Subperiosteal inferior maxillectomy in mucormycosis patients: case series.

OBJECTIVE: Mucormycosis is a rapidly progressive and fulminant fungal infection mainly affecting the nose and paranasal sinuses and often requiring aggressive surgical debridement, which commonly includes inferior maxillectomy. Conventional inferior maxillectomy involves removal of the bony hard palate and its mucoperiosteum. This can lead to formation of an oroantral fistula and thereby increase the morbidity in these patients leading to prolonged rehabilitation. Subperiosteal inferior maxillectomy involves sparing of the uninvolved mucoperiosteum of the hard palate. This flap is used for closure of the oroantral fistula, which preserves the functional capabilities of the patient, such as speech, mastication and deglutination. METHOD: This case series describes the experience of using the technique of mucosa-preserving subperiosteal inferior maxillectomy in five patients with mucormycosis. RESULTS: With the technique used in this study, complete oronasal separation was achieved in all six patients. The overall surgery time was also decreased when compared with free tissue transfer. Patients also did not have to bear the weight of prosthesis. CONCLUSION: Mucoperiosteal palatal flap-preserving subperiosteal inferior maxillectomy is an excellent approach for all patients with mucormycosis and healthy palatal mucosa.

COVID associated mucormycosis: A preliminary study from a dedicated COVID Hospital in Delhi.

BACKGROUND: It is an incontrovertible fact that the Rhino Orbital Cerebral Mucormycosis (ROCM) upsurge is being seen in the context of COVID-19 in India. Briefly presented is evidence that in patients with uncontrolled diabetes, a dysfunctional immune system due to SARS-COV-2 and injudicious use of corticosteroids may be largely responsible for this malady. OBJECTIVE: To find the possible impact of COVID 19 infection and various co-morbidities on occurrence of ROCM and demonstrate the outcome based on medical and surgical interventions. METHODOLOGY: Prospective longitudinal study included patients diagnosed with acute invasive fungal rhinosinusitis after a recent COVID-19 infection. Diagnostic nasal endoscopy (DNE) was performed on each patient and swabs were taken and sent for fungal KOH staining and microscopy. Medical management included Injection Liposomal Amphotericin B, Posaconazole and Voriconazole. Surgical treatment was restricted to patients with RT PCR negative results for COVID-19. Endoscopic, open, and combined approaches were utilized to eradicate infection. Follow-up for survived patients was maintained regularly for the first postoperative month. RESULTS: Out of total 131 patients, 111 patients had prior history of SARS COVID 19 infection, confirmed with a positive RT-PCR report and the rest 20 patients had no such history. Steroids were received as a part of treatment in 67 patients infected with COVID 19. Among 131 patients, 124 recovered, 1 worsened and 6 died. Out of 101 known diabetics, 98 recovered and 3 had fatal outcomes. 7 patients with previous history of COVID infection did not have any evidence of Diabetes mellitus, steroid intake or any other comorbidity. CONCLUSION: It can be concluded that ROCM upsurge seen in the context of COVID-19 in India was mainly seen in patients with uncontrolled diabetes, a dysfunctional immune system due to SARS-COV-2 infection and injudicious use of corticosteroids.

Comparison of efficacy of endoscopic versus microscopic transcanal inlay butterfly cartilage myringoplasty.

BACKGROUND AND OBJECTIVES: Butterfly cartilage myringoplasty has been widely practiced over two decades due to its simplicity and feasibility. The present study is aimed to compare the efficacy of endoscopic versus microscopic transcanal inlay butterfly cartilage myringoplasty. SUBJECTS AND METHODS: In this randomised control trial, fifty patients with small to medium sized perforation were included. The first group underwent butterfly cartilage myringoplasty using endoscope and the second group using microscope and, outcomes were compared. RESULTS: Graft success rates in the endoscopic group was 96% ±â€¯4% and in the microscopic group was 92% ±â€¯8%. The improvement in the Air-Bone Gap was 11.00 ±â€¯7.21 dB in the endoscopic group and 10.8 ±â€¯7.59 dB in the microscopic group. The difference was not statistically significant. CONCLUSIONS: The overall success rates and hearing outcomes were similar in the endoscopic and microscopic group with added advantages of less pain, shorter operative time and better field of vision in the endoscopic group.

Bacillus subtilis CP4, isolated from native soil in combination with arbuscular mycorrhizal fungi promotes biofortification, yield and metabolite production in wheat under field conditions.

