FLEXIBLE VERSUS RIGID ESOPHAGOSCOPY IN THE MANAGEMENT OF ESOPHAGEAL FOREIGN BODY IMPACTION

Background: Foreign body(FB) impaction accounts for 4% of emergency endoscopies in clinical practice. Flexible endoscopy(FE) is a recommended therapeutic option because it can be performed under local anesthesia, it is cost effective and is well tolerated. Rigid endoscopy (RG) under general anesthesia is another option and is advantageous in some circumstances. The aim of the study is to compare ef?cacy and safety of ?exible and rigid esophagoscopy in esophageal foreign body removal. It is a prospective study done in E.N.T department in KIMS Methods: MEDICAL COLLEGE, Amalapuram, which includes 50 patients with impacted foreign body esophagus. Parameters like type of foreign body, location of impacted foreign body are included. The study analyzies the type of procedure the patient have undergone, the intra operative and post operative complications. This prospective cohort study includes 50 patients Results: who have undergone surgical procedure for removal of impacted foreign body. Flexible esophagoscopy is performed in 30 patients and rigid esophagoscopy is performed in 20 patients . The most frequent complications are mucosal erosion, mucosal edema, and ulceration. Flexible esophagoscopy and rigid esophagoscopy are equally safe and effective for Conclusion: removal of impacted esophageal foreign body

Aggressive Central Giant Cell Granuloma in a Child: A Case Report and Review

Introduction: An aggressive variant of central giant cell granuloma in a paediatric patient is a localized benign osteolytic prolif- eration. The lesion consist of fibrous tissue with haemorrhage, hemosiderin deposits and presence of osteoclast-like giant cells with reactive bone formation. Clinically shown with rapid growth, resorption of roots, displacement of teeth and thinning or perforation of cortical bone, and marked recurrence. Case presentation: A 9-year-old boy reported with a 3 days history of asymptomatic soft tissue swelling in left mandibular pos- terior region which was diagnosed as central giant cell granuloma based on clinical, radiological and histopathological features. Management and Prognosis: Surgical resection was performed without any signs of recurrence on 9 months follow up. Conclusion: Prompt diagnosis and treatment of Central giant cell granuloma can significantly improve morbidity and long- term outcomes.

Long-term Persistence of Immunogenicity After Primary Vaccination and Response to Booster Vaccination With Typhoid Conjugate Vaccine: Results of a Phase IV Extension Study

Objective: To evaluate the persistence of antibodies three years after primary vaccination with typhoid conjugate vaccine (TCV) of either Cadila Healthcare Ltd. (Cadila-TCV) or Bharat Biotech International Ltd. (Bharat-TCV) administered in a previous phase II/III study, and to study the booster dose response to Cadila-TCV. Methods: This was an open-label, phase IV extension study conducted in tertiary care and multispecialty hospitals in India. 112 subjects (Cadila-TCV-57, Bharat-TCV-55) who had participated in previous study were enrolled. Of these, eligible subjects received a single-dose of Cadila-TCV and were followed-up for 28 days post-booster. Primary outcome was persistence of antibodies 3 years after primary vaccination and seroconversion (?4-fold rise in antibody titre from baseline) 28 days postbooster. Safety was based on reported adverse events (AEs) post-booster. Results: The baseline GMT reported in the current study was significantly higher than pre-vaccination GMT reported in the previous study. 89/112 (79.5%) subjects had antibody titer ?10 IU/mL at baseline; eligible subjects (n=17) who had baseline antibody titre <10 IU/mL were administered booster dose. All the vaccinated subjects showed seroconversion post-booster. The GMTs reported at 10 days and 28 days post-booster were significantly higher as compared to GMTs reported after primary vaccination in previous study. 4 (23.5%) vaccinated subjects reported 9 AEs; all were solicited and of mild/moderate intensity. Conclusion: There was a significant persistence of immunogenicity after primary vaccination with both the TCVs, and robust immune response after booster vaccination with Cadila-TCV.

