Hemorrhagic Pseudocyst (Polyst) and True Hemorrhagic Cyst of the Vocal Fold.

OBJECTIVES: Though hemorrhagic vocal fold polyps are a common entity, hemorrhagic vocal fold cysts have not been previously described. In our study, we have evaluated patients who were diagnosed on stroboscopy with "hemorrhagic" cysts. METHODS: This 18-month retrospective study has received institutional ethics clearance. Using the database of our voice clinic, 14 patients diagnosed with hemorrhagic cysts by stroboscopy were reviewed. Age, sex, chief complaints, symptom duration, videostroboscopy findings, surgical details, and histopathology were noted. RESULTS: Out of a total 14 patients, 12 were males with a mean age of presentation of 41 years. The duration of hoarseness ranged from 2-24 months. Videostroboscopy revealed a markedly decreased amplitude of the mucosal waves over a well-delineated ovoid or spheroid hemorrhagic lesion, which seemed tethered down by overlying vocal fold epithelium. All patients had operative findings of a well-encapsulated hemorrhagic lesion in the superficial lamina propria with anterior and posterior fibrotic bands. Histopathology of 13 patients was similar and revealed a hemorrhagic polypoidal lesion. A pseudo-capsule could be identified occasionally. These lesions seemed to be hemorrhagic pseudocysts, named "polyst" by us. In one male patient, the histopathology revealed a true vocal fold cyst (type C Koren) with hemorrhage. CONCLUSIONS: A hemorrhagic pseudocyst (polyst) of the vocal fold has stroboscopic and surgical findings resembling a true vocal fold cyst with hemorrhage; however, histologically it resembles a hemorrhagic polyp. A true hemorrhagic cyst however is typically a type C Koren cyst with hemorrhage. Both these entities have not been previously described.

Three-part scoring system (tripartite) for teledermatology versus International Contact Dermatitis Research Group criteria to interpret patch test readings: A comparative, observational study.

Background The International Contact Dermatitis Research Group (ICDRG) grading is the gold standard and is used to interpret patch test results in allergic contact dermatitis (ACD). The ICDRG readings include a combination of visual and palpation findings. Digital photography limits palpation. An alternative scoring system exists to analyse 2D images and interpret patch test readings in teledermatology (TD). Aims To compare tri-partite scoring system (TPSS) (TD) with ICDRG (face-to-face) and to assess the feasibility of TPSS by TD. Methods In this observational study, two investigators each scored the patch test readings for 78 patients at the 48th h, 96th h and on the 7th day. Results The TPSS has a sensitivity of 100%, specificity of 93.34%, positive predictive value of 91.67% and negative predictive value of 100%. At a confidence interval of 95%, Cohen's kappa (0.90) indicated excellent agreement between both investigators. The concordance between both scoring systems was at 93.2% for agreement and 6.82% for disagreement. Polysensitisation (6 patients with 16 allergens) was detected equally in both methods. Limitations A single centre study. Conclusion The readings obtained by TPSS were in agreement with ICDRG. TPSS can reduce the number of patient visits by 50% and may be used during COVID-19 times and beyond.

Utility of maximum phonation time in the diagnosis of spasmodic dysphonia (laryngeal dystonia).

OBJECTIVES: Maximum phonation time is a simple test used to assess glottic competency. Our objective was to evaluate any correlation between maximum phonation time and spasmodic dysphonia as adductor spasmodic dysphonia and abductor spasmodic dysphonia have an adductor and abductor overdrive, respectively. METHODS: A 3-year data-review was performed for patients diagnosed with adductor spasmodic dysphonia, abductor spasmodic dysphonia and mixed spasmodic dysphonia. Maximum phonation time was noted on the first visit and compared with a control group. RESULTS: Average maximum phonation time in adductor spasmodic dysphonia, abductor spasmodic dysphonia and control group was 25 seconds, 9 seconds and 16 seconds. A significant difference was found for adductor spasmodic dysphonia and abductor spasmodic dysphonia. A receiver operating characteristic curve analysis between adductor spasmodic dysphonia and control groups showed a positive predictive value of 81.3 per cent, negative predictive value of 83.9 per cent, sensitivity of 79.6 per cent and specificity of 85.2 per cent. Level of evidence = 4. CONCLUSION: We recommend that maximum phonation time be added to the diagnostic armamentarium of spasmodic dysphonia. This correlation between maximum phonation time and spasmodic dysphonia has not been previously published.

