Comparative Efficacy of Epley, Semont and Gans Maneuver in Treating Posterior Canal Benign Paroxysmal Positional Vertigo.

Pharmacological therapies are used to control Benign paroxysmal positional vertigo (BPPV) symptoms for a brief period, discontinuing them usually results in recurrence. Canalolith repositioning maneuvers, including Epley, Semont, and Gans maneuvers, have been recommended for treating posterior canal BPPV with a high rate of success. A prospective, quasi-randomized study was carried out to compare the efficacy of Epley, Semont, and Gans maneuvers in the treatment of posterior canal BPPV and their durability. All patients over the age of 20 who met the BPPV diagnostic criteria, regardless of gender, were included in the study. Diagnosis of BPPV was done by Dix Hallpike maneuver. Typical posterior canal BPPV, the most frequent form of BPPV, is characterized by paroxysmal nystagmus evoked through the Dix-Hallpike test; the nystagmus is torsional clockwise for the left side, counter-clockwise for the right side, with a vertical up-beating component. The patients were uniformly quasi-randomized in a 1:1:1 ratio to be treated with Epley, Semont, and Gans maneuvers. After performing the maneuver, the patients were again subjected to the Dix-Hallpike test. Based on the result of the Dix-Hallpike test's positivity, the maneuvers were repeated up to three times. All the patients were called for a reassessment 30 days after the last intervention to assess the durability of the maneuver. In the study, 54.44% (49) of the 90 patients were female, whereas 45.56% (41) were male. Overall, 83.33% (75) of patients required only one attempt, 15.56% (14) required two attempts, and 1.11% (1) required three attempts to improve. In the Epley maneuvers group, 86.66% (26) required only one attempt, 10% (3) required two attempts, and 3.33% (1) required three attempts. Similarly, 83.33% (25) required only one attempt in the Gans maneuvers group, and 16.67% (5) required two attempts. In Semont maneuver groups, 80% (24) required only one attempt, and 20% (6) required two attempts. The recurrence of the symptoms was seen in a total of 11 patients: 27.27% (3 patients) of the Epley maneuvers group, 36.36% (4 patients) of the Gans maneuvers group, and 36.36% (4 patients) of the Semont maneuvers group. All three maneuvers show equal efficacy in reducing vertigo. The Epley maneuver may be more relevant in the treatment of BPPV compared to others, considering the slightly higher improvement rate and the requirement for fewer attempts for the treatment.

Recurrent Angiolymphoid Hyperplasia with Eosinophilia of the Parotid.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign vasculoproliferative disorder. It usually affects young adults presenting as papules or nodules involving the skin of head and neck region and rarely involves extracutaneous sites. ALHE involving parotid is rare and can be a diagnostic dilemma as it mimics a parotid neoplasm. This is a case of a 23 year old male presenting with a recurrent swelling over the left parotid region post surgery. Ultrasonography revealed a vascular soft tissue lesion in the preauricular region suggestive of a benign lesion. Contrast enhanced magnetic resonance imaging showed a hyperintense lesion involving the superficial lobe of the left parotid gland. Patient underwent superficial parotidectomy and histopathologically was diagnosed to have ALHE. Very few cases have been reported and this case is highlighted as the facial nerve was enmeshed by the intraparotid lesion which was a surgical challenge.

Does eosinophilic esophagitis exist in India?

Eosinophilic esophagitis (EoE) has evolved over the last three decades with a better understanding of the natural course of the disease. The prevalence of EoE is higher in Western countries with increasing reports of the incidence of EoE in the east. There is less data on EoE in India. We have noticed an increase in the number of cases of EoE diagnosed in our center over the last few years. In this study, all patients with high clinical suspicion of EoE were included and prospectively evaluated with endoscopic features and esophageal biopsies. Seventeen of 73 patients were diagnosed with EoE based on clinical, endoscopic and histopathologic features. One patient was lost to follow-up and 16 of the 17 patients were initiated on standard-of-care treatment and followed up for a minimum of four weeks. Treatment with proton pump inhibitors with six-food elimination diet is highly effective in most patients with a few patients requiring systemic steroids and endoscopic treatment. In conclusion, this study highlights that EoE exists in India with varied manifestations and a high index of clinical suspicion is necessary for diagnosis. It also emphasizes the need for increasing awareness of the entity of EoE, among both patients and doctors. Further, large-scale, multi-centric population-based studies are necessary to estimate the prevalence in our country.

Biowaste-Derived, Highly Efficient, Reusable Carbon Nanospheres for Speedy Removal of Organic Dyes from Aqueous Solutions.

