Status and Depth of Mastoid Antrum and the Pattern of Mastoid Pneumatization in Cases of Large, Subtotal Perforations and Posterosuperior Retraction Pockets (PSRP).

The present study aimed to evaluate the pneumatization status of the mastoid air cells in general with the depth and status of mastoid antrum in particular, in patients of chronic otitis media (COM). This is an observational cross-sectional study in sample size of 60 participants with large, subtotal perforation and posterosuperior retraction pocket (PSRP). Mean age with large central and subtotal perforation combined was 35.78 years, compared to 32.13 years in PSRP. Granulations seen in antrum in 71.6% and cholesteatoma observed in 15%. Mean depth of the mastoid antrum was 17.27 mm. A well pneumatized mastoid in 21.6%, diploic 28.3% and sclerotic in 50% was noted in this study. Chronic otitis media affects temporal bone pneumatization, particularly the mastoid antrum. Our findings indicate that the depth of the mastoid antrum is slightly greater in cholesteatoma cases due to bone erosion. As early intervention enhances postoperative quality of life by preserving or restoring auditory function, understanding the mastoid pneumatization and antrum depth is crucial for managing chronic otitis media effectively.

Effective Treatments for Abductor Vocal Cord Paralysis: A Comprehensive Review.

Abductor vocal cord paralysis (AVCP) is a disabling disorder that affects the voice and the quality of life of a patient, and hence, there is importance in providing a detailed knowledge of its aetiology and management. In this review article, we offer an implicational definition of AVCP and a discussion of its background, viewed as potentially affecting voice production and health. Finally, we explore modalities of diagnosis by medical history and physical examination, visualization techniques like laryngoscopy and stroboscopy, and radiographic imaging such as computed tomography (CT) and magnetic resonance imaging (MRI) scans. The article reviews and categorizes approaches into operative and non-operative treatments, including injection laryngoplasty, voice therapy, botulinum toxin injections, and the management of Reinke's edema. Surgical approaches, like arytenoid adduction, cordotomy, and posterior cordotomy, are also scrutinized taking their indication, efficacy, and complication profile into consideration. Learning about the advantages and drawbacks of the following experimental yet promising directions like nerve-muscle pedicle implantation, nerve reinnervation, and engineering of tissues is therefore highly necessitated. In conclusion, the review details the measures that have shown to be useful in the treatment process and their impact on the future practice of clinical work, calling for a more clarified structure of the organization of diagnostic, therapeutic, and rehabilitative activities. Future research directions are outlined based on the gaps which include the development of new treatment approaches, the evaluation of treatment for long-term effects, and the need for interdisciplinary cooperation in the medical field for the benefit of the patients.

Identification and Validation of Biomarkers to Predict Early Diagnosis of Inflammatory Bowel Disease and Its Progression to Colorectal Cancer.

Inflammatory bowel disease (IBD) has become a common global health problem as prevalence continues to rise. It is often associated with increased risk of colorectal cancer (CRC) development. Limitations in current IBD biomarker-based diagnosis hinder the accuracy of early detection of CRC progression. Therefore, in this study, we proposed the use of transcription factor (TF)-based biomarkers that can potentially detect the transition of IBD to CRC. Various bioinformatic analysis and online database validations, and RT-qPCR validations were performed to identify possible diagnostic TFs. RUNX1 was identified as a promising TF that regulates 106 IBD/CRC-related genes. The incorporation of RUNX1 in combination with currently known IBD biomarkers, FEV + NFKB1 + RELA, achieved a comparable sensitivity and specificity scores of 99% and 87%, respectively, while RUNX1 in combination with known CRC markers, CEA + TIMP1 + CA724 + CA199, achieved a sensitivity and specificity score of 97% and 99%, respectively. Furthermore, a small pilot RT-qPCR-based analysis confirmed a demarcated shift in expression profiles in CA724, CEA, RUNX1 and TIMP1 in IBD patients compared to CRC patients' tissue samples. Specifically, CA724 is noticeably elevated in IBD, while the levels of CEA, RUNX1 with TIMP1 are probable genes that may be employed in discerning IBD progression to CRC. Therefore, these preliminary results once validated in large patient cohorts could potentially have a significant impact on CRC disease stratification, resulting in a more precise prediction for treatment and treatment outcomes, especially in South African patients.

