A Comparative Study Of Endoscopic And Microscopic Type-1 Tympanoplasty

Background:Chronicsuppurative otitis media tubotympanic type is a common pathology for which tympanoplasty is done. The decision to decide the approach for tympanoplasty de pends upon multiple factors like extent of disease, site and size of perforation, size of external auditory canal and surgeon’s own expertise and preference. This study was undertaken to compare endoscopic and microscopic approach for type-1 tympanoplasty.Material And Methods:This study data was collected from 50 patients who underwent tympanoplasty in our department in our hospital from July –2017 to November 2019.Patients above 15 years of age with inactive chronic otitis media tubotympanic type operated for type-1 tympanoplasty. Pre-operative, intra-operative and post-operative data collected as per performa and evaluated.Result:Equal (25) number of cases underwent microscopic and endoscopic type-1 tympanolasty. As far as graft taken up is concern both approaches have good and comparable result. Hearing gain is almost similar in both approaches -Endoscopic approach-10.80 dB; microscopic approach-11.23 dB.Both methods do not have any major complications. Endoscopic approach has advantage of depth and angled vision. Endoscopic approach (57.2 min.) also saves surgical time than microscopic approach (89.4 min.) and comparatively good cosmetic result. Microscopic approach has upper hand over endoscopic appr oach in having two hande d surgery with magnified surgical view. Patient compliance and satisfaction is more with endoscopic approach.Conclusion:Both microscopic and endoscopic methods are excellent for type-1 tympanoplasty with advantage and limitation of each method. A careful selection of patient is necessary for endoscopic approach.

In Vitro Comparative Assessment and Characterization of Vibrating Mesh Nebulizers with Glycopyrronium Nebulizing Solution: New Generation Impactor Study

Background: Inhalation therapy involving nebulization remains important modality of therapy for severe or high-risk obstructive airwaydiseases including bronchial asthma. The likely incremental factors for the translational impact of this delivery strategy includes fine particledose (FPD), fine particle fraction (FPF), mass median aerodynamic diameter (MMAD), and respirable fraction (RF) of the pharmaceuticalaerosols playing a key role in site-specific delivery to the lungs. The new generation active vibrating mesh nebulizers (VMNs) offer aconvenient, portable strategy in above clinical cases without compromising the delivery efficiency for improved therapeutic outcomes.Aim: This in vitro study was conducted to validate the improved efficiency and aerodynamic effect of glycopyrronium solutionnebulization with novel patented active and passive VMN devices.Materials and Methods: A in vitro lung deposition study was conducted using drug samples of glycopyrronium bromide(25 mcg/2 ml and 1 ml) using new generation cascade impactor at a flow rate of 15 L/min at Glenmark R&D Center, Sinnar, India.Results: Three samples of glycopyrronium nebulizing solution were analyzed using next generation impactor at a flow rate of15 L/min for aerodynamic aerosol parameters (FPF and RF) and total/active substance delivered (FPD and delivered dose) whenloaded with active (NEBZMART*, 2 ml) and passive (E-flow*, 1 ml) VMN. The results demonstrated comparable aerodynamicaerosol, particle size, and total delivered dose as FPF (64.9% vs. 72.8%), FPD (16.4 vs. 14.2 mcg), MMAD (3.9 vs. 3.2), andGSD (1.8 vs. 1.62) for active and passive VMN, respectively. The nebulization time was observed as 3–5 min for both thedevices demonstrating higher efficiency for active VMN.Conclusion: The results showed comparable aerodynamic aerosol, particle size, and total delivered dose or RF forglycopyrronium nebulizing solution delivered by the VMNs.

Teenage Pregnancy: A Product of Various Social and Health Factors.

A Context: The practice of child marriage in rural India is deeply rooted in cultural values. Despite laws that prohibit child marriage, the practice is still extremely prevalent in many regions. Most of adolescent fertility occurs within marriage. High adolescent fertility contributes to an elevated risk of maternal death and disability especially in adolescent girls Objectives: To find out prevalence of teenage pregnancy, its socio-demographic relationship and some health problems associated with teenage pregnancy in rural area. Settings and Design: A cross sectional study was carried out in three primary health centres of Pune District in Maharashtra state. Methods and Material: Total number of 547 who consented to participate were included in the study. Questions on demographic profile, obstetric history were asked. The antenatal mothers were clinically examined and investigated for any health problems. Statistical analysis used: Chi square test for linear trend. Results: There were 218(39.9%) teenagers. Most of the teenagers were less educated, housewives. Majority of the teenagers were pregnant for the first time but repeated pregnancies and abortions were also observed. The health problems like anemia, hypertension and edema feet were significantly high in adolescent pregnant girls in our study. Conclusions: Teenage pregnancies put mothers at high-risks to many health-related complications thereby affecting the maternal mortality.

