Spatial hearing abilities among children with bimodal versus unilateral cochlear implant: parents report on spatial hearing questionnaire

Background: Spatial hearing questionnaire (SHQ) is a questionnaire developed and validated for evaluating the spatial hearing abilities for the tasks of localization of sound to complex task of speech perception in noise. SHQ is adapted in Dutch language, and in Persian language. The study aimed to compare the spatial hearing abilities of children using bimodal cochlear implant and unilateral cochlear implant using spatial hearing questionnaire a subjective assessment tool, SHQ. Methods: The participants of the study included parents of 30 cochlear implant using children of age range 5-10 years, among 30 participants, 16 belonged to parents of children using unilateral cochlear implant and 14 were parents of children using bimodal cochlear implants. SHQ consisted of 24 questions distributed under 8 domains and the responses from the parents were collected over telephonic interview and statistically analyzed across domains. Results: The results revealed that there was no significant difference observed between both the groups across all the 8 domains, except perception of children’s voice, showed statistical difference between 2 groups. The baseline of spatial skills in children population using unilateral and bimodal cochlear implants was analysed. Conclusions: Across the 8 domains of spatial hearing questionnaire there were no significant statistical difference found between unilateral and bimodal cochlear implanted groups.

Hepatoprotective Activity of Calycopteris floribunda on Clopidogrel and Atorvastatin Induced Hepatic Damage in Rodents

Preclinical testing hepatoprotective potential of hydroalcoholic leaf extract of Calycopteris floribunda against liver damage caused by atorvastatin and clopidogrel. Atorvastatin and clopidogrel were delivered intraperitoneally for 14 days at 80mg/kg and 20mg/kg respectively, while leaf extract was given orally for the same period at 200mg/kg and 400mg/kg. To evaluate the impact of the leaf extract on the atorvastatin and clopidogrel-induced liver damage, many biochemical markers, Serum glutamate pyruvate transaminase (SGPT), serum glutamate oxaloacetate transaminase (SGOT), total protein, and serum alkaline phosphatase were measured. Blood samples from mice given hydroalcoholic Calycopteris floribunda leaf extract showed a noteworthy decrease in serum indicators, suggesting that the leaf extract had an impact on the hepatocytes' ability to operate normally again. On the other hand, the mice receiving atorvastatin and clopidogrel treatment showed increased levels, which suggested serious liver injury. Silymarin (100 mg/kg) was given as a benchmark. The current investigation found that Calycopteris floribunda hydroalcoholic extract significantly protected the liver against atorvastatin and clopidogrel-induced hepatic damage.

Evaluation of change in knowledge and attitude about noise and its effect on hearing: post awareness programme among adolescents in Varkala, Thiruvananthapuram district, Kerala

Background: There are significant literature evidence across the globe and in India, regarding the effects of recreational noise exposure among young adults and college students, but there is a dearth of literature support regarding its effects among the students of senior grade studying in Indian subcontinent. Since the awareness among school students help in the early preventive measures and hearing conservation, studies must focus on these population to reduce the burden of recreational noise-induced hearing loss on our future generation. This study aims to evaluate the change in knowledge and attitude about noise and its effect on hearing: Post awareness programme among adolescents in Varkala, Thiruvananthapuram district, Kerala. Method: A survey was conducted among the school students within the age group 16-18 years. A questionnaire containing questions related to knowledge and attitude towards noise and its effect on hearing was developed and distributed to the students prior to and after an awareness program making use of a visual awareness material. Wilcoxon signed rank test was used for pre and post comparison. Results: The p value of each aspect related to the knowledge and attitude is less than the significance level, so we can say that there is a significant change in the level of knowledge and attitude after the awareness program. Conclusions: The study highlighted low pre-awareness levels among participants regarding noise's impact on hearing. The awareness program effectively improved understanding, emphasizing its importance for all age groups in dispelling misconceptions and fostering positive attitudes.

