Nano-gel formulation of polyphenolic fraction of tobacco stem for wound healing and its inhibitory efficacies against the receptors of chronic wound development.

Current investigation deals with the gel formulation of purified polyphenol loaded nanoparticles for enhanced wound healing. Polyphenols purified using column chromatography an were characterized using HPLC in fractions. Silver nanoparticles were characterization using SEM, AFM, TEM, DLS. Cytotoxic effect was checked on L929 (Mouse fibroblast cells). Bioactive loaded nanoparticles were formulated in gel and subjected for physical characterization. Excision wound wistar rat models were established to measure the wound contraction measurement, histopathological studies, and biochemical assays. Docking and Simulation studies were performed to check the binding and stability with receptors progressing the chronic wound. From the column chromatography, B fraction has shown the presence of maximum polyphenolic content and as well as the polyphenol compounds such as quercetin, rutin and tannic acid as confirmed by the HPLC. Synthesize B fraction-AgNP were found to be below 100 nm in size and spherical in shape as per the characterization. No cytotoxic effect was observed on L929 cells treated with B fraction and its nanoparticles. Formulated B fraction-AgNP gel has revealed the better stability and earlier wound contraction, i.e. before the completion of 14 days of topical treatment. Histopathology studies and collagen content has confirmed the re-epithelization in skin wounds. MD simulation revealed the stability with PI3K and AKT. This can be concluded that tobacco stem polyphenol loaded nanoparticles has potent wound healing activity that can be utilized as nano-drug delivery system for suppression of chronic wound development.Communicated by Ramaswamy H. Sarma.

Incredible Combination of Lifestyle Modification and Herbal Remedies for Polycystic Ovarian Syndrome Management.

A relatively frequent endocrine-metabolic illness called polycystic ovarian syndrome (PCOS) is characterized by polycystic ovaries, persistent anovulation, and hyperandrogenism, which cause symptoms such as irregular menstruation, infertility, and hirsutism. PCOS is linked to obesity, insulin resistance, and increased amounts of androgens, or male hormones. The sedentary lifestyle, dietary fluctuations, inactivity, and stress are other contributing variables. According to estimates from India in 2021, around 22.5% of women, or one in five Indian women, suffer from PCOS. Evidence-based medical care for PCOS places a strong focus on a multidisciplinary approach, as standard pharmacological treatment frequently targets a single symptom, may be contraindicated, has adverse effects, and is ineffective in certain circumstances. However, long-term treatments have drawbacks and are likely to be ineffective, making complementary and alternative therapies a worthwhile choice. Yoga science is a thorough treatment plan for a healthy body and mind that may eradicate PCOS's primary causes, stress and obesity. Some common herbal remedies, including Foeniculum vulgare, Tinospora cordifolia, Asparagus racemosus, Ocimum tenuiflorum, Areca catechu, and Lepidium meyenii, have been highly regarded sources that have the benefits of lowering PCOS as well as having hypoglycemic and antiobesity effects. In light of existing literature, women with PCOS experienced symptomatic relief, improvement in hormonal balance, and the quality of life by utilizing yoga practices as well as herbal remedies. In conclusion, combining lifestyle modifications with herbal remedies can be used in the management of PCOS as a holistic approach. Therefore, this review opens a new window for researchers all across the world to validate such findings.

Local Random Pattern and Axial Flaps for Reconstruction of Nasal Surgical Defects: Retrospective Analysis with an Attempt to Inspire ENT Surgeons.

Aim: Reconstruction of the surgical defects of the external nose has been challenging and largely considered to be the domain of plastic reconstructive surgeons. The present study aims to share our experience in reconstructing such defects. Materials and methods: A retrospective analysis of 11 patients who underwent external nasal reconstruction secondary to surgical defect at our otolaryngology department in a tertiary care hospital from 2017 to 2019 was done. All the patients underwent surgical excision of a part of the external nasal dorsum followed by reconstruction by our team of otolaryngology surgeons using local random pattern/ axial flaps. The patients were followed up postoperatively for a period ranging from 3 months (for benign pathologies) to 2 years (malignant pathologies). Results: The flaps were taken up in all the patients. Minor complications like postoperative infection were seen in 2 cases, resulting in wound dehiscence in one that required resuturing that was uneventful. The appearance was bulky in all the patients, although the patients were satisfied with the overall cosmetic appearance. The average hospital stay was 2 to 4 days. Conclusion: Reconstruction of external nasal surgical defects is a challenging task. Thorough knowledge of relevant anatomy, proper planning, and availability of abundant vascularized donor tissue in the near vicinity of the defect makes this challenge acceptable with good outcomes even in the hands of otolaryngologists.

