Surgical Intervention in Allergic Rhinitis: Stuffy Versus Sneezy Runny Nose.

To detect proportion and surgical outcome of adult patients with allergic rhinitis non-responsive to medical treatment. To identify clinical candidacy for submucous turbinoplasty of inferior turbinate resection or soft tissue reduction. A prospective descriptive study of adults with clinical allergic rhinitis was done. Non-responders to medical therapy were identified and outcome of surgical intervention analyzed. There were 393 patients. Eighty-one patients (21%) were refractory to medical therapy. Presenting symptoms were sneezing with watery rhinorrhea among 72% and nasal obstruction in 28% patients All patients in the latter group had hypertrophied inferior turbinates with associated deviated nasal septum in 36.6%. Bony and mucosal inferior turbinate hypertrophy among 73.3% and mucosal hypertrophy among 26.7% were identified by a negative or positive response to on-table local vasoconstrictor application respectively. Submucosal inferior turbinoplasty with turbinate resection in the former and soft tissue reduction in the latter group were done, along with septoplasty among 36%. All patients revealed significant reduction in postoperative SNOT score. Crusting was more during early postoperative period among those with soft tissue reduction and simultaneous septoplasty, necessitating meticulous endoscopic follow-up. Adult allergic rhinitis presenting predominantly with nasal obstruction ('stuffy nose'), could be non-responsive to medical therapy unlike sneezy, runny nose, especially when obstructive symptoms are more than two years among older patients, suggesting presence of hypertrophied inferior turbinates. On-table response to vasoconstrictors is a reliable clinical indicator for submucous inferior turbinoplasty: negative and positive response suggesting turbinate resection among majority and soft tissue reduction among minority respectively.

Agricultural productivity, seasonality and gender bias in rural nutrition: empirical evidence from south India.

This paper analyzes changes in the nutrients intake, intra-household allocation and gender bias due to changes in agricultural productivity among four groups of rural households over six different seasons. The study utilizes household survey data collected from a village in Tamil Nadu, India. While the results are consistent with earlier findings that seasonality influences variation in the intake of nutrients, it is shown that subsistence agricultural households recover faster from poor crop yields than market oriented agricultural households in terms of nutrient intake. Agricultural labour households consumed lowest quantities of energy and protein in all the seasons with the highest degree of gender bias. The gender bias is more in terms of protein intake compared to energy intake for all the households. The non-agricultural households are least affected due to variability in crop yields and seasonality. While nutritional intake of the rural households is positively correlated with crop yields, the variations in yields worsen the gender bias. It is argued that reducing dependency of rural households on agriculture may reduce malnutrition and the gender bias associated with it.