A Comparative Study of Button Hole Technique Versus Underlay Technique in Type 1 Tympanoplasty.

Background: Tympanoplasty is the most common operation performed by an Otolaryngologist worldwide.Type 1 tympanoplasty involves repair of pars tensa of tympanic membrane, when the middle ear is normal. The most widely used method is underlay technique using temporalis facia. In buttonhole tympanoplasty, the temporalis fascia is anchored to the handle of malleus through the buttonhole. Objective: To compare and analyze graft uptake and hearing outcome in button hole technique and underlay technique. Material and Method: It is a comparative study done at tertiary care center, where patients suffering from tubotympanic type of chronic otitis media with medium sized perforation with moderate conductive hearing loss, within age group of 18-60 years,were selected. Results: In Button hole tympanoplasty group the mean hearing gain was 9.3dB, and 8.17 dB in Underlay tympanoplasty group which was statistically significant (p < 0.05) but P value between Button hole and Underlay tympanoplasty was not statistically significant.With regard to graft uptake 96.7% showed graft uptake in Buttonhole tympanoplasty group and in underlay tympanoplasty the graft uptake was 93.3%. Interpretation and Conclusion: Buttonhole technique is better in terms of graft uptake since the graft is anchored to the handle of malleus, and postoperatively medialisation of graft and other complications like lateralization of graft, epithelial pearl formation and anterior blunting is prevented. Both techniques are good in terms of hearing improvement for chronic otitis media with medium sized perforation with moderateconductive hearing loss.

Malaria vaccines in the eradication era: current status and future perspectives.

INTRODUCTION: The challenge to eradicate malaria is an enormous task that will not be achieved by current control measures, thus an efficacious and long-lasting malaria vaccine is required. The licensing of RTS, S/AS01 is a step forward in providing some protection, but a malaria vaccine that protects across multiple transmission seasons is still needed. To achieve this, inducing beneficial immune responses while minimising deleterious non-targeted effects will be essential. AREAS COVERED: This article discusses the current challenges and advances in malaria vaccine development and reviews recent human clinical trials for each stage of infection. Pubmed and ScienceDirect were searched, focusing on cell mediated immunity and how T cell subsets might be targeted in future vaccines using novel adjuvants and emerging vaccine technologies. EXPERT COMMENTARY: Despite decades of research there is no highly effective licensed malaria vaccine. However, there is cause for optimism as new adjuvants and vaccine systems emerge, and our understanding of correlates of protection increases, especially regarding cellular immunity. The new field of heterologous (non-specific) effects of vaccines also highlights the broader consequences of immunization. Importantly, the WHO led Malaria Vaccine Technology Roadmap illustrates that there is a political will among the global health community to make it happen.

Powered Endoscopic Endonasal Dacryocystorhinostomy with Mucosal Flaps and Trimming of Anterior End of Middle Turbinate.

Endoscopic endonasal dacryocystorhinostomy (DCR), when compared to external techniques, has always had guarded acceptance primarily due to inconsistent success rates. The most common cause of surgical failure in endoscopic DCR is very high/very low mucosal incision, obstruction of neo-ostium by granulation tissue, infolding of flap or formation of synechiae between middle turbinate and the neo-ostium site post-operatively. Several techniques and modifications have been suggested by various authors over the years since the first introduction of endoscopic endonasal DCR. With the newer techniques and advancements, the success rates have become comparable or even higher than external DCR. The aim of our study was to determine the success of endoscopic endonasal DCR using the classical Wormald technique with a few modifications. A total of 37 cases of epiphora secondary to nasolacrimal duct obstruction were operated using endoscopic endonasal DCR technique. The surgical technique included classical Wormald principle of mucosal flap, removal of the overlying bone using Kerrisons punch & chisel-hammer followed by vertical incision on the sac. The medial wall of lacrimal sac was then trimmed using microdebrider, thus apposing it to the nasal mucosal flaps. The anterior end of middle turbinate was also trimmed prophylactically to prevent synechiae formation. The outcome and long term patency of the cases were evaluated. Of the 37 cases, 35 cases (94.6 %) had complete resolution of the epiphora at the end of 1 year follow up period. The two cases of failure were due to canaliculitis in one patient and extensive granulation around the neo-ostium in another. Thus the above method has very good success rate comparable to previous studies and very less chances of granulation tissue formation and blockage of neo-ostium by synechiae/flap infolding.

The granzyme B-Serpinb9 axis controls the fate of lymphocytes after lysosomal stress.

Cytotoxic lymphocytes (CLs) contain lysosome-related organelles (LROs) that perform the normal degradative functions of the lysosome, in addition to storage and release of powerful cytotoxins employed to kill virally infected or abnormal cells. Among these cytotoxins is granzyme B (GrB), a protease that has also been implicated in activation (restimulation)-induced cell death of natural killer (NK) and T cells, but the underlying mechanism and its regulation are unclear. Here we show that restimulation of previously activated human or mouse lymphocytes induces lysosomal membrane permeabilisation (LMP), followed by GrB release from LROs into the CL cytosol. The model lysosomal stressors sphingosine and Leu-Leu-methyl-ester, and CLs from gene-targeted mice were used to show that LMP releases GrB in both a time- and concentration-dependent manner, and that the liberated GrB is responsible for cell death. The endogenous GrB inhibitor Serpinb9 (Sb9) protects CLs against LMP-induced death but is decreasingly effective as the extent of LMP increases. We also used these model stressors to show that GrB is the major effector of LMP-mediated death in T cells, but that in NK cells additional effectors are released, making GrB redundant. We found that limited LMP and GrB release occurs constitutively in proliferating lymphocytes and in NK cells engaged with targets in vitro. In Ectromelia virus-infected lymph nodes, working NK cells lacking Sb9 are more susceptible to GrB-mediated death. Taken together, these data show that a basal level of LMP occurs in proliferating and activated lymphocytes, and is increased on restimulation. LMP releases GrB from LROs into the lymphocyte cytoplasm and its ensuing interaction with Sb9 dictates whether or not the cell survives. The GrB-Sb9 nexus may therefore represent an additional mechanism of limiting lymphocyte lifespan and populations.