Access to Pterygopalatine and Infratemporal Fossa Region by Newer Maxillary Suprastracture Swing Technique: A Report of Two Cases.

Surgical access to pterygopalatine and infratemporal fossa has always been important for head and neck surgeons to deal with various benign and malignant tumours. Technical advancements leading to advent of microdebrider, coblation instruments and endoscopes, have proved helpful in gaining access to these complex anatomical areas, by way of endoscopic endonasal approaches but availability of instruments and learning curve remains a limiting factor. Thus older open surgical techniques like maxillary swing, Le Fort osteotomies and midfacial degloving still holds their importance in providing direct open access to these areas. We share our experience of the newer maxillary suprastracture swing technique in gaining direct open surgical access to these anatomical regions for two different cases i.e. neurofibroma located in infratemporal fossa and JNA involving both pterygopalatine and infratemporal fossa.

Trans-septal Suturing Versus Merocel Nasal Packing: A Post Septoplasty Comparison.

It has been observed that nasal packing following septoplasty contributes to co-morbidities like post-operative pain, bleeding and increased duration of hospital stay. Trans-septal suturing has been suggested as a safe and effective alternative with a view to obviate the need for nasal packing and the hence avoid the discomfort associated with it. To compare the outcome of trans-septal suturing technique with merocel nasal packing after septoplasty. This was a prospective comparative study done on 60 patients who underwent septoplasty. The patients were divided randomly into 2 groups, while Group A comprised of patients undergoing Post-operative nasal packing with poly vinyl alcohol sponge (also commercially called Merocel), Group B included patients who underwent nasal septal suturing after surgery. The postoperative pain, hemorrhage and duration of hospital stay were the main parameters that were assessed and a comparison was drawn between the post-operative outcome of two techniques. Post-operative global pain score was 62.18 ± 4.75 in the group A (patients with nasal packing) and 24.73 ± 4.29 (patients with trans-septal suturing) in group B ('p'value was < 0.0001). Post-operative bleeding was noticed in 19 patients (out of 30) in group A, and in 2 patients of group B ('p'value was < 0.0001). 27 out of 30 patients of Group A were discharged on day 2 whereas 24 out of 30 patients of Group B required only 1 day of hospital stay after the surgery ('p' value was < 0.0001). Trans-septal suturing technique reduces the duration of hospital stay, causes lesser post-operative bleeding and pain and is a relatively less painful technique than merocel nasal packing.

Deep Neck Space Infections: Current Trends and Intricacies of Management?

This study aims to describe the current epidemiological and etiological trends for deep neck space infections (DNIs) with an objective to understand the intricacies of their management. In this retrospective analytical study records of 52 patients with DNIs were reviewed. Patients having superficial abscess, peritonsillar abscess and abscess due to trauma/surgical procedure were excluded. Various epidemiological and etiological parameters (Demography, site, presentation, etiology, association with co-morbidities, bacteriology) and management guidelines (need for surgical interventions for DNIs and airway management, hospital stay duration, treatment outcome and complications) were reviewed and analyzed. Study recorded preponderance of DNIs in males (male:female = 1.6:1) and in younger generation (50% of patients presenting in first 2 decades). Commonest etiology being odontogenic infections (38.46%) followed by URTIs and tonsillopharyngitis (19.23%). Submandibular space involvement was noted in 42.3% cases followed by parapharyngeal space involvement in 21.15%. Nearly 55% cases of submandibular space involvement were because of odontogenic causes. 69.23% culture specimens reported no growth. 61.53% patients were diagnosed with anaemia. Up to 80% required open surgical drainage. All received broad spectrum antibiotics as a starting regime. No severe complications were recorded. Understanding the current epidemiological and etiological trends can help in early and definitive diagnosis of DNIs. Empirical starting treatment regime including broad spectrum antibiotics (till sensitivity pattern is availed) and maintaining low threshold for required surgical intervention are required to manage DNIs satisfactorily. Selected cases should be given conservative trials with close monitoring.

Added-Value of Diffusion-Weighted Imaging (DWI) and Dynamic Contrast-Enhanced (DCE-MRI) Magnetic Resonance Imaging in the Preoperative Assessment of Cervical Cancer.

