Normal Serum Levels of Otolin-1 in Patients with Meniere Disease in Remission

Abstract Introduction Degenerative changes in the otolithic organs have been theorized to be caused by the mechanical obstruction to endolymphatic flow, possibly resulting in endolymphatic hydrops (ELH). Otolin-1 is an otoconial matrix protein that crosses the blood labyrinth barrier and has been found in the serum of healthy and diseased patients. Objective To measure the serum levels of Otolin-1 in Meniere disease (MD) patients and compared them with the healthy individuals. Methods This pilot, cross-sectional study was performed at our tertiary care referral center to compare the serum Otolin-1 levels of healthy individuals with those of MD patients. The blood samples were obtained during patients' visit to the vertigo clinic following remission of an acute episode. The data was analyzed using the Stata/SE version 12.0 (StataCorp. College Station, TX, USA). Comparison between the serum Otolin-1 levels in the two groups was performed using the unpaired t-test. A p-value of 0.05 was considered to be statistically significant. Results The participants were divided into two groups, with 31 MD patients, and 30 age and gender-matched members of the control group. The serum levels of Otolin-1 in MD patients (247.6, ± 44.2 pg/ml) were not found to be significantly different from those of the control group (236.2, ± 43.5 pg/ml) (p = 0.31). Conclusion The current study reveals that the serum levels of Otolin-1 are not significantly different between the patients with MD in the interictal phase and the control group's healthy ones.

Covid-19-associated rhino-orbito-cerebral mucormycosis (CAROM) in Delhi: Demographics and risk factors in a single-centre consecutive cohort of 200 inpatients

BACKGROUND There was a dramatic rise in the incidence of rhino-orbito-cerebral mucormycosis associated with the 2021 Covid-19 wave in India. We aim to document the demographic characteristics and risk factors of a consecutive cohort of inpatients with Covid-19-associated rhino-orbito-cerebral mucormycosis (CAROM) during the surge of April–June 2021. METHODS We included all patients of CAROM treated at our tertiary referral facility from 1 April to 14 June 2021. We prospectively gathered details with regard to Covid-19 illness and treatment, CAROM presentation, comorbid conditions and risk factors. RESULTS Our prospective cohort consisted of 200 consecutive patients, of which 146 (73%) patients tested positive on the Covid-19 RT-PCR test at presentation. CAROM occurred concurrent with the Covid-19 infection in 86%, and delayed CAROM after seeming recovery from Covid-19 was seen in 14%. Covid-19 was classified as mild, moderate and severe in 54%, 33% and 13%. The surge of CAROM followed the population peak of Covid-19 infections by about 3 weeks. Advanced disease at presentation was frequent with ocular involvement in 56.6% (111/196) and central nervous system involvement in 20% (40/199). One or more comorbid conditions were identified in 191/200 (95.5%) patients. The dominant associations were with diabetes (189/200; 94.5%) and uncontrolled hyper-glycaemia (122/133; 91.7%), recent steroid use (114/ 200; 57%), which was often considered as inappropriate in dosage or duration, lymphopenia (142/176; 80.7%), and increased ferritin levels (140/160; 87.5%). No evidence supported the role of previous oxygen therapy or previous nasal swab testing as risk factors for CAROM. CONCLUSION The inpatient volumes of CAROM were noted to parallel the Covid-19 incidence curve by about 3 weeks. Covid-19 infection may directly predispose to CAROM by way of lymphopenia and increased ferritin levels. Uncontrolled hyperglycaemia is identified as a near-invariable association. Recent steroid use is noted as very frequent and was often received in excess of treatment advisories.

