Surgical Outcome in Patients with Traumatic and Atraumatic Optic Neuropathy Following Endoscopic Optic Nerve Decompression.

Endoscopic optic nerve decompression is a highly effective and reliable approach for patients with select cases of optic neuropathy. It reduces the hydrostatic pressure and helps in relieving the compressive forces within the intracanalicular portion of the optic nerve consequently preserving and arresting the deterioration of vision. The advantages of the endoscopic approach over other procedures include preservation of olfaction, quick recovery, lack of external scars and less morbidity. The objective of the study is to assess the surgical outcome of endoscopic optic nerve decompression in patients with traumatic and atraumatic optic neuropathy. The case records of consequent patients attending ENT department with defective vision due to traumatic and atraumatic causes were reviewed. The outcome was measured in terms of improvement in visual acuity by log MAR scale. Among the 14 patients studied, 57% were females and the median age of presentation was 33 years. As compared to preoperative baseline visual acuity, the overall improvement was achieved in 11 patients, with an effective rate of 78.5% postoperatively. Patients presenting with no light perception and residual vision had significant improvement in visual acuity after surgery. Trans-nasal endoscopic surgery helps in decompressing the optic nerve with proper exposure of the orbital apex and optic canal without any intracranial or intra-orbital complications. Further, being a minimally invasive procedure has great advantage in cases of optic neuropathy.

Evaluation of anti-microbial efficacy among Andrographis Paniculata and Mimusops Elengi on oral microflora: An Experimental in-vitro study.

Introduction: Oral health is an essential non-integrated part of general health that plays a vital role in preventing chronic diseases. The oral cavity acts as a suitable environment for the proliferation of bacteria by forming a connecting link to invade the tissues through direct contact from outside. For the past few decades, there has been increased resistance of human pathogenic bacteria to the currently used antibiotics and chemotherapeutics for tooth decay, gingivitis, periodontitis and fungal infection among different age groups. Hence, the search has shifted to traditional plants and natural products, which are a good alternative. To create oral hygiene solutions for the prevention of oral infections, several ayurvedic ingredients, including Andrographis paniculata and Mimusops elengi, have been tested for their effectiveness against dental pathogens. The present investigation's purpose is to determine the minimum inhibitory concentration-based antibacterial efficiency of Andrographis paniculata and Mimusops elengi against Streptococcus mutans, Lactobacillus acidophilus, Actinomyces and Candida albicans. Methodology: Antimicrobial activity of herbal extracts was determined using the agar well diffusion method. Ethanolic extracts were prepared using a cold extraction method whereas Dimethyl sulfoxide and water were used as dissolution solvents. The diluted herbal extract sample was used as the test sample, while the positive control used was an antibiotic solution and the negative control used was dissolution solvents. The samples were implanted, the bacteria along with the culture media were incubated, and the zone of inhibition was measured. Results: The Minimum inhibitory concentration and zones of inhibition of Andrographis Paniculata and Mimusops Elengi showed significant antibacterial efficacy when compared with standards. Conclusion: Andrographis Paniculata and Mimusops Elengi may be used as an efficient addition to conventional care in the management of oral disorders, according to their antimicrobial efficacy.

Prevalence and Auditory Characteristics of Auditory Neuropathy Spectrum Disorder in Adult Population with Sensory Neural Hearing Loss: A Hospital Based Study in South India.

Auditory neuropathy spectrum disorder (ANSD) is a heterogenous group of disorder characterized by abnormalities in auditory brainstem responses (ABR) with preserved otoacoustic emissions and/or cochlear microphonics. The aim of the study is to estimate the prevalence and evaluate the audiological characteristics of ANSD in adult population with sensory neural hearing loss. A prospective study was conducted on the adult population (≥ 18 years) attending ENT outpatients clinic at Rajiv Gandhi Government General Hospital, Chennai. All patients reported to the department with auditory and vestibular symptoms underwent case history, otoscopic examination, and routine audiological evaluation (pure tone audiometry, speech audiometry and immittance audiometry). Patients with indications of ANSD in case history and routine audiological evaluation were further evaluated using distortion product otoacoustic emissions and ABR. A total of 8682 adult population was evaluated during the period of 2017 to 2018. Out of 8682 patients, 1343 (15.46%) of them had sensory neural hearing loss of varying degrees. Out of 1343 adults with sensory neural hearing loss, 24 (1.78%) adults were diagnosed as ANSD. The prevalence of ANSD in adult population with sensory neural hearing loss in our study is 1.32% per 1000 adults. The clinical characteristics of ANSD shows impairment in speech perception irrespective of degree of hearing loss, preserved cochlear functions and abnormal ABR. Hence ANSD is not a rare clinical finding in adults with sensory neural hearing loss, but its prevalence was estimated to be lower in Indian population. Often young females are affected causing significant impairment in speech perception and disability.