A Case Report of Neurofibroma of the Tongue Presented as a Solitary Lesion.

Neurofibroma are rare occurrences in the oral cavity with the tongue as the most common location in the oral cavity being affected by neurofibroma. Neurofibroma are usually asymptomatic, irregular tissue masses of benign nature with a small rate of malignant conversion. Recurrence rates are also low in the neurofibromas of the oral cavity. It is rare in India with only a few cases reported to date. Hence, we report this case of a 63-year-old female with a tissue mass present on the right side of her tongue for the last five years, with a progressive nature. The mass was associated with pain during chewing food for the last three months. She was managed by a wide local incision and was reported well recovering at a three-month follow-up.

Angiosarcoma of the Maxillary Sinus: A Case Report.

Angiosarcoma can be defined as a malignant neoplasm arising from the lining of the blood and lymphatic vessels, including the endothelial cells. It can occur in any body part, such as blood vessels, skin, liver, and breast. Its incidence varies based on the site. There are different underlying etiologies associated with the incidence of angiosarcoma. Clinical presentation depends on the site of origin. Angiosarcoma of the sinus or nasal openings can be observed as a tissue mass, lesions, obstructed nasal cavity, facial swelling, proptosis, anosmia, nasal discharge, and epistaxis. These are rare malignancies with very low incidence. Though it has been reported in all age groups, it is more common in adults in their sixth decade and more. Nasal angiosarcoma can be a diagnostic challenge due to its rarity. This is a case of a 56-year-old female with a major complaint of nasal obstruction and face swelling for two months. Physical examination revealed a pinkish polypoidal mass. A contrast-enhanced computed tomography scan showed a heterogeneously arterial enhancing soft-tissue lesion in the left maxillary sinus with significant erosive changes. Histopathological analysis revealed a malignant spindle cell tumor, which was confirmed by a CD34 immunohistology stain. The patient was advised surgical excision for further management, which was denied. The patient is undergoing radiation therapy and is on third cycle as per the last follow-up.

A Comprehensive Review Exploring Allergic Rhinitis With Nasal Polyps: Mechanisms, Management, and Emerging Therapies.

Allergic rhinitis (AR) and nasal polyps (NP) are common inflammatory disorders of the upper airways that often coexist and significantly impact patients' quality of life. This comprehensive review explores the intricate relationship between AR and NP, elucidating the underlying mechanisms, clinical manifestations, and management strategies. Immunological mechanisms, genetic predispositions, and environmental factors contribute to the development and progression of both conditions. Pharmacological therapies, including intranasal corticosteroids and biologic agents, are cornerstone treatments for managing AR with NP. At the same time, surgical interventions such as functional endoscopic sinus surgery (FESS) may be necessary in refractory cases. Emerging therapies, including immunomodulatory agents and precision medicine approaches, hold promise in improving treatment outcomes. A multidisciplinary approach, personalized treatment plans, and patient education are essential for optimizing clinical practice. Future research should focus on identifying novel therapeutic targets, conducting large-scale clinical trials, exploring precision medicine approaches, and investigating the role of the microbiome. Addressing these research priorities and implementing evidence-based treatment strategies can improve outcomes for patients with AR and NP.

Enhancing wheat production and quality in alkaline soil: a study on the effectiveness of foliar and soil applied zinc.