The current work explores the adsorptive efficiency of carbon nanospheres (CNSs) derived from oil palm leaves (OPL) that are a source of biowaste. CNSs were synthesized at 400, 600, 800 and 1000 °C, and those obtained at 1000 °C demonstrated maximum removal efficiency of ~91% for malachite green (MG). Physicochemical and microscopic characteristics were analysed by FESEM, TEM, FTIR, Raman, TGA and XPS studies. The presence of surface oxygen sites and the porosity of CNSs synergistically influenced the speed of removal of MG, brilliant green (BG) and Congo red (CR) dyes. With a minimal adsorbent dosage (1 mg) and minimum contact time (10 min), and under different pH conditions, adsorption was efficient and cost-effective (nearly 99, 91 and 88% for BG, MG and CR, respectively). The maximum adsorption capacities of OPL-based CNSs for BG were 500 and 104.16 mg/g for MG and 25.77 mg/g for CR. Adsorption isotherms (Freundlich, Langmuir and Temkin) and kinetics models (pseudo-first-order, pseudo-second-order and Elovich) for the adsorption processes of all three dyes on the CNSs were explored in detail. BG and CR adsorption the Freundlich isotherm best, while MG showed a best fit to the Temkin model. Adsorption kinetics of all three dyes followed a pseudo-second-order model. A reusability study was conducted to evaluate the effectiveness of CNSs in removing the MG dye and showed ~92% efficiency even after several cycles. Highly efficient CNSs with surface oxygen groups and speedy removal of organic dyes within 10 min by CNSs are highlighted in this paper.

Garlic peel based mesoporous carbon nanospheres for an effective removal of malachite green dye from aqueous solutions: Detailed isotherms and kinetics.

Biowaste based nanoadsorbents have gained much attention in the recent times for wastewater decolourization owing to their low cost, high surface area and high adsorption capacities. In the present research, garlic peel based nanoparticles (GCNP) were synthesized at different temperatures by a one step pyrolytic green approach for the effective removal of cationic dye, malachite green from the aqueous medium. The surface properties of Garlic nanoparticles were elucidated by N2 adsorption- desorption and all the GCNP samples were found to exhibit Type IV(a) isotherm indicating the presence of mesopores in carbon matrix. Using BET calculations, highest surface area (380 m2/g) was obtained for GCNP synthesized at 1000 ◦C. Characterization of nanoparticles was done by XRD, EDAX, SEM and FTIR studies before and after the dye treatment. Adsorption studies conducted using different parameters like contact time, concentration and pH and dosage of adsorbent showed removal efficiency above 90% for the contact time of 70 min. Best adsorption experimental results were obtained for GCNP synthesized at 1000 °C ascribable to its high surface area, higher total pore volume (0.26 cm2/g) and higher carbon content. Four adsorption isotherm models were used to validate batch equillibrium studies and the results showed data in good agreement with Langmuir and Freundlich isotherms with maximum Langmuir adsorbtion capactiy to be 373.7 mg/g. Kinetic modelling of the data showed best fit with the Pseudo second order model with rate constant value of 48.726 g mg-1 min-1. Regenerative studies were conducted conducted upto 6 cycles. Also the GC nanoparticles were tested for their compatibility in membrane form wherein, removal efficiency results were obtained for GCNP anchored in polyvinyl difluoride (PVDF) and polysulfone (PSF) membrane matrix for dye adsorption.

Non-enzymatic electrochemical determination of salivary cortisol using ZnO-graphene nanocomposites.

Electrochemically deposited ZnO nanoparticles on a pencil graphite electrode (PGE) coated with graphene generate a noteworthy conductive and selective electrochemical sensing electrode for the estimation of cortisol. Electrochemical techniques such as cyclic voltammetry (CV) analysis and electrochemical impedance spectroscopic (EIS) tests were adopted to analyze and understand the nature of the modified sensor. Surface morphological analysis was done using various spectroscopic and microscopic techniques like X-ray photoelectron spectroscopy (XPS), transmission electron microscopy (TEM), and scanning electron microscopy (SEM). Structural characterization was conducted by X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR). The effect of scan rate, concentration, and cycle numbers was optimized and reported. Differential pulse voltammetric (DPV) analysis reveals that the linear range for the detection of cortisol is 5 × 10-10M - 115 × 10-10 M with a very low-level limit of detection value (0.15 nM). The demonstrated methodology has been excellently functional for the determination of salivary cortisol non-enzymatically at low-level concentration with enhanced selectivity despite the presence of interfering substances.

Mesoporous carbon nanospheres derived from agro-waste as novel antimicrobial agents against gram-negative bacteria.