Effect of aging and thermocycling on flexural strength of PEEK as a provisional restoration for full mouth rehabilitation - An In vitro study.

Introduction: To compare the flexural strength of autopolymerizing poly methyl methacrylate resins (PMMA) resin, CAD/CAM milled PMMA and CAD/CAM milled poly ether ether ketone (PEEK) when used as provisional restorative materials for long span situations in full mouth rehabilitation after aging and thermocycling. Materials and Methods: Sixty samples (25 mm × 2 mm × 2 mm) were fabricated using autopolymerizing PMMA resin (GROUP I), CAD/CAM milled PMMA (GROUP II) and PEEK (GROUP III). The groups were subdivided into A and B and subjected to 7 days of aging and 500 cycles of thermocycling (subgroup A) and 14 days of aging and 1000 cycles of thermocycling (subgroup B), respectively, and flexural strength was evaluated using a three-point bend test. The data were analyzed with student t test and pair-wise comparison of mean values was done by ANOVA. Results: The flexural strength of PEEK subjected to 7 days of aging and 500 cycles of thermocycling (III (A) - 6628.70 MPa) was the highest among all groups followed by PEEK subjected to 14 days of aging and 1000 cycles of thermocycling (III (B) - 3760.50 MPa). Conclusion: The mean flexural strength of PEEK was statistically significant than the other two materials tested and hence can be recommended for use as a provisional restorative material for long span situations in full mouth rehabilitation. However, the mean flexural strength of PEEK reduced approximately by 44% when subjected to further aging.

Anticancer Effect of Plectranthus Amboinicus and Glycyrrhiza Glabra on Oral Cancer Cell Line: An Invitro Experimental Study.

BACKGROUND AND OBJECTIVE: Oral cancer is a commonly encountered type of cancer with multifactorial etiology. The number of oral cancer cases are increasing in the recent past. Advancements in cancer therapy are continuously evolving. In spite of that, the survival rate is very low along with adverse effects associated with each treatment modality. This poses a need for a constant search for newer or alternative treatment options. Herbal medicines or plant-based medicines are derived from plant sources. Evidence supports that incorporating herbal medicines in cancer therapy offers many advantages. Hence, exploring plant species for anticarcinogenic properties can potentially benefit cancer therapy. Studies show that the two medicinal herbs Plectranthus amboinicus (Indian borage, Karpooravalli) and Glycyrrhiza glabra (Liquorice, Athimathuram) have shown excellent anticancer activity on various cancers. The present study aimed to evaluate and assess the anticancer property of two medicinal plants Plectranthus amboinicus (Indian borage, Karpooravalli) and Glycyrrhiza glabra (Liquorice, Athimathuram) on oral cancer (KB) cell line. MATERIALS AND METHODS: Ethanolic extracts of leaves of Plectranthus amboinicus and roots of Glycyrrhiza glabra were prepared. The oral cancer (KB) cell line was procured and cultured. Cell viability (MTT) assay was performed using various concentrations of both the plant extracts on oral cancer cells. The percentage of cell viability for each concentration was calculated and the IC50 value was derived for the two plant extracts. RESULTS: The results revealed a significant decrease in the percentage of viable cells with increasing concentration of the extracts. The IC50 values of Plectranthus amboinicus and Glycyrrhiza glabra were 53.0 µg/ml and 43.6 µg/ml respectively. On comparing the anticancer effect of the two extracts, Glycyrrhiza glabra was more cytotoxic than Plectranthus amboinicus on oral cancer (KB) cells. CONCLUSION: The two medicinal plants Plectranthus amboinicus and Glycyrrhiza glabra exhibited potent anticancer activity against oral cancer (KB) cells.