Pharmacognostic and Physico- Chemical Evaluation of Leaves of Tecoma Gaudichaudi DC (Bignoniaceae).

Tecoma gaudichaudi DC (Family Bignoniaceae) is a small tree of height 9-12m. and various Tecoma species are attractive to bees, butterflies or birds. Present study focuses on determination of some quantitative microscopical factors of leaves of Tecoma gaudichaudi DC includes Stomatal no., vein islet no etc. Under physicochemical standards various parameters were checked, such as ash value, acid insoluble ash value and moisture content etc. It helps in to check purity of crude drug. Ultimately it helps in evaluation of crude drug and valuable addition of pharmacognostic data towards updating of monograph of plant species.

Preparation and evaluation of fermented Ayurvedic formulation: Arjunarishta.

Growing awareness about harmful side effects of modern medicine has led to interest in Ayurveda at the international level as well as within India. Ayurveda comprises of various types of formulations including fermented forms, namely, arishtas and asavas. Arishtas are regarded as unique and valuable therapeutics due to their efficacy, stability and desirable features. It prepared using decoction of herbal drug and contains self generated alcohol. Although these formulations are mentioned in traditional literature and used regularly their scientific investigation and reporting is essential to strengthen Ayurveda in global market. In present study attempt has been made for preparation and evaluation of arjunarishta. Terminalia arjuna is a active constituent of arjunarishta and prescribed in cases of cardiovascular diseases as a cardiotonic. 6.42% w/w alcohol was generated after fermentation of traditionally prepared arjunarishta formulation. It is palatable to use due to sweet taste combined with fine aroma which masks unpleasant taste and odour of added herbal ingredients.

Changes in haemolymph constituents of American bollworm, Helicoverpa armigera (Hübner), infected with nucleopolyhedrovirus.

Six types of haemocytes viz., prohaemocytes, plasmatocytes (round, fusiform, vermiform and spindle shaped), granular cells, spherule cells, oenocytoids and adipohaemocytes were found in the haemolymph of larvae of American bollworm H. armigera. The total and differential haemocyte counts (THC and DHC) in H. armigera haemolymph were affected by nucleopolyhedrovirus (NPV) treatment. There was a general decrease in THC in response to NPV treatment in both young and old larvae. However the decrease was more apparent in 5 and 8 day old larvae than in 10 day old larvae. The differential haemocytes showed less of granular cells and more of spherule cells and prohaemocytes in the old larvae. Plasmatocytes and granular cells in 10 day old larvae initially phagocytosed polyhedra; however, disintegrated after 3 to 4 hr. The haemolymph of NPV treated larvae melanized slowly particularly in old larvae. Phenoloxidase (PO) activity decreased positively with granular cells and oenocytoids in 10 day old treated larvae. Cellular fraction had high level of PO activity, which was transferred to plasma in response to NPV infection in the older larvae. The role of NPV pathogenesis vis-à-vis immunity in insect is discussed.

Mortality and morbidity in high risk infants during a six year follow-up.

OBJECTIVE: To study the mortality and morbidity in high risk infants after discharge from the hospital. DESIGN: Prospective, 6 year follow up. SETTING: High Risk Clinic (HRC). METHODS: Infants discharged from a Neonatal Special Care Unit were identified for follow up using predetermined risk criteria. Home visits were made by the social worker, if appointments to HRC were missed. Verbal autopsy was performed in case of home deaths. Intercurrent illnesses and rehospitalizations were recorded. At six years, the children who had come for the final assessment at 30 months on the Bayley Scales, were recalled for assessment of the intelligence quotient, by Stanford-Binet Scale. RESULTS:Four hundred and four high risk infants and eighty six controls were enrolled. There were 40 deaths in the study period, out of which 38 occurred in the first year of life, sixty per cent of these occurring in the first three months. The mortality was significantly higher in the VLBW group. Out of the 22 hospital deaths, 72.7% were due to infection. There was a significant difference (p < 0.001) in the mortality rate between the group which attended the HRC regularly (6.4%) as compared to that of the defaulters (27.6%). Ninety five children had rehospitalization in the High Risk group as compared to two in the control group (p < 0.001). In the 286 children who were assessed at 6 years, the incidence of borderline intelligence was 14.6% as compared to 5.6% in the controls (p < 0.05). CONCLUSION: Mortality and rehospitalization rate is high in high risk infants, after discharge from the hospital. Children who appear to have normal development in the third year, may show a high incidence (14.6%) of borderline intelligence at six years.