AIMS: The aim of this study was to identify the best combination of plant growth promoting bacteria (PGPB) and arbuscular mycorrhizal fungi (AMF) for biofortification and enhancing yield in wheat as well as improve soil health under field conditions. Another aim was to get insights into metabolite dynamics in plants treated with PGPB and AMF. METHODS AND RESULTS: Different combinations of PGPB and AMF that gave good results in greenhouse study were used in a field study. The combined application of Bacillus subtilis CP4 (native PGPB) and AMF gave the best results with a significant increase in biomass, macronutrient and micronutrient content in wheat grains and improvement in yield-related parameters relative to the untreated control. PGPB and AMF treatment increased antioxidant enzymes and compounds and decreased the level of an oxidation marker. Metabolite profiling performed using Gas Chromatography-Mass Spectrometry (GC-MS) showed significant upregulation of specific organic acids, amino acids, sugars and sugar alcohols in plants treated with CP4 and AMF. The altered pathways due to CP4 and AMF inoculation mainly belong to carbohydrate and amino acid metabolism. A positive correlation was observed between some organic acids, sugars and amino acids with wheat growth and yield parameters. The activities of soil enzymes increased significantly with the best results shown by native PGPB and AMF combination. CONCLUSIONS: A native bacterial isolate Bacillus subtilis CP4 in combination with AMF showed exceptional ability for biofortification and yield enhancement under field conditions. The upregulation of a number of metabolites showed correlation plant growth promotion and nutrients. SIGNIFICANCE AND IMPACT OF THE STUDY: The combined application of native B. subtilis CP4 and AMF could offer a more sustainable approach for the development of a biofertilizer to enhance wheat nutrient content and production and soil health thereby advancing agriculture.

Endoscopic assisted powered adenoidectomy versus conventional adenoidectomy - a randomised controlled trial.

OBJECTIVE: To compare endoscopic assisted powered adenoidectomy with conventional curettage adenoidectomy. METHODS: A randomised controlled trial was conducted at a tertiary care teaching hospital. Fifty patients with a symptom complex pertaining to adenoid hypertrophy and requiring adenoidectomy were chosen and divided into 2 groups of 25 each. Patients in group A underwent conventional curettage adenoidectomy and those in group B underwent endoscopic assisted powered adenoidectomy. Comparison was based on the parameters of surgical time, intra-operative bleeding, post-operative pain and completeness of adenoid removal. RESULTS: The surgical time was significantly longer with the powered instrument. Mean blood loss was greater in the powered group, but was statistically insignificant. The powered procedure fared significantly better, with lower pain scores and more instances of complete tissue resection. CONCLUSION: A curved microdebrider blade can be used safely and precisely for adenoidectomy under endoscopic vision. It enables complete resection of adenoid tissue. This method also proves to be an excellent teaching aid.

Is the Voice of Professional Voice Users With no Vocal Cord Lesions Similar to That of Non Professional Voice Users?

OBJECTIVE: The objective of this study was to analyze if the voice of professional voice users (PVU) is comparable with that of a nonprofessional voice users (NPVUs), both of whom have no obvious vocal cord lesions. MATERIALS AND METHODS: Fifty professional and 50 NPVUs with no obvious vocal fold pathologies underwent voice analysis and videostroboscopic study, and various parameters were analyzed. RESULTS: Majority of the participants were found to be less than 40 years. Teachers formed the largest group (40%) of PVUs. PVUs had a significantly higher incidence of voice-related complaints compared with NPVUs. The former group also showed a higher deviation from the normative data. A significant influence of gender and the duration of work experience was also observed among PVUs. CONCLUSIONS: The voice of an apparently normal PVU is not similar to that of an apparently normal NPVU. Female PVUs and PVUs with a longer duration of work experience show the highest deviation from normative data.

Speaking and Nonspeaking Voice Professionals: Who Has the Better Voice?

INTRODUCTION: Voice professionals can be classified into two major subgroups: the primarily speaking and the primarily nonspeaking voice professionals. Nonspeaking voice professionals mainly include singers, whereas speaking voice professionals include the rest of the voice professionals. Although both of these groups have high vocal demands, it is currently unknown whether both groups show similar voice changes after their daily voice use. Comparison of these two subgroups of voice professionals has never been done before. AIM: This study aimed to compare the speaking voice of speaking and nonspeaking voice professionals with no obvious vocal fold pathology or voice-related complaints on the day of assessment. METHODOLOGY: After obtaining relevant voice-related history, voice analysis and videostroboscopy were performed in 50 speaking and 50 nonspeaking voice professionals. RESULTS: Speaking voice professionals showed significantly higher incidence of voice-related complaints as compared with nonspeaking voice professionals. Voice analysis revealed that most acoustic parameters including fundamental frequency, jitter percent, and harmonic-to-noise ratio were significantly higher in speaking voice professionals, whereas videostroboscopy did not show any significant difference between the two groups. CONCLUSION: This is the first study of its kind to analyze the effect of daily voice use in the two subgroups of voice professionals with no obvious vocal fold pathology. We conclude that voice professionals should not be considered as a homogeneous group. The detrimental effects of excessive voice use were observed to occur more significantly in speaking voice professionals than in nonspeaking voice professionals.