A rare case of pancytopenia due to leishmaniasis - A case report

Visceral Leishmaniasis (VL) or Kala Azar is a chronic protozoal infectious disease caused by the Leishmania donovani complex which causes a variety of hematologic manifestations. It is manifested by fever, hepatosplenomegaly, weight loss, pancytopenia and hypergammaglobinemia. In India it is mainly seen in the states of Bihar and West Bengal. Patients with VL can present to the hematologist for variety of hematological presentation even before the diagnosis of VL is made. Anemia is the most common hematological manifestation of VL. VL may also be associated with leucopenia, thrombocytopenia, pancytopenia, hemophagocytosis and disseminated intravascular coagulation. Hematological improvement is noted with the treatment for VL. Relapses are rare. In this case report, we present a rare case of leishmaniasis with pancytopenia, which is rare in Hyderabad, Telangana, India

24 hour urinary sodium excretion in essential hypertension

Hypertension is a common medical condition; its prevalence increases with age. It is one of the most important risk factors for cardiovascular disease, which is the leading cause of mortality. High salt intake is associated with high blood pressure. The incidence of hypertension is higher in salt-sensitive individuals. Evidence shows that reduced sodium intake lowers blood pressure and can prevent hypertension. Urinary sodium excretion was used as measure of sodium intake, which equals urinary excretion under normal circumstances. The relationship between salt intake and renal ability to excrete sodium has suggested being a major importance for the long-term blood pressure treatment especially in essential hypertension. In the present study there was increased 24 hour sodium excretion in essential hypertensives indicating a high intake of sodium, which may be the cause for hypertension. Patients with high sodium excretion, who are salt sensitive hypertensives will respond to diuretics, when compared to others. The long term reduction in salt intake may significantly reduce the prevalence of hypertension and thereby decrease the associated morbidity and mortality.

Perceptions of Medical students on “Timing of theory classes”

Background and Objectives: Most research has found that‘timing of classes’ play a significant part in studentachievement. When students were taught at times matchingtheir preferences, scores were significantly higher onachievement tests. If time is viewed as a resource and can beinfluenced to support high quality instruction, preferred time-ofday is much more likely to result in improved learning.Currently, medical schools are not set up to match everystudent’s perception on ‘timing of the class’. Therefore, there isa need for research on ‘timing of the theory class’ for medicalstudents.Materials and Methods: A cross sectional observational studywas conducted and perceptions of students belonging toMBBS stream from first semester to seventh semester wereconsidered for our study. Structured questionnaire was used inthe format of five-point Likert scale for every statementregarding the timing of theory classes, dissection hours, postlunch theory classes, interactive sessions, audio-visual aidsand experience of teaching faculty. Results were analyzed withthe help of MS office Excel and SPSS software version 20. Wehave compared the perceptions of medical students on fivepoint Likert scale on each question and the statisticalsignificance was calculated by Chi Square test.Results: Our study included a total of 505 medical studentsacross the semesters in MBBS stream. 33.1% of the studentsagreed to come for the theory class at 8° clock, across allsemesters and 34.1% of first semester students agreed tocome for 8° clock theory class when compared to 43% in 3rdSemester, 23.7% in 5th semester and 30.2% in 7th semesterstudents. In our study 50.8% of students from first semesterdisagreed to schedule ‘dissection classes’, of anatomy in thefirst hours of the day and 42.8% of students perceived thatattention span was good in the morning class. 34.1% of thefirst semester students perceived that ‘the quality of theteacher’ makes the class more interesting irrespective of timeof the day.Conclusion: Medical students perceive differently on ‘thetiming of theory classes’ across the semesters. Our studyprovides insights into student’s perceptions regarding lack ofattention during classes; which may be useful in identifyingtheir expectations and to plan theory classes in the curriculum.