Development of magnetic La doped Al2O3 core-shell nanoparticle loaded hydrogel for selective recovery of fluoride from aquatic medium.

The selective removal of pollutants from water bodies is regarded as a conciliation between the rapid expansion of industrial activities and need of clean water for sustainability. Fluoride is one such geogenic pollutant, and various materials have already been reported. Developing an efficient field employable material is however a challenge. Herein, we report the synthesis and competencies of strategically designed magnetic La-doped Al2O3 core-shell nanoparticle loaded polymeric nanohybrid as a benchmark fluoride sorbent. A facile synthesis strategy involved fabrication of Fe3O4 magnetic core followed by growth of La doped Al2O3 shell using sol-gel method. Doping of La2O3 into Al2O3 structure was optimised (6%), resulting in Fe3O4-Al0.94 La0.06O1.5 core-shell particles which provided exceptional fluoride affinity. The obtained magnetic Fe3O4-Al0.94La0.06O1.5 core-shell nanoparticles were then loaded (22%) into alginate to form cross-linked hydrogel beads (Fe3O4-Al0.94 La0.06 O1.5-Ca-ALG). These prepared hydrogel beads were characterised and utilized for selective recovery of fluoride under different ambient conditions. Driving forces for enhanced fluoride uptake by La doped Al2O3 were investigated and explained with the help of both experimental observation and theoretical simulation. Density functional theory calculations indicated significant expansion in the cell volume of Al2O3 due to La doping which favoured the fluoride sorption. The calculated defect formation energy for the incorporation of F into Al2O3 was found to decrease in the presence of La. XPS analysis suggested direct interaction of fluoride with Al, forming Al-F bond and breaking Al-O bond. Different vital parameters for uptake were optimised. Also, kinetics, isotherm and diffusion models were evaluated. Developed hydrogel beads attained record sorption capacity of 132.3 mgg-1 for fluoride. Overall, excellent stability, no leaching of constituents, effectiveness for selective fluoride recovery from groundwater, brand it a perfect epitome of sustainable water treatment application.

Cyclic extraction of phosphate from soybean meal using immobilized Aspergillus oryzae SBS50 phytase.

Phytase enzyme found in plants, animals, and microorganisms is mainly involved in catalyzing the systematic removal of a phosphate group from phytic acid. Enzyme immobilization is one of the cost-effective methods for the wide usage of enzymes in the industrial sector. This paper reports the covalent immobilization of phytase on glutaraldehyde-activated aluminum oxide beads. The immobilization yield, efficiency, and activation energy were found to be 47.8%, 71.5%, and 15.78 J/mol, respectively. The bound enzyme displayed a shift in pH optima from 5.5 to 4.5, which is more beneficial to increase digestibility in comparison with the free enzyme. Immobilized phytase retained 42.60% of its activity after 1.0 h incubation at 80 °C, whereas free enzyme retained only 4.20% of its activity. Thermodynami increase in half-lives, D-values, enthalpy and free energy change after covalent immobilization could be credited to the enhanced stability. Immobilized phytase could be reused for five consecutive cycles retaining 51% of its initial activity with sodium phytate. The immobilized phytase was also found effective to hydrolyze the soybean meal, thus increasing the digestibility of poultry feed. The hydrolyzing reaction of soybean meal was carried out for six consecutive cycles and immobilized phytase retained nearly 50% of activity till the fifth cycle. The amount of phosphorus released after treatment with immobilized phytase was far higher than that from free phytase. Immobilization on this support is significant, as this support can sustain high mechanical resistance at high pH and temperature. This considerable stability and reusability of the bound enzyme may be advantageous for its industrial application.

Production, Characterization and Prebiotic Potential of Xylooligosaccharides Produced from Wheat Bran using Enterobacter hormaechei KS1 Xylanase.