Auditory development and its significance: an awareness study among expectant mothers in Kottarakkara taluk, Kerala

Background: Studying pregnant women’s awareness of auditory development’s importance, especially in India, is an underexplored area. Given mothers’ pivotal role in monitoring child development, their understanding of auditory development is crucial. Addressing this gap could reveal insights into early hearing issue detection. Method: The study utilized a questionnaire survey employing Cluster sampling, gathering data from 103 expectant mothers aged 18 to 35. Of these, 55 were experiencing their first pregnancy, while 48 were on their second. The 16 question survey explored hearing loss, early identification, auditory behaviour, and high-risk indicators. Results: The study found that pregnant women, on average, exhibited a 42.35% knowledge level regarding the importance of auditory development during gestation. However, their attitude towards this aspect was notably high at 81.53%. This suggests a lack of awareness about auditory development, despite a generally positive attitude among expectant mothers. Importantly, there was a statistically significant difference in knowledge between first-time and experienced mothers (p<0.05), with the latter group demonstrating higher awareness, likely due to having older children. Conversely, no significant difference was observed in attitude between the two groups (p>0.05). Conclusions: The study’s findings shed light on a crucial aspect: the significance of maternal knowledge concerning hearing and its development. This understanding is pivotal for successful early identification and intervention programs. The study’s contribution lies in revealing mothers’ perspectives and attitudes towards monitoring their child’s speech, language, and motor development, emphasizing the importance of this awareness for early intervention strategies.

Efficacy and safety of endoscopic submucosal dissection for colorectal dysplasia in patients with inflammatory bowel disease: a systematic review and meta-analysis

Background/Aims@#In this meta-analysis, we studied the safety and efficacy of endoscopic submucosal dissection (ESD) for colorectal dysplasia in patients with inflammatory bowel disease (IBD). @*Methods@#Multiple databases were searched, and studies were retrieved based on pre-specified criteria until October 2022. The outcomes assessed were resection rates, procedural complications, local recurrence, metachronous tumors, and the need for surgery after ESD in IBD. Standard meta-analysis methods were followed using the random-effects model, and I2% was used to assess heterogeneity. @*Results@#Twelve studies comprising 291 dysplastic lesions in 274 patients were included with a median follow-up of 25 months. The pooled en-bloc resection, R0 resection, and curative resection rates were 92.5% (95% confidence interval [CI], 87.9%–95.4%; I2=0%), 81.5% (95% CI, 72.5%–88%; I2=43%), and 48.9% (95% CI, 32.1%–65.9%; I2=87%), respectively. The local recurrence rate was 3.9% (95% CI, 2%–7.5%; I2=0%). The pooled rates of bleeding and perforation were 7.7% (95% CI, 4.5%–13%; I2=10%) and 5.3% (95% CI, 3.1%–8.9%; I2=0%), respectively. The rates of metachronous recurrence and additional surgery following ESD were 10% (95% CI, 5.2%–18.2%; I2=55%) and 13% (95% CI, 8.5%–19.3%; I2=54%), respectively. @*Conclusions@#ESD is safe and effective for the resection of dysplastic lesions in IBD with an excellent pooled rate of en-bloc and R0 resection.

An insight into attitude about usage of ICT by teachers in school for hearing impaired

Background: Information and Communication Technology (ICT) in education is the mode of education that depends on digital medium of information transfer for delivery of course content and related learning experiences. Its focus is on utilization of different technologies in order to support, enhance, and optimise the delivery of information. ICT can be used in many ways to help both the students and the teachers gain knowledge on a particular topic/subject. The present study was inclined to look into the attitude of teacher for the hearing impaired towards usage of ICT in classrooms. Methods: Questionnaire which consists of attitude of teachers towards ICT. The questionnaire used for this study was adopted and modified from the original questionnaire designed by Gulbahar and Guven (2008), Ghavifekr and Athirah (2015) that is considered suitable for this research. Descriptive statistics was carried out for analyzing the data in SPSS version 20.0. Results: For all the questions framed to elicit positive opinions, the median values were either 4 i.e. agree is the common response of all the judges. For questions framed to elicit the common response is either disagree or strongly disagree. The responses of the judges suggest that they consider ICT to be helpful for teaching-learning of hearing impaired children. Conclusions: The study was able to demonstrate that ICT tools have gained popularity among the teachers of hearing impaired included in the study.