A Clinical and Demographic Study on Oropharyngeal Malignancies

Background: The aim of the study was to determine the distribution of oropharyngeal malignancies in terms of age, sex,personal habits, symptoms, site, histopathological type, and differentiation; and the modes of treatment adopted and its results.Materials and Methods: A total of 68 patients treated previously in the Department of Ear, Nose, and Throat of MNR MedicalCollege and Hospital were included in this study. Patients of all age groups and gender were included in the study. Patients withpersistent mass of the neck or throat or with symptoms suggesting oropharyngeal cancer were included in the study. Patientswith symptoms of chronic throat pain, difficulty swallowing, weight loss, earache, voice change, and blood-tinged saliva wereincluded in the study. Patients with severe cardiac, renal and pulmonary diseases were excluded from the study. Patientswith immunodeficiency diseases were excluded from the study. All the patients were initially evaluated by a detailed medicalhistory and comprehensive head and neck examination, which included flexible endoscope examination of the pharynx andlarynx in an outpatient department setting. Patients with suspicious looking lesions (tumors) of the oropharynx were biopsiedfor histopathological evaluation. All patients with a confirmed diagnosis of oropharyngeal squamous cell carcinoma weresubjected to evaluation by a multidisciplinary treatment team. Imaging was done to evaluate the primary tumor, involvementof lymph nodes in the neck, and for evidence of metastatic cancer spread beyond the head and neck. The patients weresubjected to either computed tomography scan or magnetic resonance imaging of the neck to evaluate the pharynx and lymphnodes in the neck.Observations and Results: Among the 68 patients, there were 41 males (60.29%) and 27 females (39.70%), with a male tofemale ratio of 1.51: 1. The mean age was 55.63 ± 5.70 years. Thirty-seven patients (54.41%) were in 55–65 years, 24 patients(35.29%) in 45–55 years, and 7 patients (10.29%) were aged above 65 years. Malignant tumors of the tonsil were observedin 21/68 (30.88%), posterior one-third of the tongue in 17/68 (25%), soft palate in 10/68 (14.70%), valleculae in 10 (14.70%),and suprahyoid epiglottis in 6 (8.82%), and posterior pharyngeal wall in 4 (105.88%) of the patients.Conclusions: Oropharyngeal cancers are one of the most common malignant tumors of the aero-digestive tract. Males aremore commonly affected than females and usually in the 5th–6th decade of life. The incidence is rising in females also becauseof using smokeless tobacco products. The most common site was tonsil followed by posterior one-third of the tongue; the leastcommon site was posterior pharyngeal wall. Well-differentiated carcinoma was the most common histopathological finding.

Refractory Allergic Fungal Sinusitis and its Medical Management in a Tertiary Hospital

Background: Allergic fungal sinusitis (AFS) is the most common form of fungal sinus disease with a high rate of recurrence ratedespite the advent of advanced endoscopic sinus surgery and usage of steroids. Refractory AFS is defined as a condition ofallergy due to fungal antigenic elements not amenable to surgical removal or prolonged medical management. Oral itraconazoleis an antifungal agent that seems to be benefit to the patients with refractory AFS. Hence, this study was conducted to comparethe outcome of AFS after addition of oral itraconazole to the treatment protocol.Aim of the Study: The aim of the study was to evaluate the acceptance and usefulness of itraconazole, an oral antifungaldrug, in the treatment of refractory AFRS.Materials and Methods: A total of 84 patients with refractory AFS were included in this study. The medical records of these patientswere retrieved from the medical records section and analyzed. A detail history of the AFS was elicited and demographic data weretabulated. Nasal endoscopy was done before and 3 months after the itraconazole therapy and the findings were classified according toLund-Kennedy endoscopic grading system, Scoring from 7 to 10 was graded as severe; scoring from 4 to 6 was graded as moderateand 1 to 3 as mild grade. Itraconazole was administered in the form of capsule 100 mg 2 times daily for 3 months. Prior hepaticfunction and renal function tests were undertaken for all the patients. All the data were analyzed using standard statistical methods.Observations and Results: Among the 84 patients, there were 52 (61.90%) males and 32 (38.09%) females with a male tofemale ratio of 1.6:1. The patients were aged between 18 years and 78 years with a mean age of 33.45 ± 4.15 years. Conversionof severe grade patients to mild grade following itraconazole therapy was note; post-treatment findings were severe in 5 patients,moderate in 1, and mild in 78 patients.Conclusions: Itraconazole may be useful as an adjunct in the management of AFRS. However, more studies, including aprospective randomized clinical trial, are required to determine if itraconazole is effective in the management of AFRS.