Radiographic Measurement of Cochlear Duct Length in an Indian Cadaveric Population - Importance of Custom Fit Cochlear Implant Electrodes

Abstract Introduction Successful cochlear implantation requires an appropriate insertion depth of the electrode, which depends on cochlear duct length CDL). The CDL can vary due to ethnic factors. Objective The objective of the current study was to determine the CDL in an Indian adult cadaveric population. Methods The present was a cadaveric study using the temporal bones obtained after permission of the Institutional Review Board. The temporal bones were subjected to high-resolution computed tomography (HRCT), and the double oblique reformatted CT images were reconstructed through the basal turn of the cochlea. The reformatted images were then viewed in the minimum-intensity projection (minIP) mode, and the 'A' value (the diameter of the basal turn of the cochlea) was calculated. The CDL was then measured using the formula CDL = 4.16A - 4 (Alexiades et al). The data analysis was performed using the Microsoft Excel software, version 2016. Results A total of 51 temporal bones were included for imaging analysis. The CDL varied from 27.6 mm to 33.4 mm, with a mean length of 30.7 mm. There was no statistically significant difference between the two sides. Conclusion The CDL can be calculated with preoperative high-resolution CT, and can provide a roadmap for effective cochlear implant electrode insertion. The population-based anatomical variability needs to be taken into account to offer the most efficient and least traumatic insertion of the electrode.

Clinical Profile of Patients with Head and Neck Amyloidosis: A Single-Institution Retrospective Chart Review

Abstract Introduction Isolated amyloidosis involving the head and neck is a rare entity. The pathophysiology of the localized disease appears to be distinct from that of the systemic counterpart. Systemic progression of the localized disease is unusual, and the prognosis of the localized form is excellent. Objective To describe the demographic and clinicopathological characteristics of patients presenting with localized head and neck subsite amyloidosis. Methods A retrospective chart review of the patients with head and neck amyloidosis identified by the electronic search of the electronic database of the Departments of Pathology and Otorhinolaryngology was performed. The various demographic and clinical data were tabulated. Results In total, seven patients (four females, three males) with localized head and neck amyloidosis (three supraglottic, three lingual and one sinonasal) were identified. Six patients had AL-amyloid deposits, and one patient had AA-amyloid deposits. Supraglottic involvement and that of the base of the tongue were treated surgically using CO2 laser, and these patients were disease-free at the last follow-up. The patient with sinonasal amyloidosis experienced symptom recurrence after six months of the functional endoscopic sinus surgery. All of the patients were screened for systemic amyloidosis with abdominal fat pad biopsy, and were found to be free of systemic spread. Conclusion Isolated head and neck amyloidosis, as opposed to systemic amyloidosis, has an excellent prognosis in terms of survival. Therefore, systemic amyloidosis should be excluded in all cases. The treatment of choice remains surgical excision; however, watchful waiting may be a suitable strategy for mild symptoms or for cases in which the disease was discovered incidentally.

Study of Sigmoid Sinus Variations in the Temporal Bone by Micro Dissection and its Classification - A Cadaveric Study

Abstract Introduction Sigmoid sinus (SS) variations have been classified variously in the literature. These classifications suffer from some form of shortcoming from a clinical point of view for their application. Objective We propose a clinically relevant classification of the SS in relation to the posterior semicircular canal (PSCC) and to the exposure of the presigmoid dural plate. The positioning of the SS was analyzed with reference to the volume of themastoid and to the level of mastoid pneumatization. Methods A total of 94 formalin-preserved human cadaveric temporal bones were microdissected to carry out a complete mastoidectomy. The SS, the presigmoid dural plate, and the PSCCwere exposed, and the position of the former was analyzed in relation to the latter two in order to classify the position of the SS into three grades. Results GradeI hadthebest exposureof the presigmoid dura andof the PSCC,while grade III had the poorest exposure of the presigmoid dura and of the PSCC. Grade I SS was associated with good pneumatization and highermastoid volumescompared with grades II and III. Conclusions The SS exhibits considerable anatomic variability. A favorable positioning of the SS is associated with a large mastoid volume and pneumatization. A careful preoperative study of the imaging may help in understanding the positioning of the SS and the safety of various transmastoid approaches.