An exploratory study for the perception and attitude of internship program by students of speech and hearing

Background: The attitude and opinion of internship experience as reported by students can be a useful data for effective monitoring of any academic program. Such methods are common practice worldwide, e.g., ASHA publishes survey reports annually. The present project was aimed at evaluating the perception and attitude of students of the internship program of speech and hearing sciences at the graduate level of DrSRCISH. Methods: The data was from 75 intern students posted at different rehabilitation, diagnostic and school setups. The study used a self-administered questionnaire in digital form (Google form) which had 22 questions in multiple choice or true/false statements. The questionnaire had three sections-demographic, experiences of the internship, and shortcomings in the internship. Results: Completed forms were received from the 31 out of 75 subjects. The forms were available for internees for a period of one month. Return rate was 41%. Current internship is able to provide diversity of internship training. Institution, special schools and Hospitals were the highest choices with 23%. The results support the principles of internship as formulated by RCI and ASHA. i.e. internship is necessary for clinical training programs. Supervision received, infrastructure, case load and working hours received favourable rating. The least favourite part of internship postings was logistics or travel concerns. Conclusions: The results of the data depict the effectiveness of the internship program on the professional - personal growth and skills of the students of speech and hearing sciences. Multidisciplinary working atmosphere, learning new skills were the strength of the program.

Social anxiety among trainee audiologist and speech language pathologist in Bengaluru: a cross sectional study

Background: Audiologist and Speech language pathologist (ASLPs) are a group of professionals specialized in communication disorders. Their work responsibilities require them to be interacting with people with different backgrounds, education and ages who seek assistance from these young professionals. It is important to know whether the professionals who are meant to deal with individuals with communication disorders are themselves going through social anxiety or not. Methods: A questionnaire was prepared and was used for assessing social anxiety among trainee undergraduate and postgraduate ASLP’s. Data was collected via Google form further was analyzed using SPSS version 20.0. Results: Total 124 students participated in the study (20 males and 104 females). Cronbach’s test was administered to check the internal consistency of questionnaire. The overall questionnaire had a global alpha of 0.926 and global alphas for different scenarios of the questionnaire were 0.865 and 0.894 respectively indicating high internal consistency. The test retest stability for the total score found to be high with r =0.773and p<0.01. Social anxiety score differs significantly with respect to ‘Traumatic life events’ and ‘Age’. Conclusions: The study was able to deliver the answers to the questions of the researcher, that is, first, the study was able to assert the use of the questionnaire in the target population. Second, study found a statistically significant difference on anxiety scores between different scenarios i.e, social and professional life.

Performance of Tomato Hybrids Arka Abhed and Arka Samrat in Visakhapatnam District of Andhra Pradesh, India

The farmers of Visakhapatnam district were in a great need of best performing and high yielding tomato variety as the existing varieties are less yielders and highly succumb to pests and diseases. An On-Farm Trial (OFT) for three consecutive years (2020-21, 2021-22) was conducted by ICAR- ANGRAU, Krishi Vigyan Kendra, Kondempudi directly in the farmers’ fields of five selected villages viz. Bangurumeta, Adduru, Thotakurapalem, Pottidorapalem, Jaithavaram and Chedikada in Visakhapatnam district of Andhra Pradesh to evaluate the performance of two very promising tomato hybrids viz. Arka Abhed and Arka Samrat with regard to yield and economic analysis vis a vis the farmers’ practice variety Laxmi. A total of twenty-five farmers actively participated in the OFT covering an area of 7.5 acres. As regards fruit yield, the tomato hybrid Arka Abhed proved to be the best followed by Arka Samrat and Laxmi hybrid for all the three years of the study with fruit yields of 587.32, 569.13 and 409.14 q/ha, respectively. During the years of the trial, the fruit yields of Arka Abhed and Arka Samrat improved from 27.44 to 30.33% and 24.57 to 28.11%, respectively. Average cost-benefit ratios for three years for Arka Abhed, Arka Samrat and Laxmi hybrid were 1:2.30, 1:2.16 and 1:1.58, respectively. The Extension gap was between 111.18 to 183.86 and 129.08 to 202.83 q/ha for Arka Samrat and Arka Abhed, respectively. Results on Technology Index viz. 15.25, 19.47 and 28.83% for Laxmi (farmers’ practice), Arka Abhed and Arka Samrat, respectively, revealed that for both the tomato hybrids, there is viability of the demonstrated technology in the area of the OFT viz. Visakhapatnam district and the surrounding areas of north coastal Andhra Pradesh.