Purpose: To evaluate the added-value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the preoperative assessment of carcinoma cervix. Methods: This prospective study was carried out on histopathologically proven 45 patients of carcinoma cervix presented to a tertiary care hospital with bleeding per vagina between August 2017 and July 2018. Relevant local per vaginal examination and MRI examination of the pelvis were performed. Results: A total of 45 patients with carcinoma of the cervix, having 11 patients (24.4%) in Stage-I, 22 patients (48.9%) in Stage-II, 3 patients (6.7%) in Stage-III and 9 patients (20%) in stage-IV, were included in this study sample. The mean ADC value of the carcinoma of cervix was 0.802 ± 0.123 [SD] × 10-3 mm2/s. The stage-I carcinoma cervix had a mean ADC value of 0.915 ± 0.109 [SD] × 10-3 mm2/s, Stage-II 0.778 ± 0.099 [SD] × 10-3 mm2/s, Stage-III 0.762 ± 0.123 [SD] × 10-3 mm2/s and Stage-IV 0.737 ± 0.116 [SD] × 10-3 mm2/s. ROC curve analysis showed the percentage of signal intensity changes within cervical tumor on arterial phase of DCE-MRI had a threshold value of 42.25 in differentiating Stage-I carcinoma of cervix from other stages with a sensitivity of 81.8% and specificity of 44.1%. Conclusion: The DWI and DCE-MRI added valuable inputs over conventional MR sequences in the early diagnosis and preoperative staging of carcinoma cervix. DCE-MRI had a high accuracy for assessing the cervical stromal and parametrial invasions, which helps in selecting the optimal therapeutic protocol and prognostication in gynecological malignancies.

Rhino-Orbito-Cerebral Mucormycosis During the Second Wave of Covid-19: The Indian Scenario.

Mucormycosis is a life threatening, opportunistic infection often seen in individuals with a weak immune system. With an upsurge of cases of Covid-19, a drastic increase in cases of Rhino-Orbito-Cerebral Mucormycosis is being witnessed at present. This article has been written with the purpose of understanding the factors responsible for it and the challenges it brings along for the Indian health-care system at present. Possible solutions for dealing with these problems have also been included in the manuscript. Google, PubMed and ENT Cochrane databases were searched without a time limit using key words like "Mucormycosis", "Rhino-cerebral-mucormycosis" in conjunction with "COVID-19" and "SARS CoV-2". We found 34 articles to be relevant and hence included them to write this review. Rhino-Orbito-Cerebral Mucormycosis is being seen due to coming together of the three entities-the agent, host and environment that constitute the epidemiological triad for this disease in India. Responsible factors are uncontrolled diabetes mellitus, overzealous use of steroids and antibiotics and other environment related issues. The solutions for these problems lie in spreading awareness about prevention of these practices along with early diagnosis and treatment of mucormycosis. To deal effectively with this situation, particularly when there is an existing overload on otolaryngologists and the rest of the health-care system, a multipronged and multilevel collaborative approach is the need of the hour. With effective Standard Operating Procedures and guidelines promoting a multidisciplinary approach for early diagnosis and treatment, we can surely overcome this situation.

Covid-19 and Ear Surgery: Treatment Strategies and Triage during the Post-lockdown Period.

The accumulated disease burden during lockdown period, due to postponement of regular surgeries, is expected to put additional pressure on surgeons during the post-lockdown period. Due to the contagious nature of SARS-CoV-2 and its suspected presence in middle ear mucosa and mastoid, Ear surgeons are bound to face a challenging situation in present times as well as in times to come. Through this article we aim to streamline fresh management strategies particularly for the post-lockdown period keeping in mind that immunity after vaccination may take a few months to develop due to various factors discussed in the article. The ENT Cochrane, Pubmed and Web of Science databases were searched extensively using the terms 'Covid-19 and SARS-CoV-2 in conjunction with Ear surgery and Otology. Data collected from these, put together with our experience helped us in putting forward fresh management strategies to deal with the current situation being experienced worldwide. To reduce the risk of infection to the healthcare staff, we have suggested a new triage strategy for ear surgeries to reduce the accumulated disease burden in the post-lockdown period until immunity by vaccination develops amongst a good number of Ear surgeons. Also we have put forward certain operating guidelines that might prove helpful for the Ear surgeon during these times. Fresh Triage guidelines mentioned in this article are particularly meant to help ear surgeons reduce the accumulated disease burden in the post lockdown-period with ease and efficacy. Since ear surgery poses a risk of infection to the healthcare workers, specific guidelines pertaining to ear surgery during the pandemic are mentioned in detail which in our opinion can be of immense help to all the healthcare professionals involved in ear procedures till the time the vaccine is administered on a large scale.