Cultivation of high-yield varieties and unbalanced fertilization have induced micronutrient deficiency in soils worldwide. Zinc (Zn) is an essential nutrient for plant growth and its deficiency is most common in alkaline and calcareous soils. Therefore, this study aimed to evaluate the effect of Zn applied either alone or in combination with foliar application on the quality and production of wheat grown in alkaline soils. Zn was applied in the form of zinc sulfate (ZnSo4) to the soil and as a foliar spray during the sowing and tillering stages, respectively. Results showed that Zn fertilization of wheat, irrespective of modes of application, significantly increased grain and biological yield, grain per spike, and 1,000 grains weight over control; however, its effect was more noticeable when applied as 7.5 kg ha-1 of soil Zn combined with foliar Zn at 2.5 kg ha-1. Zn application significantly increased the grain protein content from 9.40% in the control to a maximum of 11.83% at soil Zn of 10 kg ha-1. Similarly, Zn application improved Zn, phosphorus (P), and potassium (K) concentrations in wheat grains. Moreover, correlation analysis showed that the grain Zn concentration was positively correlated with the grain P concentration. The correlation between P concentration in wheat grains and 1,000 grain weight was not significant. A total of 1,000 grains weight was positively correlated with tillers per plant, grain yield, and biological yield. There were positive correlations between protein content, biological yield, grain yield, and tillers per plant. Therefore, soil-applied Zn + foliar application in alkaline soils with limited Zn availability is crucial for improving wheat yield and grain quality.

Implementation of a Bleeding Risk Screening Tool and Hematology Referral Process Prior to Pediatric Endoscopy.

OBJECTIVES: Gastrointestinal (GI) endoscopic procedures are considered low risk with an overall bleeding risk for upper and lower endoscopies of 0.11%. However, a certain population of patients may have a higher risk for bleeding, and there is not a standardized process for screening patients to determine who these patients are. METHODS: At Children's Wisconsin, our gastroenterology and hematology divisions adapted an abbreviated version of a validated, history-based bleeding risk screening tool and implemented a hematology referral process to identify those at risk for bleeding prior to their first endoscopy. Provider compliance with the bleeding screen, referral to hematology, time to be seen in hematology clinic, new diagnoses of bleeding disorders, and bleeding complications were assessed from 2019 to 2021 across 3 phases. RESULTS: Provider compliance with the bleeding screen improved throughout our study from 48% (120/251) to 75% (189/253). For those who screened positive, compliance with referral to hematology ranged from 38% to 74% across our phases. The overall time to be seen by hematology decreased from 30 days to 7.5 days. Eighteen patients ultimately screened positive and were seen in hematology clinic, of whom 22% (4/18) were diagnosed with a new bleeding disorder. No bleeding complications were seen in our study population. CONCLUSIONS: Our quality improvement project provided a standardized screening tool to assess preoperative bleeding risk and reinforced the value of a history-based screening tool. This modified screening tool identified those with an undiagnosed bleeding disorder and preventative measures were undertaken to prevent procedural bleeding complications.

Dengue beyond fever-fatal dengue myocarditis and complete heart block: A case report and brief overview of cardiac manifestations of dengue fever.

Dengue is an endemic viral fever transmitted by mosquitoes that may be asymptomatic or cause a nonspecific flu-like illness. The disease's most severe manifestations are dengue hemorrhagic fever and dengue shock syndrome. Various atypical manifestations have been observed that constitute the expanded dengue syndrome. Although uncommon, it is now known to cause cardiac complications that can be life-threatening and difficult to diagnose. We illustrate a case of a 16-year-old boy infected with dengue who experienced syncope, dizziness, and lethargy. His electrocardiogram showed third degree atrioventricular block which did not resolve with atropine and fluid resuscitation. After excluding all possible causes of complete heart block, transvenous pacing was done. A detailed workup was carried out that favored a diagnosis of subclinical myocarditis leading to complete heart block. The patient did not regain a normal rhythm and was considered for permanent pacemaker implantation. Myocarditis, pericarditis, rhythm disturbances, first- and second-degree atrioventricular blocks, and rarely third-degree heart blocks have been seen in dengue patients. However, a case of dengue illness associated complete heart blocks that is irreversible and necessitates a permanent pacemaker has never been described in the literature, and this is the first such case being reported. This article intends to increase clinicians' awareness, particularly those in dengue-endemic regions, about better recognition and comprehension of cardiac problems associated with dengue fever.

