 9.311 MWh, respectively, followed by Jaisalmer, Barmer, and Jaipur. The economic analysis results clarified that the simple payback period ranged from 4.5 to 4.75 years and the discounted payback period ranged from 6.6 to 7 years based on a 6% discount rate. At the same time, the levelized cost of heating for the given system is around 0.023 $/kWh which is very economical closest to that of CNG as a fuel which costs around 0.059 $/kWh. The internal rate of return is reported to be 16.76, 16.82, 16.77, and 16.75% for Barmer, Jodhpur, Jaipur, and Jaisalmer, respectively, and savings of 74.4, 78.1, 75.4, and 73.8 tonnes of CO2 emission to the environment.

Preparation and in-vitro, in-vivo characterisation of pioglitazone loaded chitosan/PEG blended PLGA biocompatible nanoparticles.

The purpose of this research was to formulate Polymeric (Chitosan/PEG blended PLGA) nanoparticles containing Pioglitazone as a model drug using the solvent evaporation method. The resultant nanoparticles were characterized by dynamic laser spectroscopy, transmission electron microscopy, atomic force microscopy, and X-ray diffraction. The nanoparticles had a spherical shape with a mean particle diameter of 323 ± 1.15 nm. Furthermore, data from differential scanning calorimetry (DSC) and Fourier transform infrared spectroscopy (FTIR) research revealed no drug-polymer interaction. The efficiency of drug encapsulation was determined to be 61.7 ± 2.91%. The formulated nanoparticles also showed improved drug bioavailability in an in vivo system. When compared to the native drug-treated group, blood glucose levels in Pioglitazone-loaded nanoparticle treated streptozotocin caused diabetic rats were reduced dramatically (up to 7 days) to normal levels (up to 6 h). In albino rats, the nanoparticles' in vivo toxicity investigation revealed no significant changes in behavioral, biochemical, or hematological exams. As a result, the developed system may be useful in achieving a controlled release of the drug, which may help decrease dose frequency and increase patient compliance with pioglitazone for the treatment of type 2 diabetes mellitus.

Smartphone Applications for Otolaryngology: Head and Neck Surgery-A Recent Update.

Rise in the number of smartphone users have led to an increased development of smartphone applications. Advent of technology and increased awareness has led to an increased use of healthcare apps by both the physicians and patients. This study aims to provide an up to date review on applications related to Otolaryngology, head and neck surgery (Oto-HNS). The smartphone applications were reviewed in May 2020 in Google play store and apple app store using relevant search words. We included apps relevant for physicians, students as well as patients. Apps providing alternative therapies and home remedies were excluded. A total of 619 apps were included with 352 apps from play store and 267 apps from apple store. Number of apps have remarkably increased in the last 2 years till May 2020, 63 apps were developed and last year 141 Oto-HNS apps were developed. Maximum number of apps were available in hearing aid category with 144 (23.2%) mobile hearing aids and 138 (22.2%) hearing aid control apps. 445 apps were available free of cost. Use of smartphone apps have increased dramatically in the last few years. However, their authenticity is still uncertain. Actual involvement of Otolaryngologist in app development is still rare. We recommend formation of scientific committees to regulate the apps development, to access apps quality and effectiveness before incorporated in clinical practice, medical education and patients use.

Olfactory and Gustatory Dysfunction in COVID-19 Patients: A Tertiary Care Institute Experience in India.

COVID-19 epidemic has varied spectrum of symptoms. With this study we aim to evaluate prevalence of Olfactory and Gustatory dysfunction in COVID-19 patients. To assess Olfactory and Gustatory dysfunction in COVID-19 Patients in Indian Population. Settings and Design: Prospective observational study. RT-PCR proven COVID-19 patients were enrolled in the study. Detailed history and olfactory function and Taste function were evaluated. Patient with symptoms of olfactory dysfunction were subjected to fill (sQOD-NS questionnaire). Re-evaluation was done weekly till the time of discharge. Analysis was done with Wilcoxon test with help of SPSS software. A total of 152 patients (Male-78, Female-74) completed the study after weekly evaluation. Olfactory and Gustatory dysfunction was seen in 28 (18.41%) and 20 (13.15%). Mean duration of symptoms was 2.4444 ± 0.352 days. Olfactory dysfunction was the first presenting symptom in 11 out of 152 patients (7.23%). Mean QD-NOS score in patients with Anosmia and Hyposmia (28 patients) was 11.4 ± 2.01 and 13.61 ± 2.82 at 1st evaluation, 20.3 ± 1.49 and 20.33 ± 1.57 at 7th day and 21 in both subgroups at 14th day follow up. Dysgeusia was noticed in 20/152 patients (13.15%). Recovery in olfactory dysfunction and Dysgeusia was complete in all patients. Olfactory and gustatory dysfunctions are significant part of clinical spectrum of COVID-19 disease In Indian Population.