Ivabradine toxicity: a case report.

BACKGROUND: We describe a case of symptomatic bradycardia resulting from ivabradine toxicity by measurement of ivabradine levels, of which there are limited reports in the literature. CASE PRESENTATION: A 43-year-old White female presented with several days of near syncope and dizziness accompanied by a drop in her heart rate to 50 beats per minute. She was taking ivabradine for inappropriate sinus tachycardia. After excluding several other causes of bradycardia, we made the diagnosis of ivabradine toxicity by measurement of serum ivabradine levels, an approach that is currently not clinically available. CONCLUSIONS: Measurement of serum ivabradine levels and knowledge of the pharmacokinetic properties of the drug can be utilized to confirm the diagnosis of ivabradine toxicity.

HBE homozygous haemoglobinpathy - Fortuitous finding.

A 24-year-old male patient presented with the principal complaint of deposits on his teeth and gingival pigmentation. After examination, he was diagnosed with chronic generalized gingivitis. He was further referred for pre-procedural routine blood investigations. Bleeding time, clotting time, and his random blood sugar values were normal. CBC report revealed the presence of erythrocytosis with microcytic hypochromic red blood cells. Following this peripheral smear was taken which reveals the presence of polychromatophils, target cells and a few spherocytes. Haemoglobin electrophoresis by high-performance liquid chromatography (HPLC) was performed which disclosed 90.8% of HbE, suggestive of homozygous haemoglobinopathy. He had no other associated systemic findings, and there was no relevant family history. The patient was informed about his condition and stated to have pre-marital and pre-natal genetic counselling in the future. The patient being a carrier of the thalassaemic trait happened to know his condition incidentally, which could prevent future complications.

Evaluation of Efficacy of Foldscope - A Paper Microscope to be Used as a Chairside Diagnostic Tool in Oral Dysplastic Lesions: A Comparative Study.

INTRODUCTION: Precancerous lesion of the oral mucosa consists of a group of diseases which sometimes resemble each other leaving the clinician in a diagnostic dilemma. Etiology of these diseases varies geographically with most frequently being tobacco use, alcohol drinking, chewing of betel quid containing areca nut, and solar rays. The long-standing practice of these lifestyle habits causes an alteration in the mucosal barrier level leading to malignant transformation. Earlier, the diagnosis of malignant transformation was confirmed using biopsy, but the advent of exfoliative cytology showed that histological features of a cell undergoing transformation are distinctive during early stages. Early diagnosis can be lifesaving, along with chairside adjunct tools that can facilitate the clinician for better diagnosis and use it as an explanatory tool for patients. AIM: The aim of this study was to test the efficacy of foldscope as a chairside diagnostic tool to detect dysplastic changes in potentially malignant lesions affecting the oral cavity. MATERIALS AND METHODS: This was a cross-sectional comparative study of a total of 54 individuals clinically diagnosed with oral premalignant lesions. Exfoliative cytological smears were taken and observed under light microscope and foldscope. After Papanicolaou stain, it was subjected to cytomorphometric analysis. RESULTS: Cytological changes in potentially malignant lesions detected using foldscope were appreciable and found to be a mirror image of the routine light microscope. CONCLUSION: Morphological parameters assessed by foldscope proved to be employed in routine practice as well as in the mass screening of oral lesions.

Ideal Flap Cover for the Salvage of Exposed/Infected Cochlear Implants: A Case Series and Literature Review.

With an increase in the number of cochlear implant surgeries there is bound to be an increase in the number of complications. A dreaded problem in any implant procedure is the implant exposure and infection. Explantation of the implant leads to an unpleasant situation to the patient and the surgeon owing to the high cost of the device. There are reports in the literature favouring the mandatory relocation or removal of the infected implants. On the other hand, there are convincing reports of implant salvage using skin, muscle or fascial flaps. In this paper we have analysed a series of cases referred to us from the departments of E.N.T for the management of implant exposure/infection. We have also reviewed similar case series reported in the literature. From 2014 to 2017 we operated six cases of exposed cochlear implant. We salvaged the implant in five cases, where we could do two layer coverage consisting of the inner temporoparietal fascial flap and outer scalp skin flap. In one case where the temporoparietal fascial flap could not be done as superficial temporal vessels were found to be injured in the previous surgery, the implant was removed due to persistent infection. All these cases were administered appropriate antibiotics for a minimum period of 3 weeks. Early double layer closure with inner temporoparietal fascial flap and outer scalp rotation flap coupled with appropriate antibiotics can salvage an infected, exposed implant.