Bilateral spontaneous salivary otorrhoea: Case report and a review of the literature.

Spontaneous salivary otorrhoea is an extremely rare clinical entity. Most of the times, salivary otorrhoea results from various forms of trauma. It has also been attributed to the patent foramen of Huschke, and fissures of Santorini. Here, we present a rare case of an 8 year old child presenting with salivary discharge from both the ears. The diagnosis was established on the basis of biochemical and radiological investigations. The patient was managed by surgical exploration and ligation of the fistulous tract.

Gunshot Injury with Facial Palsy: An Unusual Case.

As the use of firearms has become increasingly common in the civilian society, the incidences of homicidal as well as suicidal firearm injury have increased several folds. We here present an interesting case of celebratory firing which accidently caused injury in the head & neck region and an unusual trajectory adopted by the bullet which prevented a fatal outcome.

Sutureless tympanoplasty using acellular dermis.

OBJECTIVE: A prospective randomized unblinded controlled trial was conducted by comparing acellular dermis with temporalis fascia as graft materials in tympanoplasty (type 1) in terms of operative time, postoperative pain, graft success rate, and audiologic outcome. STUDY DESIGN: Forty-two patients with (inactive) chronic suppurative otitis media of tubotympanic type were randomized, matched, and divided equally into 2 groups of 21 each. One group underwent tympanoplasty (type 1) via transcanal route using temporalis fascia graft and the other using acellular dermis. Both groups were compared for operative time, postoperative pain, graft success rate, and audiologic improvement in hearing. RESULTS: There was a statistically significant reduction in operative time (P < .05) and postoperative pain (P < .05) in the acellular dermis group. However, there was no statistical difference in graft success rate (P > .05) and hearing improvement (P > .05) between both the groups. CONCLUSION: Results of tympanoplasty using acellular dermis as graft material are comparable to that using temporalis fascia in terms of graft uptake and hearing improvement. However, tympanoplasty using acellular dermis has the advantage of shorter operative time and lesser postoperative pain.

Topical mitomycin C as a postoperative adjunct to endonasal dacryocystorhinostomy in patients with anatomical endonasal variants.

PURPOSE: Unusual intranasal conditions may increase the rate of complications and affect success rate of endonasal dacryocystorhinostomy (DCR) surgery. The purpose of this study was to find the influence of endonasal abnormalities on outcome of endonasal DCR surgery and to find the role of topical mitomycin C (MMC) as a postoperative adjunct to endonasal dacryocystorhinostomy in these patients. METHODS: A total of 23 patients (19 males and 4 females) of bilateral chronic dacryocystitis in the age range of 18-60 years, having endonasal anatomical variants were included in this study. After endonasal DCR, the right side of nasal cavity was packed with 0.05% MMC nasal pack and left side of nasal cavity was packed with normal saline pack for 48 hours. During postoperative visits, the patients were checked for improvement in clinical symptoms and watched for complications including formation of adhesions and/or synechaie. The statistical association between endonasal pathologies and 3 dichotomous outcome variables (clinical features, adhesions, synechaie) was assessed by applying Fisher's Exact Test. RESULTS: Postoperative retention of nasal packs for 48 hours after endonasal DCR, did not cause any side effect in our patients. An improvement in clinical symptoms (23/23 = 100%) was seen in all the patients on side with 0.05% MMC soaked nasal pack, while 10/23 i.e., 43.47% patients did not show improvement in symptoms on side of saline nasal pack. Postoperatively, the MMC nasal pack side nasal cavity had a healthy nasal mucosa during the entire follow up, while the saline nasal pack side nasal cavity had synechiae in 15/23 (65.2%) patients and adhesions in 15/23 (65.2%) patients. In our study, none of the anatomical endonasal variants had a statistically significant association with either formation of adhesion or formation of synechiae, as the p-value was > 0.05 in all these instances. CONCLUSIONS: The patients with endonasal anatomical variants have a higher incidence of complications like formation of adhesions and synechaie after endonasal DCR than other patients. Topical MMC is safe and effective agent to decrease the rate of complications when used as an adjunct in endonasal DCR in patients with endonasal anatomical variants.

In vitro growth and shoot multiplication in Terminalia bellerica roxB. under controlled carbon dioxide environment.