Evaluating the Effectiveness of Low Pressure Carbon Dioxide as a Hurdle in Raw Milk Storage

Aims: To evaluate the effectiveness of low pressure carbon dioxide as a hurdle in raw milk storage. Study Design: Milk samples were stored at under low pressure carbon dioxide at 29°C for 6 hours and the microbial quality of milk was compared with control milk. Place and Duration of Study: Department of Dairy Microbiology, Verghese Kurien Institute of Dairy and Food Technology (VKIDFT), Kerala Veterinary and Animal Sciences University, Mannuthy between January 2020 and December 2020. Methodology: Milk samples were collected from an organized farm. The initial microbial quality of milk was determined and samples were carbonated to a pressure of 20 psi and stored for six hours 29°C, uncarbonated milk sample kept at 29°C acted as the control. The microbial quality of the carbonated milk and uncarbonated milk was determined after storage in terms of total viable count, coliform count and gram negative organism count. Results: Significant growth suppression (P=0.05) of bacteria was observed in the carbonated milk. Total Viable count showed a suppression of 1.05 log cfu/ml while coliforms showed a suppression of 1.3 log cfu/ml. The greatest log reduction was observed in gram negative organisms with a difference of 2.2 log cfu/ml and psychrotrophic organisms with 1.54 log cfu/ml. Conclusion: Carbon dioxide was found to be an effective bacteriostatic agent which could be used for extending the keeping quality of raw milk. The bacteriostatic action could be due to anaerobic conditions developed by carbon dioxide and also due to the increased acidity of the medium.

Development of Automatic Fish Feeding Machine for Integrated Floating Cage Aquageoponic System

Aims: The objective of this work was to develop and evaluate the performance of an automatic fish feeder- to enhance aquacultural practices and farmponds Place and Duration of Study: The research study was conducted at Madakasira, (Latitude: 13°56?55.96? N and Longitude: 77°18?45.38? E) which is located in Anantapur district of Andhra Pradesh, India. The mean annual temperature and annual rainfall of the study area are 27.6°C and 532 mm, respectively. Most of the rainfall (~80%) is received during South-West monsoon. The experiment study was conducted from March?June, 2018. Methodology: Automatic fish feeder includes both electrical and mechanical mechanism. The materials includes for the development of the feeder was cone shape hopper, top covering lid, base, 12V DC motor, 12V 7Ah Rechargeable Lead Acid Battery, Arduino Uno, Bluetooth HC-05 module, 5v Relay, DC-DC step-down converter. The developed feeder was operated with the help of mobile app by using Bluetooth HC-05 module. The spreading distance and amount of feed spread, opening angles of the feeder were evaluated during the research period. Results: Our results showed that the amount of feed spread was maximum (140 g m-1) with 1.0 m height and was minimum (101 g m-1) at 0.2 m height. This results clearly shows that the fish feeder has to be kept at maximum height so that it covers maximum spreading distance with minimum loss of fish feed by drift. With increase in height of the machine from ground surface, the spreading distance of the fish feed from the feeding machine was also increased. Conclusion: Farmers were satisfied with this new technology which helps to avoid manual feeding and provides the clean environment.

Hepatoprotective Activity of 6-Heptadecylcyclohex -3-ene-1 Carboxylic Acid Isolated from the Methanol Extract of Dichrostachys cinerea Wight & Arn. Stem Bark

Aim of the Study: The phytoconstituent 6-heptadecylcyclohex 3-ene-1 carboxylic acid isolated from the methanol extract of Dichrotachys cinerea Wight. stem bark was evaluated for hepatoprotective activity against CCl4 induced toxicity. Materials and Methods: The constituent 6-heptadecylcyclohex 3-ene-1 carboxylic acid isolated from the methanolic extract of D. cinerea and the structure was confirmed by spectroscopic studies. Hepatoprotective property was screened in male wistar strain rats. The parameters studied were estimation of liver function serum markers such as serum total bilirubin, total protein, alanine transaminase, aspartate transaminase, alkaline phosphatase and histological profile of the liver tissue. Results: The LD50 of methanolic extract and constituent, 6-Heptadecylcyclohex -3-ene-1 carboxylic acid were evaluated and found to be 500 and 100 mg/kg body weight respectively. The hepatoprotective activity of constituent was more significant as similar to the standard hepatoprotective drug silymarin. The histological profile of the liver tissue showed the presence of normal hepatic cords, absence of necrosis and fatty infiltration as similar to the controls. Conclusion: The methanolic extract of D. cinerea stem bark and the phytoconstituent 6-heptadecylcyclohex-3-ene-1 carboxylic acid showed significant protection from CCl4 induced liver damage.