Pectoralis Major Myocutaneous/Myofascial Flap and Split Skin Grafting for Repair of Post Laryngectomy Pharyngo Cutaneous Fistula: An Undemanding and a Reliable Solution.

Pharyngo cutaneous fistula occurs in 16-32% of cases after laryngectomy. Repair of a non healing fistula is a reconstructive challenge due to inherent problems like malnutrition, lung infection, infected and soiled neck wound, irradiated neck field and hypothyroid status. As the defect is composite involving the neck and the aero digestive tract, there is requirement for two epithelial surfaces. The selected flaps should be thin and rigid to maintain a patent food passage and an unobstructed tracheostoma. From January 2008 to December 2016 we operated 14 cases of post laryngectomy pharyngo cutaneous fistula. 12 cases had undergone radiotherapy before laryngectomy. Duration of the fistula was 2-9 months. There was history of previous reconstructive attempts in four cases. The size of the neck defects ranged from 2 cm × 4 cm to 4 cm × 8 cm. In four cases, primary pharyngeal repair, Pectoralis major myofascial flap reinforcement and split skin grafting was done. In 10 cases, pharyngeal repair by Pectoralis major myocutaneous flap and split skin graft was done. Follow up was for 3 months to 3 years. In 13 cases, the fistula and the neck wound healed well and there was no recurrence of the fistula. Patients were on normal oral diet. One patient succumbed to the disease due to tumour recurrence at the tracheostomy site. We propose PMMF/PMMC flap and SSG for the reconstruction of post laryngectomy pharyngocutaneous fistula as an undemanding and a reliable solution.

Clinical Experience on Hearing Screening in Twins and Triplets: A Retrospective Study.

Twin or multiple pregnancies often have neonatal complications. Common complications include low birth weight, respiratory distress, neonatal intensive care unit (NICU) admission (>5 days) and low APGAR score especially on second twin. (1) To compare referral rates of newborn hearing screening in twins and triplets between risk and non-risk babies for hearing loss, (2) to determine the effects of birth order on referral rates in twins and triplets. A retrospective study was carried out from the case records of the neonates enrolled in the referral based NICU hearing screening program during April 2013 to December 2014 at Institute of Obstetrics and Gynecology, Chennai. 1405 neonates (723 males and 682 females) in the age range of 3-28 days were screened during this period among which 76 were twins (38 pairs) and 9 were triplets (3 sets). We classified them further into non risk and risk babies among twins according to the Joint Committee for Infant Hearing (JCIH) recommendations. A dual step hearing screening protocol was used to screen the neonates. They were initially tested with distortion product otoacoustic emission (DPOAE) then with automated auditory brainstem response (AABR) before discharged from the hospital. Out of 76 (100%) twin babies 43 (56.58%) babies had one or more risk factors for hearing loss. Most common risk factors were low birth weight, premature birth, mechanical ventilation >5 days, hyperbilirubinemia, infections, ototoxic medications and family history of hearing loss. Each risk factor was observed in equal proportion in 1st born and 2nd born twins. 12 (15.76%) risk babies and 11 (14.47%) non risk babies failed in DPOAE testing. Out of 9 triplets babies (3 set) 3 babies had risk factors for hearing loss. One baby in 2nd born babies group failed AABR screening. Referral rates were slightly higher in 2nd born twins when compared to 1st born twins in DPOAE testing. Chi square test did not reveal any significant association between referral rates with risk factors and birth order (p > 0.05). The referral rates in twins are higher than the total population screened. There is some influence of birth order on the referral rates in twins. It needs to be further investigated on larger population.

Vestibular Evoked Myogenic Potentials After Epleys Manoeuvre Among Individuals with Benign Paroxysmal Positional Vertigo.