Evaluation of Dental CBCT in Assessing the Furcation Involvement in Mandibular Molars

Furcation involvement (FI) refers to the invasion of the bifurcation and trifurcation areas of multi-rooted teeth by periodontal disease. Diagnosis of FI by 2D radiographs can be overcome by the use of cone-beam computed tomography (CBCT) imaging technique. Objective: To compare the measurements of furcation depth by clinical method and CBCT in assessing the FI. Methods: The present study comprised of 60 furcation involved mandibular molars from 45 patients suffering from Chronic Generalized Severe Periodontitis. Teeth having probing pocket depth of ≥6mm were considered for the study. Clinical measurements of furcation depth were made on buccal or lingual sides of mandibular molars by using endodontic file with stopper which was done by two clinicians. The CBCT measurements were performed by measuring the deepest vertical and horizontal furcation defects at each furcation entrance. These measurements were then recorded, compiled and statistically analysed. Results: The comparison of furcation involvement clinically by clinician 1 and CBCT measurements in buccal side was statistically significant (p=0.0255*), while it was statistically not significant (p=0.3696 NS) on lingual side. Similarly, the comparison of furcation involvement clinically by clinician 2 and CBCT measurements in buccal side was statistically significant (p=0.0278*), while it was statistically not significant (p=0.4951 NS) on lingual side. Conclusion: CBCT technique can be considered a reliable tool for detecting FI as CBCT imaging showed high accuracy and moderate reproducibility in the assessment of furcation depth.

Study of Assessment of Patient Satisfaction in Outpatient Clinic of Newly Created Department of Geriatric Medicine in a Tertiary Care Hospital: A Questionnaire based Cross Sectional Study

Introduction: Patient satisfaction is cornerstone parameter toevaluate the service of any hospital. This study was plannedto assess the level of satisfaction among patients attendingGeriatric outdoor clinic in a tertiary care government healthfacility.Material and Methods: A pilot cross‑sectional study wasconducted among 100 eligible geriatric patients attendinga government health care facility in Eastern Uttar PradeshIndia during December, 2018 and January 2019 usinga semi‑structured questionnaire covering factors likeinterpersonal manner of health service providers, accessibility,physical environment, and quality of medical care. Descriptivestatistics such as mean, standard deviation, percentiles, andpercentages were generated and Chi‑square. test was appliedto look for association between the level of satisfaction andother variables such as income, gender, education and age.Ethical approval was obtained from the Institutional EthicsCommittee.Results: Out of 100 patients, males were 60 and females were40 with average age of 62.24 + 9.25 years. Medium satisfactionlevel was found in 56% and low and high satisfaction was foundin 23% and 21% patients respectively. Quality, accessibilityand interpersonal played a major role in affecting averagesatisfaction score. It was also found that other two domainsof questionnaire such as availability of resources and physicalenvironment needs to be improved and emphasized more inorder to get high level of patient satisfaction.Conclusion: Although the overall satisfaction level of patientswas moderate to high still there is need to strengthen themanpower in outdoor clinic with better environment. Anotherfocus area is better referral services and a safe environmentso that the outdoor is in reach of elderly patients in order toimprove the quality of care provided.

Ectopic Supernumerary Tooth As A Nidus For Rhinolith Formation

Rhinolith is a calcified irregular mass around an exogenous or endogenous nidus. Factors responsible for the formation of rhinolith are chronic inflammation around nidus, deposition of mineral salts and enzymatic activity of bacterial pathogens. We report the case of a 53-year-old patient with a hard radio-opaque mass in the nasal cavity and complaints of nasal obstruction and foul-smelling nasal discharge. On imaging, it was found out to be formed around an ectopic single cusp tooth in the nasal cavity and which is rarest. Endoscopic removal was performed and the patient was relieved and asymptomatic after the procedure. Hence, endogenous etiology of the ectopic supernumerary tooth should be kept in mind

Estimation of gingival blood glucose using a sensitive self-monitoring device in periodontitis patients