In the present investigation, xylooligosaccharides were produced from wheat bran and wheat bran extracted xylan through enzymatic hydrolysis using xylanase from novel Enterobacter hormaechei KS1. Xylooligosaccharides/reducing sugars production from wheat bran was found maximum (374 mg/g) when 4.0% of wheat bran was treated with 375 units (IU/mL) of Enterobacter hormaechei KS1 xylanase at pH 6.0 and incubated at 50 °C for 24 h of incubation. In case of wheat bran extracted xylan 419 mg/g of xylooligosaccharides were produced when 3% of extracted xylan was incubate for 8 h. Analysis of the enzymatic hydrolysate through high performance liquid chromatography equipped with refractive index detector showed the presence of xylose, xylopentose and xylohexose. The decrease in pH with 1.0% dose of xylooligosacchaides produced from extracted xylan hydrolysis using E. hormaechei KS1 xylanase showed more decrease with L. rhamnosus (6.72 to 5.94) followed by L. brevis (6.71 to 6.15) and L. plantarum (6.71 to 6.41). In case of increase in optical density both wheat bran and wheat bran extracted xylan generated xylooligosaccharides exhibited similar pattern i.e., L. rhamnosus > L. plantarum > L. brevis.

Pattern of Surgical Diseases Affecting Females in a Teaching Hospital in Central India: A Demographic Study.

Introduction Despite progress in eliminating the social and health disparity between men and women during the last century, gender equality remains an elusive goal, particularly in the developing world. This gender-based bias has been found to directly result into poor health outcome in females. Hence, it is vital to know the number and pattern of surgical diseases affecting females in any setup, so as to improve their admission rates and reach out to this neglected half of population. Materials and Methods This was a demographic study done at a teaching hospital in Central India from January to June 2020. Data of patients discharged from female surgery ward were collected from medical record department. Age, diagnosis, urban-rural distribution, and length of hospital stay of patients were noted, and data were analyzed statistically. Results A total of 187 patient records were studied, which revealed that the mean age of the patients was 40.35 years; maximum patients were of gastrointestinal surgery (53.42%) in which the most common diagnosis was cholelithiasis (25.13%). Urological diseases (15.50%), breast diseases (12.83%), perianal disease (9.09%), and thyroid diseases (5.34%) were found in decreasing order of frequency. Overall hospital stays of patients ranged from 1 to 14 days with average stay of 6.35 days. Conclusion In our study, cholelithiasis was found to be the most common surgically treated disease followed by urological diseases. Breast symptoms, although commonly affecting females, did not turn into admissions as there remains a social taboo attached to it. Breast cancer still presents late, despite being the most common cancer in females in India. Approximately 65% patients were discharged within first 5 days of their admission, which indicates good hospital care and improves patient satisfaction levels. Still there is greater need for public health efforts to improve the monitoring, safety, and availability of surgical services to female patients.

Clinical Uses of NPWT with Irrigation of Normal Saline in Diabetic Foot Ulcer: Outcome Assessed by DEPA Score.

Introduction: Diabetic foot ulcer (DFU) is a common complication of uncontrolled diabetes. Negative pressure wound therapy (NPWT) with irrigation of normal saline is one of the methods for wound care and dressing techniques in DFU. Wound assessment is another aspect of DFU management for deciding whether the wound is prepared or not for coverage. The present study uses DEPA score as a wound assessment tool in DFU. Materials and Methods: This case series include 11 patients with DFU who were treated using NPWT with simultaneous irrigation of normal saline. Results: All 11 patients were male and age more than 60. Most patients have duration of diabetes for less than 10 years. Staphylococcus aureus (n = 5, 45.4%) was most common bacterial flora. Most patients in series presented with DEPA score more than 7 and after application of NPWT instillation therapy significant improvement seen with score in most of the patient with DEPA score below 6. Mean time for NPWT (irrigation) application was 15 days. Mean time of wound preparation was 18.7 days. Final surgical procedures executed in all patients, split skin grafting performed in 7 patients. 4 patients had wound coverage by reverse sural flap (2), medial plantar flap (1) and local flap coverage (1). Conclusion: NPWT with normal saline irrigation is an effective method of wound preparation in DFU. DEPA score is an important tool for assessment of wound preparation which gives exact information for timing of wound coverage once diabetic foot wound is prepared.

Reconstruction of Lower Eyelid with Nasolabial Flap for Anterior Lamella and Turnover Flap for Posterior Lamella.