Vulvar vestibular papillomatosis: A diagnostic conundrum.

Vulvar vestibular papillomatosis (VP) is considered a normal anatomical variant of the vulva. We present a 19-year-old girl with a history of "small itchy growths" on the vulva for 2 months without any associated discharge. These lesions were causing significant anxiety to the patient. Cutaneous examination revealed multiple, uniformly arranged, skin-colored, monomorphic micropapillae on the inner aspect of the labia minora. Biopsy showed mucosal hyperplasia with papillomatosis and loosely arranged subdermal tissue, no koilocytes were spotted. The diagnosis of vulvar VP was made. We want to highlight this clinical entity as most dermatologists are not familiar with this benign condition and easily confuse it with genital warts. This inexperience may result in unnecessary investigations causing psychological discomfort to the patient. We herein present such a case which brings out the diagnostic dilemma.

Angiogenic footprints in diabetic retinopathy: opportunities for drug development.

Diabetic retinopathy is one of the withering disorders that has been making the lives of patients miserable. Arising as a result of chronic high blood sugar levels in diabetes patients, retinopathy has become a major reason causing permanent blindness, retinal detachment, vitreous humor, rage, or glaucoma among patients. Angiogenesis being the major culprit behind the development of this condition is the growth of new blood vessels from the earlier ones existing. The abnormal growth and poor development of blood vessels also lead to aggravation of the conditions, with vascular endothelial growth factor (VEGF) playing a major role in the process. Various anti-angiogenic therapies or anti-VEGF therapies are being explored for the treatment of this condition. 4 widely explored drugs being-Bevacizumab, pegaptanib sodium, ranibizumab, and aflibercept. The review article tries to summarize studies illustrating the efficacy of these drugs in the treatment of diabetic retinopathy along with some of the herbal therapeutic paradigms displaying anti-angiogenic action that is being used to treat this condition.

A Rare Case of Multidrug-Resistant Lupus Vulgaris with a Mixed Pattern of Resistance - A Long Journey to Diagnosis and Treatment.

An 18-year-old male presented with a single round to oval well-defined irregular erythematous plaque 10 cm × 6 cm, with a verrucous surface, central atrophy, and crusting at the periphery on the right knee of one-year duration. The patient had received ATT (anti-tubercular treatment) twice in the past without any improvement. MGIT (mycobacteria growth indicator tube) and CBNAAT (Cartridge-based nucleic acid amplification test) were performed, and drug sensitivity testing was done, which led to a diagnosis of multidrug resistance (MDR) with a mixed pattern. The management of cutaneous tuberculosis (TB) is becoming difficult due to an increase in resistance to category-I ATT. Patients harboring MDR and extensively drug-resistant (XDR) strains present a fearsome challenge for the clinician. A cure is possible with early identification of resistance and the use of an appropriate regimen.

Exploration of Site-Specific Drug Targeting-A Review on EPR-, Stimuli-, Chemical-, and Receptor-Based Approaches as Potential Drug Targeting Methods in Cancer Treatment.

Cancer has been one of the most dominant causes of mortality globally over the last few decades. In cancer treatment, the selective targeting of tumor cells is indispensable, making it a better replacement for conventional chemotherapies by diminishing their adverse side effects. While designing a drug to be delivered selectively in the target organ, the drug development scientists should focus on various factors such as the type of cancer they are dealing with according to which drug, targeting moieties, and pharmaceutical carriers should be targeted. All published articles have been collected regarding cancer and drug-targeting approaches from well reputed databases including MEDLINE, Embase, Cochrane Library, CENTRAL and ClinicalTrials.gov, Science Direct, PubMed, Scopus, Wiley, and Springer. The articles published between January 2010 and December 2020 were considered. Due to the existence of various mechanisms, it is challenging to choose which one is appropriate for a specific case. Moreover, a combination of more than one approach is often utilized to achieve optimal drug effects. In this review, we have summarized and highlighted central mechanisms of how the targeted drug delivery system works in the specific diseased microenvironment, along with the strategies to make an approach more effective. We have also included some pictorial illustrations to have a precise idea about different types of drug targeting. The core contribution of this work includes providing a cancer drug development scientist with a broad preliminary idea to choose the appropriate approach among the various targeted drug delivery mechanisms. Also, the study will contribute to improving anticancer treatment approaches by providing a pathway for lesser side effects observed in conventional chemotherapeutic techniques.