Background: Diabetes Mellitus is a complex disease with varying degree of systemic and oral complications. The prognosis is quite favorable if a disease is diagnosed in early stages. Since a large number of patients seek dental treatment routinely, screening procedures for early detection of subclinical cases can help in diagnosis of asymptomatic diabetes. Aim: The present study was undertaken to evaluate if gingival crevicular blood can be used for the estimation of blood glucose levels in periodontitis patients. Material and Methods: A prospective study was carried out comprising 150 patients Group A comprised of 75 subjects with gingivitis and group B comprised of 75 subjects with periodontitis. For gingival crevicular blood glucose (GCBG) level estimation, the blood was drawn onto the glucometer strip after gently probing the gingival sulcus and the readings were recorded. At the same time, blood Vijayendra Pandey, Akhilesh Chandra, Deepak Kumar, Anup Kumar Singh, Priyankesh, Alok Kumar Gupta. Estimation of gingival blood glucose using a sensitive self-monitoring device in periodontitis patients. IAIM, 2019; 6(6): 51-56. Page 52 was also collected from the index finger onto the glucometer strip for the capillary finger-prick blood glucose (CFBG) sample. Both the values were compared and statistical analysis of data was performed. Results: The mean GCBGL and CFBGL in group A was 98.43 mg/dl ± 18.62 and 103.48 mg/dl ± 13.90 respectively, while in group B it was 136.37 mg/dl ± 36.95 and 141.62 mg/dl ± 51.84, respectively. There was no statistically significant difference (p> 0.05) between the two values in both the groups. Conclusion: It can be concluded that GCBG levels are positively correlated with CFBG levels. Therefore, clearly indicating that gingival crevicular blood collected during diagnostic periodontal examination may be an excellent source of blood sample for glucometric analysis.

Correlative study of serum hepcidin levels and serum iron reserve parameters in preeclampsia and HELLP syndrome

HELLP syndrome is described as a special group of severe preeclampsia characterized by haemolysis (H), elevated liver enzymes (EL) and low platelets (PL), whereas preeclampsia is a disease of unknown etiology characterized by hypertension and proteinuria after the 20th week of gestation. The objective of the study was to evaluate the level of hepcidin in the serum of the patient suffering from HELLP syndrome and preeclampsia. It was done by competitive sandwich ELISA which assesses the serum level of hepcidin in the forty patients suffering from preeclampsia and HELLP syndrome (as cases) and forty healthy individuals (as control). The results of our study showed that serum hepcidin levels were significantly increased among the cases (P =0.00171) in comparison to control (P <0.05) and transferrin saturation levels were significantly decreased (P <0.05) among the cases (P =0.001) in comparison to controls. The decrease in transferrin saturation indicates that there is low serum iron level among the cases. It was concluded that increased hepcidin level may be the cause of anemia among the cases.

Manifestations of pulmonary disease in adults with congenital heart disease.

Children with congenital heart disease (CHD) are more frequently living into adulthood as their survival has improved due to availability of better medical and surgical management in recent times. Management of adults with CHD is emerging as new challenge in the field of medical science. Adults surviving with CHD for longer duration have been observed to develop more complications as compared to children. It is important to recognise and treat these complications early to reduce the morbidity. Pulmonary diseases are the most common systemic complications associated with adults having CHD. These individuals are presenting to clinics or emergency for pulmonary complaints, hence, pulmonologist must be aware about the pulmonary manifestations of CHD and their management.

A review on spice of life curcuma longa (turmeric).

Curcumin obtained by solvent extraction of turmeric i.e., the ground rhizomes of Curcuma longa L. belonging to family Zingiberaceae and most useful herbal medicinal plant. Extensive research within the last half a century has proven that most of these activities, associated with turmeric are due to curcumin. Curcumin has been shown to exhibit various diseases such as anti- inflammatory, anti-oxidant, antifungal. Antimicrobial, antiulcer, anticancer and hepatoprotective activities and thus has a potential against various malignant diseases, diabetes, allergies, arthritis, Alzheimer’s disease and other chronic diseases. These effects are mediated through the regulation of various transcription factors, growth factors, inflammatory cytokines, protein kinase and other enzymes remarkably non-toxic. The purpose of this review is to provide a brief summary of the current knowledge of the effects of curcumin. Curcumin exhibits great promise as a therapeutic agent, and is currently in human clinical trials for a variety of conditions. Since multi targeted therapy is more effective than the mono targeted therapy, curcumin has promising scope in the future research.