Reconstruction of full-thickness eyelid defects is done to provide a mobile lid with corneal protection, having good aesthetic quality, and acceptable donor site morbidity. Various flap procedures have been described and used for the lower eyelid reconstruction; however, the nasolabial flap is rarely employed. It is a random pattern cutaneous flap with redundant blood supply from the perforating branches of the facial and angular arteries and can be used as an inferiorly or superiorly based flap. Here, we aim to present the clinical results of using the superiorly based nasolabial island flap for reconstruction of anterior lamella and turnover/hinge flap of infraorbital skin and palpebral conjunctiva with support of conchal cartilage for reconstruction of posterior lamella for lower eyelid defect. To our best knowledge, this reconstructive combination of flaps has not been described previously for total and full-thickness posttraumatic defect of lower eyelid.

Comparative Bone Graft Evaluation for Dental Implant Success: An Evidence-Based Review.

In this review, we provide a comparative evaluation of different bone grafts for dental implants success. We performed a literature review to analyze dental implant success and survival rates after the use of various grafts for bone augmentation. A total of 41 studies were selected and analyzed based on parameters including study design, number of implants placed, total number of participants, type of graft used, site from which graft was obtained, time elapsed between bone augmentation and implant placement, implant survival, and success rates. Results indicate that after a follow-up period of 1-5 yr, respective success and survival rates are as follows: block grafts, 91.5% and 75%; blood derivatives, 91.5% and 96.7%; composite grafts, 80.9% and 94.2%; xenografts and particulate grafts, 100% for both success and survival. After evaluating the available studies, we can report that autologous block grafts, composite grafts, and blood derivatives were the most commonly used grafting materials for bone augmentation before placing dental implants. Xenografts and particulate grafts had 100% success and survival rates, but more studies are needed to assess the impact of these grafting materials.

Overexpression of IL-10 Enhances the Efficacy of Human Umbilical-Cord-Derived Mesenchymal Stromal Cells in E. coli Pneumosepsis.

Enhancing the immunomodulatory effects of mesenchymal stromal cells (MSCs) may increase their effects in sepsis. We tested the potential for overexpression of Interleukin-10 (IL-10) in human umbilical cord (UC) MSCs to increase MSC efficacy in Escherichia coli (E. coli) pneumosepsis and to enhance human macrophage function. Pneumonia was induced in rats by intratracheal instillation of E. coli ((2.0-3.0) × 109 Colony forming units (CFU)/kg). One hour later, animals were randomized to receive (a) vehicle; (b) naïve UC-MSCs; or (c) IL-10 overexpressing UC-MSCs (1 × 107 cells/kg). Lung injury severity, cellular infiltration, and E. coli colony counts were assessed after 48 h. The effects and mechanisms of action of IL-10 UC-MSCs on macrophage function in septic rodents and in humans were subsequently assessed. Survival increased with IL-10 (9/11 (82%)) and naïve (11/12 (91%)) UC-MSCs compared to vehicle (9/15 (60%, p = 0.03). IL-10 UC-MSCs-but not naïve UC-MSCs-significantly decreased the alveolar arterial gradient (455 93 and 520 81, mmHg, respectively) compared to that of vehicle animals (544 52, p = 0.02). Lung tissue bacterial counts were significantly increased in vehicle- and naïve-UC-MSC-treated animals but were not different from sham animals in those treated with IL-10 overexpressing UC-MSCs. IL-10 (but not naïve) UC-MSCs decreased alveolar neutrophils and increased alveolar macrophage percentages compared to vehicle. IL-10 UC-MSCs decreased structural lung injury compared to naïve UC-MSC or vehicle therapy. Alveolar macrophages from IL-10-UC-MSC-treated rats and from human volunteers demonstrated enhanced phagocytic capacity. This was mediated via increased macrophage hemeoxygenase-1, an effect blocked by prostaglandin E2 and lipoxygenase A4 blockade. IL-10 overexpression in UC-MSCs enhanced their effects in E. coli pneumosepsis and increased macrophage function. IL-10 UC-MSCs similarly enhanced human macrophage function, illustrating their therapeutic potential for infection-induced acute respiratory distress syndrome (ARDS).

Extracellular Vesicles from Interferon-γ-primed Human Umbilical Cord Mesenchymal Stromal Cells Reduce Escherichia coli-induced Acute Lung Injury in Rats.