Preparation of Angiotico-2 (A-2) an Electrohomeopathic Remedy, its TLC, FTIR, Pharmacognocalogical, Phytochemical, Chemical, Heavy Metal, Pesticide, Food Additives and Microbial Screening for Safe Usage

To evaluate phytochemical, heavy metal, pesticide, microbial assay, and also FTIR studies of Angiatico-2 (A-2) an Electrohomeopathic remedy to evaluate safety and efficacy for its usage. Electrohomeopathy / Electropathy is one purely herbal medical system invented by Italian C. C. Mattie (1809-1896) has been practiced since the 1860s across the world. Electrohomeopathy has its own unique principles, plants selection, the process of remedies preparation, diagnosis, selection, and combination of drugs for different diseases, dosage, and treatment methods. In India, it is estimated that there are about 450-500 institutions imparting education and research, about 4.5 to 5 lacks practitioners are practicing and millions of population getting benefits currently. The government of India initiated steps to recognize Electrohomeopathy medical system under the constitution. Unfortunately, there is very limited scientific evidence to evaluate the safety, efficacy, phytochemical, and pharmacology studies in Electrohomeopathy. We prepared Angiatico-2 an Electrohomeopathic remedy as Mother Solution and D4 dilutions and evaluated it’s phytochemical screening, TLC, FTIR spectrum, Physical and Chemical nature, presence or absence of heavy metals, Pesticide, Food Additives and Microbial under NABL standards for its safety usage. Electrohomeopathic herbal remedy Angiatico-2 prepared by using 7 non poisonous plants by Krauss method under standard condition and not shown any heavy metals, pesticide presence and also no microbial presence above the limit level of FSSAI standard. Present studies of Electrohomeopathic herbal remedy Angiatico-2 preparation and its screening in standard scientific laboratory condition, TLC & FTIR studies may become reference standards for the manufacture of Angiatico-2 for bulk quantity at industrial level for. The present research investigations outcome with reproducibility may become standard markers or signatures to assess the quality and safe use of Angiatico-2.

Underwater Endoscopic Mucosal Resection for 10 mm or Larger Nonpedunculated Colorectal Polyps: A Systematic Review and Meta-Analysis

Background/Aims@#Recent studies have reported the favorable outcomes of underwater endoscopic mucosal resection (UEMR) for colorectal polyps. We performed a systematic review and meta-analysis evaluating the efficacy and safety of UEMR for nonpedunculated polyps ≥10 mm. @*Methods@#We performed a comprehensive search of multiple databases (through May 2020) to identify studies reporting the outcomes of UEMR for ≥10 mm nonpedunculated colorectal polyps. The assessed outcomes were recurrence rate on the first follow-up, en bloc resection, incomplete resection, and adverse events after UEMR. @*Results@#A total of 1276 polyps from 16 articles were included in our study. The recurrence rate was 7.3% (95% confidence interval [CI], 4.3–12) and 5.9% (95% CI, 3.6–9.4) for nonpedunculated polyps ≥10 and ≥20 mm, respectively. For nonpedunculated polyps ≥10 mm, the en bloc resection, R0 resection, and incomplete resection rates were 57.7% (95% CI, 42.4–71.6), 58.9% (95% CI, 42.4–73.6), and 1.5% (95% CI, 0.8–2.6), respectively. The rates of pooled adverse events, intraprocedural bleeding, and delayed bleeding were 7.0%, 5.4%, and 2.9%, respectively. The rate of perforation and postpolypectomy syndrome was 0.8%. @*Conclusions@#Our systematic review and meta-analysis demonstrates that UEMR for nonpedunculated colorectal polyps ≥10 mm is safe and effective with a low rate of recurrence.