The shoot cultures of Terminalia bellerica Roxb. were grown on Murashige and Skoog's medium containing 1.5 mg 1(-1) BAP (6- benzyl aminopurine), and supplemented with or without sucrose (3%). A range of CO2 concentrations (0.0, 0.6, 10, 40 g(-3)) was provided in small acrylic chambers by using different concentrations and combinations of NaHCO3 (sodium bicarbonate), Na2CO3 (sodium carbonate), KHCO3 (potassium bicarbonate) and K2CO3 (potassium carbonate). To obtain a CO2-free environment, a saturated solution of 10% of KOH (potassium hydroxide) was kept in the chamber. Complete absence of carbon source caused death of shoots within 20 days. Under controlled and enriched CO2, the shoots grew fully photoautotropically on sucrose-free medium. The growth of cultures was better with carbon dioxide (40 g(-3)) than sucrose (3%) in the medium. Maximum number of shoots, number of leaves per cluster, fresh and dry weight and chlorophyll contents were recorded when both sucrose and CO2 (40 g(-3)) were provided to the culture.

Prolonged foreign body impaction in the oesophagus.

It is not unusual for a foreign body to be swallowed and become lodged in the oesophagus. It is, however, very unusual for such a foreign body to remain lodged for a period of six months. This particular case, a 37-year-old man, is interesting because of the length of time the foreign body, a denture, remained in the oesophagus without complications, its successful removal and the nature of the foreign body, which is prone to cause complications on prolonged stay or during removal.

Synthesis and Antiviral Studies of Novel N-Sulphonamidomethyl piperazinyl Fluoroquinolones.

A series of novel N-Sulphonamidomethyl piperzinyl fluoroquinolones were synthesized and screened antiviral activity. Eight compounds were synthesized through modifying the N(4)-hydrogen of piperazine in fluoroquinolones with formaldehyde and sulphanomides by Mannich reactions. The structures of the synthesized compounds were characterized by means of their IR and (1)H-NMR spectral data. Synthesized compounds were screened for antiviral activity against influenza A (H1N1, H3N2, H5N1) and influenza B viruses in MDCK cell culture. The antiHIV activities of the new compounds were screened for antiviral activity against replication of HIV-1(III(B)) in MT-4 cells. Cytotoxicity of the synthesized compounds was also tested in mock-infected MDCK and MT-4 cells. Compound CF-SD and CF-SDM inhibits the influenza A (H1N1) and compound GF-SDM inhibit the replication of influenza A (H5N1) and B in MDCK cells. All compounds displayed cytostatic propertity in MT-4 cells. Among the compounds tested, GF-SDM (CC(50)=39.44 muM) most toxic compound in this series.

Predictors of mortality in very low birth weight neonates in India.

INTRODUCTION: Very low birth weight (VLBW) neonates constitute approximately 4-7 percent of all live births and their mortality is very high. The objective of the present study was to determine the predictors of mortality in VLBW neonates. METHODS: A retrospective cohort of VLBW neonates admitted over three years was studied. Exclusion criteria were: (1) neonates weighing less than 500 g and with gestational age less than 26 weeks; (2) presence of lethal congenital malformations; and (3) death in the delivery room or within 12 hours of life. The outcome measure was in-hospital death. Medical records were reviewed and data was analysed. Univariate analysis and logistic regression analysis were done to determine the predictors of mortality. RESULTS: A total of 260 cases were enrolled, of which a total of 96 (36.9 percent) babies died. The survival rate was found to increase with the increase in birth weight and gestational age. Univariate analysis showed maternal per vaginal bleeding, failure to administer steroid antenatally, Apgar score less than or equal to 5 at one minute, apnoea, gestational age, neonatal septicaemia and shock are the factors directly responsible for neonatal mortality. Logistic regression equation showed maternal bleed (1.326), apnoea (3.159), birth weight (0.037), gestational age (0.063), hypothermia (1.132) and shock (3.49) predicted 65 percent of mortality in VLBW babies. CONCLUSION: Common antenatal and perinatal predictors of mortality in VLBW infants in India include maternal bleed, failure to administer antenatal steroids, low Apgar score, apnoea, extreme prematurity, neonatal septicaemia and shock.

Ear abuse in school children.

Ear abuse in school children is common in low socio-economic strata and is often associated a long-term morbidity in our country. This paper presents a study of 250 such children with discussion. Incidence of ear abuse with long term learning deficit was found to be 18.4%.

Role of Bupivacaine in reducing post tonsillectomy pain.

Pain following tonsilleclomy is of major concern to both the surgeons and the Anesthesiologists. Pre-incisional Bupivacaine infiltration into the tonsillar fossa has been used as a method of relieving post-operative pain in children. In this study pre-incisional Bupivacaine infiltration into the tonsillar fossa resulted in immediate post-operative pain lasting four to six hours.

Giant ossifying chondroma of skull.

We report a rare case of giant ossifying chondroma of skull arising from temporoparietal region in a 14-year-old female, which was successfully excised. While reviewing world literature few cases of extracranial chondromas arising from the skull base were found.