BACKGROUND: Human umbilical cord mesenchymal stromal cells possess considerable therapeutic promise for acute respiratory distress syndrome. Umbilical cord mesenchymal stromal cells may exert therapeutic effects via extracellular vesicles, while priming umbilical cord mesenchymal stromal cells may further enhance their effect. The authors investigated whether interferon-γ-primed umbilical cord mesenchymal stromal cells would generate mesenchymal stromal cell-derived extracellular vesicles with enhanced effects in Escherichia coli (E. coli) pneumonia. METHODS: In a university laboratory, anesthetized adult male Sprague-Dawley rats (n = 8 to 18 per group) underwent intrapulmonary E. coli instillation (5 × 10 colony forming units per kilogram), and were randomized to receive (a) primed mesenchymal stromal cell-derived extracellular vesicles, (b) naïve mesenchymal stromal cell-derived extracellular vesicles (both 100 million mesenchymal stromal cell-derived extracellular vesicles per kilogram), or (c) vehicle. Injury severity and bacterial load were assessed at 48 h. In vitro studies assessed the potential for primed and naïve mesenchymal stromal cell-derived extracellular vesicles to enhance macrophage bacterial phagocytosis and killing. RESULTS: Survival increased with primed (10 of 11 [91%]) and naïve (8 of 8 [100%]) mesenchymal stromal cell-derived extracellular vesicles compared with vehicle (12 of 18 [66.7%], P = 0.038). Primed-but not naïve-mesenchymal stromal cell-derived extracellular vesicles reduced alveolar-arterial oxygen gradient (422 ± 104, 536 ± 58, 523 ± 68 mm Hg, respectively; P = 0.008), reduced alveolar protein leak (0.7 ± 0.3, 1.4 ± 0.4, 1.5 ± 0.7 mg/ml, respectively; P = 0.003), increased lung mononuclear phagocytes (23.2 ± 6.3, 21.7 ± 5, 16.7 ± 5 respectively; P = 0.025), and reduced alveolar tumor necrosis factor alpha concentrations (29 ± 14.5, 35 ± 12.3, 47.2 ± 6.3 pg/ml, respectively; P = 0.026) compared with vehicle. Primed-but not naïve-mesenchymal stromal cell-derived extracellular vesicles enhanced endothelial nitric oxide synthase production in the injured lung (endothelial nitric oxide synthase/ß-actin = 0.77 ± 0.34, 0.25 ± 0.29, 0.21 ± 0.33, respectively; P = 0.005). Both primed and naïve mesenchymal stromal cell-derived extracellular vesicles enhanced E. coli phagocytosis and bacterial killing in human acute monocytic leukemia cell line (THP-1) in vitro (36.9 ± 4, 13.3 ± 8, 0.1 ± 0.01%, respectively; P = 0.0004) compared with vehicle. CONCLUSIONS: Extracellular vesicles from interferon-γ-primed human umbilical cord mesenchymal stromal cells more effectively attenuated E. coli-induced lung injury compared with extracellular vesicles from naïve mesenchymal stromal cells, potentially via enhanced macrophage phagocytosis and killing of E. coli.

A Comparative Evaluation of Intravenous Dexmedetomidine and Fentanyl in Breast Cancer Surgery: A Prospective, Randomized, and Controlled Trial.

BACKGROUND AND AIM: Recent studies have advised narcotic less anaestheic techniques for breast cancer surgeries due to altered immune system by use of opioids. So we planned this study to compare the efficacy of dexmedtomidine with fentanyl in breast cancer surgery in terms of haemodynamic stability, anaesthetic sparing effects, recovery profile and postoperative analgesia. MATERIAL AND METHODS: In this randomized prospective controlled trial, a total of 60 female patients were randomly assigned into two groups. Patients in group F (n = 30) received a loading dose of fentanyl 2 µg/kg with maintenance dose of 0.5 µg/kg/h and in group D (n = 30) received dexmedetomidine 1 µg/kg as loading dose with maintenance dose of 0.25 µg/kg/h till the end of surgery. Hemodynamic parameters, desflurane requirement, recovery profile and postoperative analgesia were monitored and compared in both the groups. RESULTS: Mean HR was less in group D compared to group F intraoperatively, before and after extubation with a significant p value. The mean MAP was also lower in group D compared to group F at all the time points. MAC requirements were found lower in group D compared to group F with a significant P < 0.001. Cognitive recovery in the form of time to respond to verbal commands, time to extubation, time to orientation was early in dexmedetomidine group. CONCLUSION: Dexmedtomidine can be used as suitable alternative to fentanyl in breast cancer surgeries due to better hemodynamic stability, anaesthetic sparing effects and better recovery profile.