Clinical Evidence of Hearing Loss in Patients Treated with Cisplatin for Head-and-Neck Squamous Cell Carcinomas

Background: Cisplatin is a chemotherapeutic agent that is widely used to treat a variety of malignant tumors. Serious doselimiting side effects such as ototoxicity, nephrotoxicity, and neurotoxicity are likely to occur with its use.Aim of the study: The aim of the study was to do audiological evaluation of patients on cisplatin before and after chemotherapyfor squamous cell carcinomas of head and neck and analyze for hearing loss (HL).Materials and Methods: A total of 46 patients undergoing cisplatin administration were included in the study. History taking,preliminary ENT examination, and audiological evaluation with pure-tone audiometry were done. A pure-tone average (PTA) wascalculated using the speech frequencies (500, 1000, and 1500 kHz). High-frequency pure-tone audiometry was also done in allpatients to know the basal auditory threshold before starting cisplatin therapy. Baseline audiometry was done Prior to Chemotherapyor at least 24 h after administration of Cisplatin. Monitoring audiometry was done before each cycle of Cisplatin therapy. Follow-upaudiometry was done 1, 3, and 6 months after chemotherapy. Dosage of cisplatin ranged from 50 mg to 115 mg with cumulativedose ranging from 250 mg to 850 mg in all the patients. All the data were analyzed using standard statistical methods.Observations and Results: Among 46 patients, there were 33 males and 13 females (28.26%) with a male-to-female ratioof 2.53:1. Patients were aged between 45 years and 70 years and the mean age was 55.35 ± 2.70 years. 22/46 (47.82%)patients were in the range of 55–65 years age group followed by 15/46 (32.60%) patients who were in the 45–55 yearsage group. 9/46 (19.56%) patients were in the 65–75 years age group. Patients of all age groups showed high-frequency(3000 kHz–12,000 kHz) HL in the study group. The thresholds were found to be increasing from 35 dB to 59 dB with increasingfrequencies from 3000 kHz to 12,000 kHz.Conclusions: In this study, all the patients showed significant evidence of severe mixed type of HL. The HL was significant inall the age groups and in both the genders. Six months follow-up showed no recovery of HL presumable resulting in permanentHL. Very few patients showed vestibular involvement. Audiometric monitoring may help to provide early evidence of decreasedhearing ability, leading to the possible limitation of the severity of ototoxicity.

Analysis Of Effect Of Amla Rasa (sour Food) In Different Concentrations On Mamsa Dhatu (muscle Tissue)

It is said that one should consume Shad-Rasayuktha Ahara for better nourishment. The nutritive value of the 6 Rasas (taste) has been explained in the classics of Ayurveda along with their harmful effects when used in excess. When Amla Rasa is taken in excess it produces Dantaharsha (Morbid sensation of teeth), Trishna (thirst) etc. Objectives - The present study is designed by administering Amla Rasa Pradhana Drvya given in different concentration 10% and 15% and effect on the Mamsa Dhatu is assessed by certain blood parameters. Material and Methods -Wistar strain albino rats of either sex, weighing of 200-300 g. Obtained from S.D.M Centre for Research in Ayurveda, Udupi, Karnataka. 5Groups were taken and Group 1 is Control, Group-2 is 15% Chincha, Group-3 is 15% Vrukshamla, Group-4 is 10% Chincha, Group-5 is 10% Vrukshamla which receives drug and laboratory food for 28days, next day blood was collected by supra-orbital puncture with the help of micro capillary tubes under mild ether anesthesia. Results - There was increase in the Total Protein, Serum Albumin and serum creatinine levels and decrease in Serum globulin, Serum Urea level and Body weight. Conclusion – the study suggests that there is catabolic action of the Amla Rasa on the Mamsa Dhatu and anabolic act action on serum protein especially at the level of liver, so there will be a loss of muscle tissue which suggests Mamsa Vidhahyati action.

Intraoral Myolipoma in a 6-Year-Old Child: A Rare Case Report.