Porous carbon nanospheres were synthesized from agro-waste garlic peels by a one-pot facile and easy to scale-up pyrolysis method. Surface morphology and structural features of the nanospheres have been studied by field emission scanning electron microscopy, energy-dispersive spectroscopy, X-ray diffraction, and Raman spectroscopy. Fourier transform infrared spectroscopy (FTIR) and N2 adsorption desorption experiments were explored to detect surface functionality, surface area, and porosity. Average particle diameter of the synthesized nanospheres was 31 ± 6.3 nm and zeta potential of - 25.2 mV ± 1.75 mV. Nanoscale carbon was mesoporous in nature with type IV isotherms, mean pore diameter of 15.2 nm, and total pore volume of 0.032 cm3/g. Minimum inhibitory concentration and minimum bactericidal concentration values of carbon nanospheres against Escherichia coli are 480 ± 0.5 µg/ml and 495 ± 0.5 µg/ml, respectively. Synthesized nanospheres exhibited gram-selective antimicrobial action against Escherichia coli probably linked to membrane deformity due to interaction of nanocarbon with the bacterial membrane. Carbon nanospheres resulting from waste to wealth transformation emerged as promising candidates for antibacterial application. Graphical abstract.

Utility of bowel ultrasound in assessing disease activity in Crohn's disease.

BACKGROUND: Gastrointestinal ultrasound (GIUS) has been used increasingly for monitoring inflammatory bowel disease (IBD) patients. The aim of this study was to assess the utility of GIUS in assessing disease activity in Crohn's disease (CD). METHODS: Consecutive patients with CD (diagnosis established for at least 6 months) between July 2017 and July 2018 requiring assessment of disease activity were prospectively assessed by magnetic resonance enterography, colonoscopy (CS), and GIUS within a 2-week period and without any change in ongoing treatment. Features on GIUS which correlated with disease activity were assessed. Sensitivity and specificity of the GIUS in assessing disease activity and localization were calculated. RESULTS: Thirty-five patients were enrolled in the study. Bowel wall thickness (BWT) ≥ 3 mm and Doppler activity ≥ 2 had the highest sensitivity (100% and 95.6%, respectively) for detecting active disease on CS. BWT ≥ 3 mm had sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 83.3%, 92%, and 100%, respectively for assessing active disease. Combination of median BWT, Doppler activity, and loss of bowel wall stratification correlated with simplified endoscopic score (SES) for CD (r = 0.8, p 0.009) and Harvey-Bradshaw index (HBI, r = 0.76, p 0.04). For localizing active disease in the ileum, GIUS had a sensitivity of 93.7%, 80% for lesions in the right colon, 100% for transverse colon, and 89% for the left colon. Specificity was 100% for ileal and colonic lesions. CONCLUSION: Loss of stratification, BWT, and Doppler activity in the bowel wall correlate with endoscopic and clinical disease activity in CD. GIUS is a sensitive modality in assessing disease activity in CD.

Unique Host Matrix to Disperse Pd Nanoparticles for Electrochemical Sensing of Morin: Sustainable Engineering Approach.

Biomass-based carbon nanospheres derived from Mimosa pudica (commonly called "Touch-me-not") smeared on carbon fiber paper have been used as a host matrix for electrochemical deposition of palladium nanoparticles. The physicochemical characterization of modified electrodes was performed by field emission scanning electron microscopy, energy-dispersive X-ray spectroscopy, X-ray diffraction spectroscopy, transmission electron microscopy, and X-ray photoelectron spectroscopy techniques. Cyclic voltammetry and electrochemical impedance spectroscopy were used to study the electroanalytical properties of the electrodes. The modified electrode demostrated an excellent electrocatalytic activity for the oxidation of a flavonoid, morin, which gave a sensitive anodic peak at -0.30 V (vs SCE). An ultralow-level detection limit of 572 fM with a linear dynamic range of 37.50-130 pM was achieved. The proposed electrochemical sensor was successfully employed for the analysis of morin in mulberry and guava leaves. This is a sustainable engineering approach where a perfect unique host matrix is created using carbon nanospheres from biomass.

Reliability of Thyroid FNAC as a Single Diagnostic Modality: A Systematic Review.

To determine the reliability of thyroid FNAC as a single diagnostic modality in the case of nodular neoplastic lesions of the thyroid. Multiple databases were searched using the MESH terms thyroid*lesion*nodule*neoplasm*fine needle aspiration*histopathology*correlation. Meta analyses, RCTs, cohort or case control studies and case series were searched. 61 studies were examined to verify the search results after applying the inclusion and exclusion criteria. 422 studies were excluded after the first screening, leaving 61 full text articles. These were further analyzed for outcomes, and ultimately 9 studies were chosen for the final synthesis on the basis of clear recommendations given. FNAC as a single modality for the diagnosis of nodular neoplastic thyroid lesions is highly variable and therefore unreliable. The diagnostic yield may be improved if the Bethesda system of reporting is applied.

Stable silicon-ionic liquid interface for next-generation lithium-ion batteries.