Pune low birth weight study--a six year follow up.

OBJECTIVE: To evaluate the intelligence, visuo-motor perception, emotional problems and preschool skills in low birth weight (LBW) infants and the impact of social and environmental factors on their development. DESIGN: A prospective cohort study. SETTING: Infants discharged from a Neonatal Special Care Unit of a referral hospital with birth weight less than 2000 g followed up in the High Risk Clinic. METHODS: Low birth weight infants were assessed by Stanford Binet Scales of intelligence, Bender Gestalt Test for visuo-motor perception, Human Figure Drawing for emotional indicators and occupational therapy assessment. A detailed evaluation of their environment and socio-economic status was done. Hearing and ophthalmic assessment was also done and the school progress report was scrutinized. RESULTS: Two hundred and one LBW and seventy one control children were assessed. The mean IQ of LBW children was within normal limits (94.3), though significantly lower than controls (101.3). Preterm SGA children had the lowest mean IQ. Visuo-motor perception and preschool skills and language development was poorer in LBW children. There was no difference in the emotional indicators. Thirteen per cent of LBW children had borderline IQ, as compared to 5.6% in controls (p<0.05). Mother's education and spaciousness of the house had a positive impact and chronic medical problems had a negative impact on the IQ. CONCLUSIONS: The mean IQ of LBW children was within normal limits. The incidence of children with borderline intelligence (IQ 70-85) was significantly higher than controls. Mother's education had a positive impact on the intelligence of the children. A longer follow up is necessary to identify "slow learners".

Growth and development of twins compared with singletons at ages one and four years.

OBJECTIVE: To compare the growth and development of twins with normal control singletons and also with matched 'high risk' singletons, at one and four years of age. DESIGN: A four year prospective follow up study. SETTING: High risk clinic (HRC) of a referral hospital. SUBJECTS: Twin pairs enrolled in the HRC; normal full term singleton controls; and high risk "matched" singletons enrolled in the HRC. METHODS: The height, weight and head circumference was measured at one and four years. Development was assessed at 1 year using the Bayley Scales of Infant Development. At 4 years, the intelligence quotient was determined by the Stanford Binet Intelligence Scale. RESULTS: Forty two twins and an equal number of controls were assessed at one year. All the twins weighed less than 2 kg at birth. They lagged behind in all three parameters of growth, namely, height, weight and head circumference. AT 4 years, 24 twins came for follow up. Although, they had caught up for head circumference, they lagged behind in height and weight, particularly the group of fourteen SGA twins. The growth parameters of LBW twins and LBW matched singletons did not show any significant difference. At one year, the development of twins was within normal limits although the motor quotients were significantly lower than that of controls. At 4 years, the intelligence quotients of twins were well within normal limits. CONCLUSIONS: Twins were lighter and shorter than controls at four years, particularly the SGA twins. The growth parameters of LBW twins and LBW matched singletons showed no significant difference. The intelligence of twins was normal at four years.

Early predictors of neurodevelopmental outcome in high risk infants.

OBJECTIVE: To find out a few simple and easily elicitable items at three and six months of age that can predict neurodevelopmental outcome at one year in high risk babies. DESIGN: One year longitudinal follow up study. SETTING: Hospital based study including inborn and outborn infants discharged from the Neonatal Intensive Care Unit (NICU) of a referral hospital, followed up in a High Risk Clinic. METHODS: Sixty high risk babies were followed up longitudinally for a period of one year. A detailed neurodevelopmental examination was done with special attention to the following items-axillary suspension, head support, social smile, disappearance of primitive reflexes and neurobehavior at three months age while pull to sit, rolling over, sitting momentarily without support, transfer of objects and voluntary reach were evaluated at six months age. Bayley Scales of Infant Development (Baroda Norms) was used for assessing the outcome at one year. RESULTS: Babies with absence of social smile, abnormal neurobehavior at three months and absent pulling to sit position, absent voluntary reach, and absent transfer of objects, remained delayed at one year. The specificity of each of these items was 100%. These items had a positive predictive value of 100%. CONCLUSIONS: Inability to achieve social smile and abnormal neurobehavior at three months age and absence of pulling to sit position, transfer of objects and voluntary reach at six months age, warrant early intervention. These items are easy to elicit, do not require any special kit or elaborate training. Hence these items can be tested even by those working at the primary level or in office practice.