Lipoma is the most common benign soft tissue mesenchymal neoplasm, which occasionally occurs in the oral cavity. It has many variants such as infiltrating lipoma, fibrolipoma, angiolipoma, spindle cell/pleomorphic lipoma, myxolipoma, chondroid lipoma, osteolipoma, and myolipoma. Myolipoma is a rare benign lipomatous soft tissue tumor which is diagnosed histologically because of presence of irregularly admixed mature adipose tissue and smooth muscle fibers. The most common site of its occurrence is retroperitoneum, abdominal and pelvic cavity, and the abdominal wall. Rarely myolipomas occur in the oral and maxillofacial region. Here, we present a rare case of intraoral myolipoma present in the buccal mucosa of a 6-year-old child.

Clinical manifestation and prevalence of peripheral neuropathy and nerve dysfunction in patients with chronic kidney disease.

Background: Chronic Kidney Disease (CKD) is recognized as a major health problem. Prevalence of CKD is rising continuously; mostly CKD is affecting the elderly aged population and/or patients with diabetes and hypertension. Present study was aimed to explore clinical manifestation and evaluate the prevalence of peripheral neuropathy and peripheral nerve dysfunction in CKD patients attending our hospital with reference to the severity and duration of the CKD. Methods: The present cross sectional study was conducted in 74 patients affected with chronic kidney disease, of different age groups at the medical wards of King George Hospital, Visakhapatnam. The presence of peripheral nerve dysfunction was assessed by nerve dysfunction clinically (motor or sensory symptoms and signs) and electrophysiological nerve conduction studies. Results: Out of 74 patients, 65% of study population was suffering from chronic kidney disease with peripheral nerve dysfunction. The peripheral nerves dysfunction was more prevalent in elder age (>65 years) subjects when compared to subjects with age <65 years. Moreover, the results shown that the rate of prevalence of peripheral nerves dysfunction was observed higher in subjects with longer duration of CKD. Male subjects were affected more when creatinine clearance is <15 ml/minute. Both sexes were affected equally when creatinine clearance is between 30-59 ml/minute. Conclusion: This study enlightens the prevalence and clinical presentation of peripheral nerve dysfunction in patients with CKD. The CKD was found to cause peripheral neuropathy including overt and subclinical neuropathy, of which distal symmetrical sensory motor neuropathy was common in CKD. The prevalence of peripheral neuropathy was directly proportional to duration and severity of CKD.

A Validated Ion Chromatography method for determination of Ammonium content.

A simple, feasible, definite and strong Ion chromatography method was developed for the quantitative determination of ammonium content in Omeprazole tablets. The method was developed using Ion pac CS17 Column, 250 X 4.6mm X 5.0 mm column with mobile phase containing 1.5mM Methane sulfonic acid in water. The eluted compounds were monitored using conductivity detector. The unknown peak and ammonium peak were well separated with resolution more than 2.0. The developed method was validated as per Internatonal Conference on Harmonisation of technical Requirements for registration of pharmaceuticals for human use guidelines with respect to linearity (The high correlation coefficient >0.99), limit of detection, limit of quantification, exactness, precision and robustness. The Limit of detection, Limit of quantification values of Ammonium were 8ppm and 30ppm respectively.

Rendimiento masticatorio en pacientes rehabilitados con prótesis total removible v/s prótesis Ad-Modum Branemark / Masticatory performance in patients rehabilitated by means of removable complete dentures vs. Ad-Modum Branemark prostheses

Propósito: el propósito de este estudio fue evaluar y comparar el rendimiento masticatorio de pacientes desdentados totales rehabilitados mediante (prótesistipo Ad-Modum y/o prótesis removibles convencional. Método: Se evaluaron24 pacientes divididos en 3 grupos de ocho pacientes. Grupo Ipacientes rehabilitados con prótesis Ad-Modum bimaxilar, Grupo IIpacientes rehabilitados con prótesis Ad-Modum inferior y prótesis total removible superior, Grupo III pacientes rehabilitados con prótesis total removible bimaxilar. Se solicitó a cadapaciente realizar 20 golpes masticatorios a una pastilla de silicona previamente estandarizada, a la muestra obtenida se le realizó tamizado múltiple y los resultados fueron procesados con la fórmula de obtención de rendimiento masticatorio propuesta por el protocolo de Edlund y Lamm en 1980. Resultados: Lospromedios de rendimiento masticatorio fueron: Grupo I(15,6 por ciento±3,4), Grupo II (4,3 por ciento±4,6), Grupo III (0,3 por ciento±0,7). Mediante test de Tukey se demostró que existendiferencias significativas entre el grupo I y II, pero no entre los Grupos II yIII. Conclusiones: El tratamiento con prótesis Ad-Modum bimaxilar logró elmejor rendimiento masticatorio entre los 3 tratamientos rehabilitadores evaluados, el tratamiento con prótesis total removible superior y Ad-Modum inferior fue más exitoso en términos de rendimiento masticatorio que el grupo rehabilitado con prótesis total removible bimaxilar. Los tratamientos con prótesis removible total convencional, no otorgan al paciente una óptima función masticatoria