Underwater Endoscopic Mucosal Resection for 10 mm or Larger Nonpedunculated Colorectal Polyps: A Systematic Review and Meta-Analysis

Background/Aims@#Recent studies have reported the favorable outcomes of underwater endoscopic mucosal resection (UEMR) for colorectal polyps. We performed a systematic review and meta-analysis evaluating the efficacy and safety of UEMR for nonpedunculated polyps ≥10 mm. @*Methods@#We performed a comprehensive search of multiple databases (through May 2020) to identify studies reporting the outcomes of UEMR for ≥10 mm nonpedunculated colorectal polyps. The assessed outcomes were recurrence rate on the first follow-up, en bloc resection, incomplete resection, and adverse events after UEMR. @*Results@#A total of 1276 polyps from 16 articles were included in our study. The recurrence rate was 7.3% (95% confidence interval [CI], 4.3–12) and 5.9% (95% CI, 3.6–9.4) for nonpedunculated polyps ≥10 and ≥20 mm, respectively. For nonpedunculated polyps ≥10 mm, the en bloc resection, R0 resection, and incomplete resection rates were 57.7% (95% CI, 42.4–71.6), 58.9% (95% CI, 42.4–73.6), and 1.5% (95% CI, 0.8–2.6), respectively. The rates of pooled adverse events, intraprocedural bleeding, and delayed bleeding were 7.0%, 5.4%, and 2.9%, respectively. The rate of perforation and postpolypectomy syndrome was 0.8%. @*Conclusions@#Our systematic review and meta-analysis demonstrates that UEMR for nonpedunculated colorectal polyps ≥10 mm is safe and effective with a low rate of recurrence.

Adverse drug reactions in patients taking anti tuberculosis therapy from directly observed treatment short course centre at Mandya Institute of Medical Sciences, Mandya: a cross sectional study

Background: Ending the tuberculosis (TB) epidemic by 2030 is among the health targets of the sustainable development goals. Side effects to anti-TB drugs are common and may lead to reduced compliance to treatment. These adverse effects must be recognized early to reduce associated morbidity and mortality. Objective of this study was to determine the adverse drug reactions (ADR) to anti-tubercular therapy among patients visiting directly observed treatment, short-course (DOTS) centre MIMS, Mandya.Methods: A cross sectional study was conducted at DOTS Centre MIMS, Mandya. TB patients registered at DOTS Centre during the year 2018 were selected for the study. Verbal informed consent was taken from the TB patients and interviewed using pretested semi-structured questionnaire. Data analysis was done using descriptive statistics and chi square test.Results: Among the study population (n=90), 67 (74.4%) experienced ADR among which 47.7% took treatment for ADR and the remaining 52.3% patients were given reassurance. In this study, gastrointestinal manifestations (42.3%) were the most common adverse drug reaction (ADR). Of the TB patients who experienced ADR, 9.0% of them had interrupted ATT, however they completed full course of ATT.Conclusions: A considerable number of TB patients taking ATT experience ADRs and some of them may have to interrupt treatment. However, they need to be counselled or supervised with caution to complete their course of treatment to reduce the chances of treatment default and also reduce the occurrence of drug resistance.

Efficacy and Safety of Lumen-Apposing Stents for Management of Pancreatic Fluid Collections in a Community Hospital Setting

Background/Aims@#Endoscopic ultrasound-guided transmural drainage and necrosectomy employing lumen-apposing metal stent (LAMS) are used for treating pancreatic fluid collections (PFCs) with excellent results from academic centers. Herein, we report the efficacy and safety of LAMS in the treatment of PFCs at a community hospital. @*Methods@#We retrospectively reviewed the etiology of pancreatitis, type and size of PFCs, length of procedure, technical success, clinical success, adverse events, and stent removal. The primary outcome was the rate of clinical success, and secondary outcomes were technical success and adverse events. @*Results@#Twenty-seven patients with a mean age of 54.1±6.5 years were included, 44% of which were men. The mean size of the PFCs was 9.7±5.0 cm (range, 3–21). The most common etiology of pancreatitis was alcohol (44%) followed by idiopathic causes (30%) and presence of gallstones (22%). The diagnosis was pseudocyst in 44.4% (12/27) and walled off necrosis in 55.6% (15/27) of patients. There was 100% technical success without any complications. Clinical success was achieved in 22 of 27 patients (81.5%) who underwent stent removal. @*Conclusions@#Our study is the first to report that endoscopic therapy of PFCs using LAMS is safe and effective even in a community hospital setting with limited resources and support compared to large academic centers.