Preclinical assessment of stem of Nicotiana tabacum on excision wound model.

Agro-waste material derived from N. tabacum has shown enormous potential antioxidant and antimicrobial activity. Hence in the present study, we investigated the wound healing efficacy of ethanolic extract of stem of Nicotiana tabacum on wistar rat model. Ethanolic extract prepared from defatted stem was to check various phytochemicals using spectrophotometric and chromatographic technique. The antioxidant potential was determined by FRAP and Reducing Power assay in extract. Cytotoxicity of extracts was determined using mouse fibroblast L929 cell lines by MTT assay. In vivo angiogenic activity was observed on chick chorioallantoic membrane (CAM) model by observing blood vessels formation and its branching. In vivo wound healing activity was observed on excision wounds in rat model by quantifying percentage of wound contraction, antioxidant activity and histopathology studies. From the present study, polyphenols, tannins and alkaloids were found to be determined in the ethanolic extract by means of spectrophotometric and chromatographic analysis against standards. Antioxidant assay revealed maximum antioxidant potential in ethanolic extract. Cytotoxic effect of extract has not been shown on L929 cell line. From CAM model, extract has shown growth of blood vessels formation at concentration of 480 µg/ml. Topical application of extracts on excision wounds, revealed wound healing activity i.e. 98.7% ± 0.002 on 14th day as well as enzymatic activity (SOD, CAT, GST) and non enzyme content (GSH and Lipid peroxidation) has been found to be high in granulated tissue. Hisopathological studies confirmed the re-epithelization in skin wounds. It can be concluded that stem of N. tabacum can be used as herbal remedy in wound healing process as a topical application.

Robotic Surgery in Otolaryngology During the Covid-19 Pandemic: A Safer Approach?

The COVID-19 outbreak was announced a pandemic by the World Health Organization in March 2020. The contagious nature of this virus to spread through droplets, puts the ENT surgeon at an added risk of exposure and infection, particularly while performing various aerosol generating procedures of the oral cavity and upper airway. While it is being recommended worldwide to postpone all elective surgeries to a later date, certain emergency procedures must be undertaken promptly but in a manner that minimizes the exposure of the surgeon and health care staff to the SARS-CoV-2. This article is meant to provide an insight into the possible role of robotic surgery in Otolaryngology and Head and Neck during the Covid-19 pandemic along with providing a brief review of its pros and cons.

COVID-19 and ENT surgery: a brief review of essential precautions and triage.

PURPOSE: This study is a brief review of the existing knowledge on the ENT surgeon's approach towards management of patients during the COVID-19 pandemic. While it is being recommended to carry out only the emergent procedures and to postpone the non-urgent ones to a later date, this article is meant to provide an insight into triage of the ENT procedures and the various precautions to be taken into account by the ENT surgeons while carrying out a procedure during the COVID-19 pandemic. METHODS: The ENT Cochrane, Pubmed and Web of Science databases were searched without a time limit using the terms 'COVID-19 and SARS-CoV-2 in conjunction with ENT surgery. RESULTS: Elective and non urgent cases are best avoided during this time. Only absolutely essential and emergent procedures need to be carried out with the use of Personal protective equipment comprising of safety gown, N95 mask, safety goggles, disposable gloves and caps. There is a possibility of transmission of the SARS- CoV-2 through asymptomatic patients and hence all patients, even with an unknown COVID-19 status, need to undergo a preoperative screening. As all procedures under general anesthesia are aerosol generating, the use of Personal protective equipment (PPE) is recommended for all the health care workers present in the operation theater. CONCLUSION: A proper knowledge of triage would be of immense help to the ENT surgeon in minimizing the exposure to health care workers and patients during this pandemic. All patients with an unknown COVID-19 status should be considered suspects and essential precautions for their management be taken accordingly.

Acceleration of Wound Healing in Diabetic Rats through Poly Dimethylaminoethyl Acrylate-Hyaluronic Acid Polymeric Hydrogel Impregnated with a Didymocarpus pedicellatus Plant Extract.