Diagnosis and treatment of flurbiprofen-induced Stevens-Johnson syndrome: A rare case report.

Our case highlights the occurrence of severe cutaneous adverse reactions with flurbiprofen use and alerts physicians to its odds with safer drugs.

Heterocyclic Compounds as Dipeptidyl Peptidase-IV Inhibitors with Special Emphasis on Oxadiazoles as Potent Anti-Diabetic Agents.

Dipeptidyl peptidase-IV (DPP-IV) inhibitors, often known as gliptins, have been used to treat type 2 diabetes mellitus (T2DM). They may be combined with other medications as an additional treatment or used alone as a monotherapy. In addition to insulin, sulfonylureas, thiazolidinediones, and metformin, these molecules appear as possible therapeutic options. Oxadiazole rings have been employed in numerous different ways during drug development efforts. It has been shown that including them in the pharmacophore increases the amount of ligand that may be bound. The exceptional hydrogen bond acceptor properties of oxadiazoles and the distinct hydrocarbon bonding potential of their regioisomers have been established. Beside their anti-diabetic effects, oxadiazoles display a wide range of pharmacological properties. In this study, we made the assumption that molecules containing oxadiazole rings may afford a different approach to the treatment of diabetes, not only for controlling glycemic levels but also for preventing atherosclerosis progression and other complications associated with diabetes. It was observed that oxadiazole fusion with benzothiazole, 5-(2,5,2-trifluoroethoxy) phenyl, ß-homophenylalanine, 2-methyl-2-{5-(4-chlorophenyl), diamine-bridged bis-coumarinyl, 5-aryl-2-(6'-nitrobenzofuran-2'-yl), nitrobenzofuran, and/or oxindole leads to potential anti-diabetic activity.

Application of Nano-Inspired Scaffolds-Based Biopolymer Hydrogel for Bone and Periodontal Tissue Regeneration.

This review's objectives are to provide an overview of the various kinds of biopolymer hydrogels that are currently used for bone tissue and periodontal tissue regeneration, to list the advantages and disadvantages of using them, to assess how well they might be used for nanoscale fabrication and biofunctionalization, and to describe their production processes and processes for functionalization with active biomolecules. They are applied in conjunction with other materials (such as microparticles (MPs) and nanoparticles (NPs)) and other novel techniques to replicate physiological bone generation more faithfully. Enhancing the biocompatibility of hydrogels created from blends of natural and synthetic biopolymers can result in the creation of the best scaffold match to the extracellular matrix (ECM) for bone and periodontal tissue regeneration. Additionally, adding various nanoparticles can increase the scaffold hydrogel stability and provide a number of biological effects. In this review, the research study of polysaccharide hydrogel as a scaffold will be critical in creating valuable materials for effective bone tissue regeneration, with a future impact predicted in repairing bone defects.

Recent Advances in Adsorptive Nanocomposite Membranes for Heavy Metals Ion Removal from Contaminated Water: A Comprehensive Review.