Clinical study of reconstruction of devastating defects around the elbow region at a tertiary care hospital

Back ground: Devastating defects are those defects where the major structures like bones, joints, nerves, and blood vessels are exposed. These defects may be due to road traffic accidents, train traffic accidents, post burn scar contracture release raw area etc. Skin grafting or simple flaps may not help in these cases making reconstruction challenge. To study the various flap options for the coverage of the elbow defects and its outcomes. Materials and methods: From the period of 2016 to 2017, all patients with elbow defects that required local or locoregional flaps were chosen for the study. Investigations included plain X-ray of the elbow. Hand held Doppler was done for patients in whom the perforator based flaps were selected for reconstruction. Results: In our study (23 patients) were males and (4 patients) were females. The most common cause was the road traffic accident (18 patients). Two patients were due to a post burn contracture release raw area. One of the patients was due to a work place accidental injury. Six patients were due to train traffic accident and of which 5 patients presented with total amputation (stump raw area). The site of the wound played a major role in determining the flap selection. In our series, most of the patients presented with defects over lateral (6 patients) and posterior lateral (7patients) elbow region. Conclusion: Meticulous planning for their construction of devastating elbow defects is necessary to achieve satisfactory results. The choice between different flaps depends on the nature of the defect, availability of donor tissues and the patient’s needs.

Clinical study of pedicled sternocleidomastoid muscle flap interposition for cervical tracheo oesophageal fistula repair at a tertiary care hospital

Introduction: Tracheo Oesophageal Fistula (TEF) is a major cause of morbidity and mortality necessitating complex clinical evaluation and decision making for optimal management. It is best treated in a specialty tertiary care setting by a multidisciplinary team approach. In acquired nonmalignant causes of airway-oesophageal fistulas, the patients suffer from significant morbidity due to recurrent pulmonary sepsis. These diseases are complex and mandate critical preoperative evaluation for optimal management. Prolonged endotracheal intubation combined with a nasogastric tube may lead to a TEF. This results from pressure necrosis generated by a ventilating cuff in the trachea and a prolonged feeding tube in the esophagus. Aim of the study: To study the results of function preserving pedicled perforator based sternocleidomastoid muscle as an inter position flap after primary repair of cervical tracheaoesophageal fistula. Materials and methods: The study was conducted from the period of one year from 2015-2016 at IRRH and Plastic Surgery Department of Government Stanley Medical College, Chennai. Totally 15 patients were included in the study. Patients with clinical presentation were evaluated, a pre operative P.S. Ganesh Babu, T.M Balakirshnan, Ramadevi. Clinical study of pedicled sternocleidomastoid muscle flap interposition for cervical tracheo oesophageal fistula repair at a tertiary care hospital. IAIM, 2017; 4(9): 105-109. Page 106 investigation like Bronchoscopy, OGD MRI, CECT of the neck was taken. All patients with tracheal oesophageal fistula in the cervical region following corrosive poisoning (organophosphates) on prolonged intubation who under went closure with the pedicled sternocleidomastoid muscle as an interposition flap. Results: All patients diagnosed with Tracheo oesophageal fistula following corrosive poisoning on prolonged intubation were included. (N = 15). The study period was from 2015 to 2016. Patient’s demographic data and clinical course were closely monitored and recorded. All Patients recovered well. Oral feeding started (liquids) on 4th post-operative day after doing gastro Graffin study, and solids on the 10th day. No recurrence in 1 year follows up. Conclusion: In our technique, we maintained the intramuscular cock screw perforators from the transverse cervical artery. This constant anatomy favored us to use sternal head component separate from the clavicular head and interposed them between the repaired trachea and esophagus. Preserving the clavicular head of SCM maintains the form and function of the muscle. The vascularized muscle flap prevents both tracheal and oesophageal strictures and stenosis.

A Comparative Study of Temporalis Fascia versus Tragal Peri-chondrium as Graft in Repair of Tympanic Membrane Perforation

The perforations of the tympanic membrane may be of traumatic origin or due to chronic suppurative otitis media. If the perforations fail to heal conservatively, they require surgical closure. Autologous graft materials have stood the test of time in repairing tympanic membrane perforations. In our tertiary care institution, we conducted a prospective randomised control trial on 20 subjects to evaluate the comparative efficacy of temporalis fascia and tragal perichondrium as grafting material in underlay tympanoplasty. In this study, surgical success was evaluated in terms of intact drum membrane and minimal complications during the follow-up period. Temporalis fascia achieved a graft uptake of 90% and a satisfactory hearing improvement in 76% of the patients with minimal postoperative complications. Tragal perichondrium achieved a success rate of 80% graft uptake and 75% hearing gain. The rates are comparable with no statistical significance of difference between them.