Levofloxacin induced bullous fixed drug eruption: a rare case report.

A 42-year-old male patient visited the outpatient department for follow-up with a history of respiratory tract infection and diabetes mellitus. His main symptom was peeling of his epidermal layer of skin, and bullous fixed drug eruption on the lower and upper limbs and bank region of the body. Following assessment, the patient was prescribed levothyroxine, hydroxychloroquine, levofloxacin, and a combination of sulfamethoxazole-trimethoprim. On assessing causality of the adverse drug reaction (ADR), different ADR assessment scales such as the WHO-UMC Scale, Naranjo Scale, and Hartwig's Severity Assessment Scale were used, and the ADR was found by these scales to be 'likely', 'moderate', and 'probable', respectively. It was found that ADRs such as bullous fixed drug eruptions are not fatal but can cause patient anxiety and a reduced quality of life. This case report will help physicians and clinicians to become aware and vigilant about the ADR caused by levofloxacin, facilitating its early detection and management.

Ototoxicity in Patients of Advanced Head and Neck Malignancies Receiving Chemoradiation Versus Radiation Alone: Comparative Study.

To evaluate ototoxicity in patients receiving combined cisplatin and radiotherapy in comparison to patients receiving radiotherapy alone. A prospective study was conducted in sixty (60) cases of advanced Head and Neck malignancy (stage III and IV). Patient were divided in two randomized groups (30 each), group I received chemoradiation and group II received radiation alone. Inclusion criteria were histopathologically confirmed head & neck malignancy, normal baseline audiograms. Exclusion criteria were defined as: previously treated cases with chemotherapy/radiotherapy, patients who didn't complete treatment or lost to follow up. Ototoxicity was evaluated as per criterion established by the American speech-language-hearing association. Study participants were evaluated for ototoxicity at intervals defined as per study design. Sensorineural hearing loss (SNHL) was noticed in 56.6% and 36.6% of subjects in Group I & II respectively at 6 months follow up post completion of treatment. Incidence of sensorineural hearing loss increased significantly with cumulative dosages of chemoradiotherapy in group I and radiotherapy in group II. Incidence of SNHL in both study groups was found to be higher in patients older than 50 years. Incidence of ototoxicity in chemoradiated patients was found to be higher in comparison to patients receiving radiation alone. Ototoxicity occurred more with cumulative doses, with higher speech frequencies affected earlier in comparison to middle range frequencies. Lower frequencies were spared.

Intratemporal Facial Nerve Anatomy and its Variations in 30 Cases of Cadaveric Temporal Bones.

It is important for the ENT surgeon to be familiar with the anatomy of the facial nerve and to prevent iatrogenic injury to nerve as it shows variations in its intratemporal course. Present study was done to delineate the intratemporal course of facial nerve and observe its variations. Thirty wet cadaveric temporal bones were dissected in the temporal bone dissection laboratory in the Department of Otorhinolaryngology and Head Neck Surgery, Government Medical College, Patiala. The length of intratemporal segments of facial nerve, its relationship with important bony landmarks, and the presence of any anomaly or variations in its course were observed. The mean length of labyrinthine, tympanic and mastoid segment was found to be 4.28 ± 0.605 mm, 10.40 ± 1.416 mm and 12.34 ± 0.915 mm respectively in the dissected specimens. The first and second genu angle varied between 50°-90° and 90°-120° respectively. Facial canal dehiscence was present at the level of first genu in 10% of cases and at the level of tympanic segment in 33%. Distance between chorda tympani origin and stylomastoid foramen varied between 4 and 6 mm with mean value of 5.31 ± 0.603 mm. Chorda-facial angle was found to be in the range of 20° to 31° with mean of 25.30° ± 2.90°. The tympanomastoid segment of facial nerve has variations in length and in its relations with various middle ear structures. The facial canal, as it traverses the temporal bone, may display bony dehiscence, variations, and anomalies in its natural course, having its own clinical and surgical significance.