Wound is the major health problem associated with skin damages and arises because of various types of topical injuries. Furthermore, wounds in patients with diabetes take a relatively long time to heal. Currently, herbal medicines have been extensively used for wound care and management. Here, we engineered polymeric hybrid hydrogel of dimethylaminoethyl acrylate and hyaluronic acid (pDMAEMA-HA), which was impregnated with a herbal extract of Didymocarpus pedicellatus. The developed polymeric hybrid hydrogel system can be used for effective therapy of incurable wounds. Therefore, the development of D. pedicellatus-impregnated pDMAEMA-HA (pDPi-DMAEMA-HA) hybrid hydrogel was accomplished by the synthesis of pDMAEMA-HA hydrogel via the optimization of various reaction parameters followed by impregnation of herbal drugs D. pedicellatus. The developed hydrogel composite was well characterized via various techniques, and swelling kinetics was performed to analyze the water uptake property. The swelling ratio was found to be 1600% in both types of hydrogels. To evaluate the wound healing of these polymeric hydrogels, the Wistar rats full-thickness excision wound model was utilized. The healing strength of hydrogels was determined using measurement of wound contraction and histopathological study. The results of wound healing by these polymeric hydrogels revealed that animals treated with the pDPi-DMAEMA-HA hybrid hydrogel group were found to have a higher level of wound closure as compared to marketed formulation as well as polymeric hybrid hydrogel. The histopathologic examinations implied that pDPi-DMAEMA-HA hybrid hydrogel and polymeric hybrid hydrogel-treated groups exhibited enhanced cutaneous wound repair as well as high level of cellular repair and maintenance compared to the standard group because of hyaluronic acid roles in various stages of wound repair.

Burden of influenza-associated respiratory and circulatory mortality in India, 2010-2013.

BACKGROUND: Influenza causes substantial morbidity and mortality worldwide, however, reliable burden estimates from developing countries are limited, including India. We aimed to quantify influenza-associated mortality for India utilizing 2010-2013 nationally representative data sources for influenza virus circulation and deaths. METHODS: Virological data were obtained from the influenza surveillance network of 10 laboratories led by National Institute of Virology, Pune covering eight states from 2010-2013. Death data were obtained from the nationally representative Sample Registration System for the same time period. Generalized linear regression with negative binomial distribution was used to model weekly respiratory and circulatory deaths by age group and proportion of specimens positive for influenza by subtype; excess deaths above the seasonal baseline were taken as an estimate of influenza-associated mortality counts and rates. Annual excess death rates and the 2011 India Census data were used to estimate national influenza-associated deaths. RESULTS: Estimated annual influenza-associated respiratory mortality rates were highest for those ≥65 years (51.1, 95% confidence interval (CI) = 9.2-93.0 deaths/100 000 population) followed by those <5 years (9.8, 95% CI = 0-21.8/100 000). Influenza-associated circulatory death rates were also higher among those ≥65 years (71.8, 95% CI = 7.9-135.8/100 000) as compared to those aged <65 years (1.9, 95% CI = 0-4.6/100 000). Across all age groups, a mean of 127 092 (95% CI = 64 046-190,139) annual influenza-associated respiratory and circulatory deaths may occur in India. CONCLUSIONS: Estimated influenza-associated mortality in India was high among children <5 years and adults ≥65 years. These estimates may inform strategies for influenza prevention and control in India, such as possible vaccine introduction.

Reactive oxygen species in periodontitis.

Recent epidemiological studies reveal that more than two-third of the world's population suffers from one of the chronic forms of periodontal disease. The primary etiological agent of this inflammatory disease is a polymicrobial complex, predominantly Gram negative anaerobic or facultative bacteria within the sub-gingival biofilm. These bacterial species initiate the production of various cytokines such as interleukin-8 and TNF-α, further causing an increase in number and activity of polymorphonucleocytes (PMN) along with these cytokines, PMNs also produce reactive oxygen species (ROS) superoxide via the respiratory burst mechanism as the part of the defence response to infection. ROS just like the interleukins have deleterious effects on tissue cells when produced in excess. To counter the harmful effects of ROS, human body has its own defence mechanisms to eliminate them as soon as they are formed. The aim of this review is to focus on the role of different free radicals, ROS, and antioxidants in the pathophysiology of periodontal tissue destruction.

Ellis-van Creveld syndrome: A rare clinical entity.

Ellis-van Creveld (EVC) syndrome is a genetic disorder with autosomal recessive transmission, which may clinically present as small stature, short limbs, fine sparse hair, hypoplastic fingernails, multiple musculofibrous frenula, conical teeth, hypoplasia of the enamel, hypodontia, and malocclusion. Heart defects, especially abnormalities of atrial septation, have been found in about 60% of cases. The mutation in EVC and EVC2 gene is responsible for this syndrome. The presence of multiple orodental findings makes this syndrome important for dentists. The aim of this article is to present a rare case of EVC syndrome in a 10-year-old girl along with the review of literature.