Design and Development of Transdermal Patches for Trandolapril

Trandolapril is an antihypertensive agent which undergoes extensive first pass metabolism making it a possible candidate for transdermal delivery. Patches were prepared using hydroxypropylmethylcellulose, eudragit RL 100, gantrez and carbopol. The results of FTIR and DSC revealed no interaction between drug and polymers. The loss of moisture and uptake of moisture were within the limits. The formulations showed an extended release of the drug upto period of 24 hours during in vitro permeation studies and showed non-Fickian drug release. Stability of the optimized formulation was investigated as per ICH guidelines and was found to be stable with respect to drug content and in vitro permeation.

Oral manifestations of lipoid proteinosis: a case report and literature review

Lipoid proteinosis is an uncommon autosomal recessive metabolic disorder that presents in early life with hoarseness and pox-like acneiform scars involving the skin and mucous membranes. Previous studies have attributed the prevalence of lipoid proteinosis to consanguineous parents. This paper reports a classical case of lipoid proteinosis with oral manifestations but without a history of consanguinity

Multiple gingival metastasis of adenocarcinoma of the lung.

Metastasis to the gingival soft tissues is an extremely rare phenomenon, and metastasis of multiple lesions (i.e. more than 2 lesions), is even more hard to find. In this study, we have reported a rare case of lung adenocarcinoma, which metastasized to the maxillary (2 lesions) and mandibular gingivae (1 lesion) in a 57 year old male patient. Metastasis was also seen to the vertebrae. The differential diagnosis consisted of acute myelomonocytic leukemia, chronic lymphocytic leukemia, haemangioma, pyogenic granuloma, giant cell granuloma, peripheral fibroma, primary gingival carcinoma and secondary metastasis. Contrast enhanced computed tomography of the lung showed a well-defined mass situated below the right hilum with lower lobe consolidation and pleural effusion on the right side with dorsal spinal metastasis. Excisional biopsy of the lesions was consistent with the diagnosis, and the immunohistochemical analysis was positive for cytokeratin 7, carcinoembryonic antigen (CEA), thyroid transforming factor 1 (TTF1), and negative for vimentin and cytokeratin 20 (CK20).

Cowden syndrome.

Cowden syndrome or multiple hamartoma syndrome is an autosomal dominant condition with variable expressions that result mainly from mutation in the PTEN gene on arm 10q. It is characterized by multiple hamartomatous neoplasms of the skin, oral mucosa, gastrointestinal tract, bones, CNS, eyes, and genitourinary tract. Mucocutaneous features include trichilemmomas, oral mucosal papillomatosis, acral keratosis, and palmoplantar keratosis. Here we present a case of Cowden syndrome in a 14-year-old female patient with the chief complaint of multiple oral papillomatous lesions.

Blue rubber bleb nevus syndrome: Prominent oral findings.

Blue rubber bleb nevus syndrome is a rare disorder characterized by multiple cutaneous venous malformations in association with visceral lesions, most commonly affecting the gastrointestinal tract. Oral cavity lesions occur in 59 to 64% of cases. We report a unique presentation of this syndrome in a 25-year-old male patient with prominent oral findings. This is a sporadic case, started during early childhood, progressively increasing in number and size. Oral vascular lesions were part of gastrointestinal involvement. Associated cardiac abnormalities were also observed. An early diagnosis of this syndrome is required as it gets complicated with bleeding, anemia and other systemic complications.