VEMP abnormalities in individuals with BPPV are often reported to be associated with utricle and saccule degeneration. The aim of the present study is to assess the frequency of VEMP abnormalities using vestibular evoked myogenic potentials in individuals with Posterior canal Benign Paroxysmal Positional Vertigo (BPPV) after Epley's manoeuvre. 36 individuals (36 ears) with definite posterior canal BPPV and 36 healthy controls were considered for the present study. All the them underwent otoscopic examination, Dix-Hallpike manoeuvre to diagnose posterior canal BPPV. Further Audiological Evaluation including pure tone audiometry was carried out to rule out vestibular disorders associated with hearing loss. Epley's manoeuvre was performed on all individuals with BPPV by an experienced otorhinolaryngologist. Cervical and Ocular Vestibular Evoked Myogenic Potentials (VEMP) were used to investigate the saccule and utricle functions following Epley's manoeuvre. Cervical VEMP and ocular VEMP abnormalities were observed in 8/36 (22.22%) and 18/36 (50%) affected ears with BPPV respectively. Cervical VEMP responses were reduced in amplitude among 1/36 (2.77%) and absent in 7/36 (19.44%) of affected ears with BPPV. Ocular VEMP responses were reduced in amplitude on 11/36 (30.55%), followed by absent responses in 5/36 (13.88%) ears with BPPV. Two patients with posterior canal BPPV i.e., 4/64 (5.55%) ears had bilateral absence of ocular VEMP responses. Two ears with BPPV 2/36 (5.55%) had absence of both cervical and ocular VEMP responses in BPPV affected ear. T test showed significant difference (p < 0.01) in the amplitude of ocular VEMP among posterior canal BPPV individuals when compared to cervical VEMP. The present study highlights individuals with Posterior canal BPPV may have otoconia dislodgement or macular degeneration of utricle, saccule, both utricle and saccule unilaterally, or bilaterally. VEMP may be useful in evaluating degeneration of both otolith organs associated with BPPV.

A systems biological approach reveals multiple crosstalk mechanism between gram-positive and negative bacterial infections: an insight into core mechanism and unique molecular signatures.

BACKGROUND: Bacterial infections remain a major threat and a leading cause of death worldwide. Most of the bacterial infections are caused by gram-positive and negative bacteria, which are recognized by Toll-like receptor (TLR) 2 and 4, respectively. Activation of these TLRs initiates multiple pathways that subsequently lead to effective immune response. Although, both the TLRs share common signaling mechanism yet they may exhibit specificity as well, resulting in the release of diverse range of inflammatory mediators which could be used as candidate biomolecules for bacterial infections. RESULTS: We adopted systems biological approach to identify signaling pathways mediated by TLRs to determine candidate molecules associated with bacterial infections. We used bioinformatics concepts, including literature mining to construct protein-protein interaction network, prioritization of TLRs specific nodes using microarray data and pathway analysis. Our constructed PPI network for TLR 2 (nodes: 4091 and edges: 66068) and TLR 4 (node: 4076 and edges: 67898) showed 3207 common nodes, indicating that both the TLRs might share similar signaling events that are attributed to cell migration, MAPK pathway and several inflammatory cascades. Our results propose the potential collaboration between the shared signaling pathways of both the receptors may enhance the immune response against invading pathogens. Further, to identify candidate molecules, the TLRs specific nodes were prioritized using microarray differential expressed genes. Of the top prioritized TLR 2 molecules, 70% were co-expressed. A similar trend was also observed within TLR 4 nodes. Further, most of these molecules were preferentially found in blood plasma for feasible diagnosis. CONCLUSIONS: The analysis reveals the common and unique mechanism regulated by both the TLRs that provide a broad perspective of signaling events in bacterial infections. Further, the identified candidate biomolecules could potentially aid future research efforts concerning the possibility in differential diagnosis of gram-positive and negative bacterial infections.

Bilateral fusion of mandibular second premolar and supernumerary tooth: A rare case report.

Fusion is the union of two normally separated tooth germs resulting in the formation of a single large tooth. The prevalence of this anomaly is less than 1% and most common in the primary dentition, in the incisor-canine region. Fusions are almost always unilateral, but few cases of bilateral fusions have been reported. The purpose of this article is to report a rare case of bilateral fusion of mandibular second premolar with supernumerary tooth.