Neurologic sequelae in high risk infants--a three year follow up.

OBJECTIVE: To determine the neurologic sequelae in high risk infants. DESIGN: A three year longitudinal follow up. SETTING: Inborn and outborn infants discharged from the Neonatal Special Care Unit (NSCU) of a referral hospital. METHODS: High risk infants were identified for follow up using predetermined risk criteria. A detailed neurodevelopmental examination was done 3 monthly in the first year and 6 monthly subsequently. The Amiel-Tison Method, Bayley Scales of Infant Development and Raval's Scale for social maturity were used. EEG was done in children with seizures. Hearing and ophthalmic assessments were done at 6 months. RESULTS: Three hundred and thirty six high risk infants and 70 normal control infants came for regular follow up. Out of these, 16 (4.8%) had cerebral palsy and 11 had associated mental retardation. Six other children had mental retardation without motor problems. None of the children in the control group had any neurological problems. Sensorineural hearing loss was present in 5 (1.5%) children while 1 subject had corfical blindness. Three children with cerebral palsy had infantile myoclonus, nine had generalized seizures and one child had a focal seizure. The incidence of seizure disorders was 3.9%. CONCLUSIONS: The incidence of major handicap in our study was low. Many of the risk factors which caused adverse outcome, could have been prevented by good antenatal and perinatal care.

Ultrasonography of the brain in preterm infants and its correlation with neurodevelopmental outcome.

Two hundred and eighteen preterm neonates had ultrasonography (USG) brain done on third, and/or seventh and fourteenth day of life. Fifty eight (26.3%) had intraventricular/ periventricular hemorrhage, 3 had parenchymal lesions. 46 had Grade I hemorrhage, 9 had Grade II, 2 had Grade III and 1 had Grade IV hemorrhage. Grade III and IV hemorrhages occurred in neonates below 34 weeks gestation. There was an inverse relationship between gestation age and hemorrhage (p = 0.0001). A comparison of incidence of hemorrhage between preterms who were appropriate for gestational age was not significant. Out of the 63 neonates who had serial USGs on the third and seventh day of life, 15 of the 16 bleeds (94%) were detected on the third day itself, indicating it to be a opportune time for doing an USG. USG at term (40 weeks postconceptual age) was done in 99 infants to see if it could correctly predict the neurodevelopmental outcome using the Bayley Scales of Infant Development. Out of these 99 infants, 72 came for the developmental assessment at one year. One neonate who had periventricular leucomalacia with cystic changes on USG at term, was grossly abnormal with cerebral palsy and mental retardation. Six infants showed delayed development with a mean mental development quotient of 79.1 +/- 1.72 at 2 years. The specificity of USG at term for predicting outcome was 89.2% and negative predictive outcome was 90%, indicating that a normal USG at term predicted a good neurodevelopmental outcome.

A longitudinal follow up of development of preterm infants.

A prospective study was undertaken to determine the development of preterm (PT) babies (gestation less than 37 weeks). One hundred and seventy two preterm babies and 36 control babies were followed up for a period of 18-24 months. Psychomotor development was assessed using the Bayley Scales of Infant Development at 3, 6, 9, 12, 18, 24 months, using the corrected or post conceptional age. Preterm babies, as a group, caught up with normal babies between 18-24 months, both on the motor and mental scale. Higher the birth weight, better was the mean motor development quotient at 18 months. Uncomplicated preterm babies showed higher mean development quotients at 18 months than preterm babies with additional complications and they also caught up earlier (12-18 months) than the latter group who caught up between 18-24 months. Similarly, PT appropriate for gestational age (AGA) babies showed, earlier 'catch up' than PT small for gestational age (SGA) babies. The incidence of cerebral palsy was low (4%).

A longitudinal follow up of neurodevelopment of high risk newborns--a comparison of Amiel-Tison's method with Bayley Scales of Infant Development.

The neurodevelopment of 42 high risk babies and 7 control babies was assessed longitudinally till the age of 12 months by using two different methods. The method of neurological evaluation described by Amiel-Tison was used, and the results compared with those of a standard developmental test, the Bayley Scales of Infant Development. The Amiel-Tison method was found to be a sensitive test for picking up abnormalities till the age of 9 months, but lost its advantage over the Bayley Scales at 12 months. Besides, the test was quick, simple to learn and did not need a special kit or a trained psychologist and was hence found to be a good screening method.