We are currently in the midst of a race to discover and develop new battery materials capable of providing high energy-density at low cost. By combining a high-performance Si electrode architecture with a room temperature ionic liquid electrolyte, here we demonstrate a highly energy-dense lithium-ion cell with an impressively long cycling life, maintaining over 75% capacity after 500 cycles. Such high performance is enabled by a stable half-cell coulombic efficiency of 99.97%, averaged over the first 200 cycles. Equally as significant, our detailed characterization elucidates the previously convoluted mechanisms of the solid-electrolyte interphase on Si electrodes. We provide a theoretical simulation to model the interface and microstructural-compositional analyses that confirm our theoretical predictions and allow us to visualize the precise location and constitution of various interfacial components. This work provides new science related to the interfacial stability of Si-based materials while granting positive exposure to ionic liquid electrochemistry.

Deroofing of auricular pseudocyst: our experience.

AIM: To ascertain a definitive treatment modality for a frequently recurring condition, pseudocyst of pinna in the form of deroofing and compression. MATERIALS AND METHODS: Thirty patients were diagnosed with pseudocyst of pinna from July 2011 to March 2013. All 30 patients underwent surgical deroofing of the pseudocyst along with compression by buttoning. The patients were followed up for a period of six months Results: No recurrence was seen in 29 patients in the follow up period of six months (96.7%). One patient had recurrence 15 d following the procedure. The recurrence in the case could be attributed to the usage of improper buttons for compression. CONCLUSION: Despite numerous treatment options for pseudocyst of pinna, there remains high recurrence rate in patients. Additionally, some treatments carry the risk of cartilage damage or visible distortion of the auricle. Surgical deroofing followed by compression using buttons can be considered as first line treatment of this entity as it is associated with very less rate of recurrence and gives a cosmetically acceptable result.

Ionic liquid enabled FeS2 for high-energy-density lithium-ion batteries.

High-energy-density FeS2 cathodes en-abled by a bis(trifluoromethanesulfonyl)imide (TFSI-) anion-based room temperature ionic liquid (RTIL) electrolyte are demonstrated. A TFSI-based ionic liquid (IL) significantly mitigates polysulfide dissolution, and therefore the parasitic redox shuttle mechanism, that plagues sulfur-based electrode chemistries. FeS2 stabilization with a TFSI(-) -based IL results in one of the highest energy density cathodes, 542 W h kg(-1) (normalized to cathode composite mass), reported to date.

Thermal treatment effects on charge storage performance of graphene-based materials for supercapacitors.

Graphene materials were synthesized by reduction of exfoliated graphite oxide and then thermally treated in nitrogen to improve the surface area and their electrochemical performance as electrical double-layer capacitor electrodes. The structural and surface properties of the prepared reduced graphite oxide (RGO) were investigated using atomic force microscopy, scanning electron microscopy, Raman spectra, X-ray diffraction pattern analysis, and nitrogen adsorption/desorption studies. RGO forms a continuous network of crumpled sheets, which consist of large amounts of few-layer and single-layer graphenes. Electrochemical studies were conducted by cyclic voltammetry, impedance spectroscopy, and galvanostatic charge-discharge measurements. The modified RGO materials showed enhanced electrochemical performance, with maximum specific capacitance of 96 F/g, energy density of 12.8 Wh/kg, and power density of 160 kW/kg. These results demonstrate that thermal treatment of RGO at selected conditions is a convenient and efficient method for improving its specific capacitance, energy, and power density.

Elective open tracheostomy for patients under prolonged mechanical ventilation-a study.

OBJECTIVE: To determine the safety of elective open tracheostomy as a routine intensive care unit (ICU) procedure without any selection criteria, considering its peri- and postoperative complications. MATERIALS AND METHODS: This is a descriptive study conducted in two hospitals in Davangere for a period of three years between April 2005 and March 2008. 40 patients, both male and female, of all age groups who were under mechanical ventilation in whom open tracheostomy was performed were included in the study. All patients who recovered were followed-up for two months. Complications arising during this period were recorded in the proforma. RESULTS: Our study consisted of 40 patients comprising 30 males and 10 females with male to female ratio of 3:1 and average age of 35 years, all undergoing open tracheostomy for prolonged mechanical ventilation. Various indications for mechanical ventilation included polytrauma, head injury, septicemia with multiorgan failure and dengue encephalitis. The complications which arised during the procedure and follow-up period included cardiac arrest, surgical emphysema, reactionary hemorrhage, pneumothorax, tracheo-cutaneous fistula, tracheo-oesophageal fistula. CONCLUSION: Elective open tracheostomy seems to be a safe and simple procedure, when performed by experienced surgeon under controlled circumstances, and should be considered as an option for mechanically ventilated patients.