Water contamination is one of the most urgent concerns confronting the world today. Heavy metal poisoning of aquatic systems has piqued the interest of various researchers due to the high toxicity and carcinogenic consequences it has on living organisms. Due to their exceptional attributes such as strong reactivity, huge surface area, and outstanding mechanical properties, nanomaterials are being produced and employed in water treatment. In this review, recent advances in the use of nanomaterials in nanoadsorptive membrane systems for wastewater treatment and heavy metal removal are extensively discussed. These materials include carbon-based nanostructures, metal nanoparticles, metal oxide nanoparticles, nanocomposites, and layered double hydroxide-based compounds. Furthermore, the relevant properties of the nanostructures and the implications on their performance for water treatment and contamination removal are highlighted. The hydrophilicity, pore size, skin thickness, porosity, and surface roughness of these nanostructures can help the water permeability of the nanoadsorptive membrane. Other properties such as surface charge modification and mechanical strength can improve the metal adsorption effectiveness of nanoadsorptive membranes during wastewater treatment. Various nanocomposite membrane fabrication techniques are also reviewed. This study is important because it gives important information on the roles of nanomaterials and nanostructures in heavy metal removal and wastewater treatment.

Drug-Loaded Chitosan Scaffolds for Periodontal Tissue Regeneration.

Chitosan is a natural anionic polysaccharide with a changeable architecture and an abundance of functional groups; in addition, it can be converted into various shapes and sizes, making it appropriate for a variety of applications. This article examined and summarized current developments in chitosan-based materials, with a focus on the modification of chitosan, and presented an abundance of information about the fabrication and use of chitosan-derived products in periodontal regeneration. Numerous preparation and modification techniques for enhancing chitosan performance, as well as the uses of chitosan and its metabolites, were reviewed critically and discussed in depth in this study. Chitosan-based products may be formed into different shapes and sizes, considering fibers, nanostructures, gels, membranes, and hydrogels. Various drug-loaded chitosan devices were discussed regarding periodontal regeneration.

Pneumatization Pattern and Status of the Mastoid Antrum in Chronic Otitis Media: A Review.

Chronic otitis media is generally more prevalent in individuals with a weakly pneumatized temporal bone, whereas acute otitis media has a propensity for pneumatized temporal bone. Antimicrobial drugs are thought to have influenced the incidence and progression of middle ear infections. The mastoid air cell system, a part of the middle ear cleft, has recently been recognized as a crucial factor in the genesis, behaviour, course, and outcome of middle ear inflammatory conditions. Epithelium infiltrates the growing bone and produces epithelium-lined air cell chambers, a process known as pneumatization. Conventional temporal bone radiography, i.e. X-ray mastoid, has not kept up with recent otology breakthroughs. Detailed visualization of the aural structures has advanced significantly with the introduction of high-resolution computed tomography (HRCT). HRCT has a clear edge in the assessment of the temporal bone, especially when thin-section, high-resolution methods are used, resulting in a more precise description of the pneumatization pattern and the anatomical extent of middle ear pathology. Our results of the review indicated that persistent inflammation of the middle ear in children inhibits pneumatization of the temporal bone. Due to its potential to exert a greater negative middle ear pressure, the middle ear volume is insufficient to generate a retraction pocket; thus, the size and state of the antrum is also a significant factor in the establishment of a COM-like retraction pocket in inactive squamosal disease. Numerous factors, including the number of patients, regional, genetic, ethnic and hereditary characteristics, as well as the cellularity of the mastoid, which is impacted by a multitude of factors, may account for the variable reports and inter-study variation in this regard.

A Background Search on the Potential Role of Scutellaria and Its Essential Oils.

Scutellaria (Lamiaceae), which contains over 350 species, usually known as skullcaps, is found throughout Europe, the United States, and East Asia. In traditional Chinese medicine, several species are used to wipe out heat-evil and remove surface ills (TCM). The current study examines the ethnopharmacology, biological activity, and chemical substances associated with Scutellaria species. More than 295 chemicals, including flavonoids and diterpenes, have been identified. Scutellaria and its active principles have been shown in studies to have a wide range of pharmacological activities, including antioxidant, antimicrobial, antifeedant, phytotoxic, acaricidal toxicity, antibacterial, anti-inflammatory, and antianalgesic activities. Currently, effective monomeric compounds or active components from Scutellaria have been evaluated for pharmacological action in vivo and in vitro. More data facilitates applications and exploitation of novel medication development.