Image analysis in laryngopharyngeal reflux disease: A road less traveled.

Background: Laryngopharyngeal reflux disease (LPRD) is a common condition affecting patients reporting to an otolaryngologist. However, the diagnosis of this condition is usually hinged on the combination of largely non-specific symptoms, and clinical findings on laryngoscopy. This study aimed at evaluating the utility of digital image analysis to quantitatively evaluate the severity of signs as recorded with laryngoscopy in patients of LPRD. Methods: The study group included individuals who were aged between 18 and 65 years and reported to the ENT OPD. These were then divided into two groups depending on symptoms and laryngoscopic findings. The LPRD group had symptomatic patients with an Reflux finding score (RFS) score >7. Those with an RFS of <6 were designated as the 'Normal group'. The Laryngoscopic images were recorded and analyzed using Image J software as per the set protocol. The Red Green Blue (RGB) values of the laryngoscopic images of each group were obtained and subjected to statistical analysis. Results: 200 participants were enrolled in the study with 100 participants in the LPRD group (mean age = 46.2, 40 males, 60 females) and 100 in the control group (mean age = 43.6, 55 males, 45 females). The measured RGB values were more in the LPRD group as compared to the control group and the results were statistically significant (P < 0.001). Conclusion: By providing an objective value to the degree of inflammation, RGB value measurement provides a quick, economical, adaptable tool for auxiliary and corroborative information for the diagnosis of LPRD.

Our Experience with Sinonasal Glomangiopericytoma in North India: A Case Series.

Glomangiopericytoma (GPC) is a rare benign sinonasal tumor originating from Zimmerman's Pericytes surrounding capillaries and accounting for less than 0.05% of all sinonasal tumors. Glomangiopericytoma has low malignant potential (5-10%) and is mostly diagnosed in the 6th or 7th decade of age with slight female preponderance. We presented here a case series of 5 patients with sinonasal GPC. This research was conducted at a tertiary healthcare centre in North India. In our case series, all the patients were evaluated and underwent endoscopic surgical resection. All patients underwent digital subtraction angiography (DSA) and preoperative embolization. The coblation technique used for haemostasis proved very effective and time-saving. All patients exhibited cytoplasmic SMA positivity (a marker of GPC) and CD34 negativity, while one patient exhibited a high Ki-67 index (> 10%), which is a predictor of aggressive tumor behavior. None of the patients showed any recurrence in follow-up. We recommend performing complete endoscopic surgical excision to prevent recurrence. The use of DSA, preoperative embolization, and intraoperative use of the coblation technique provides a cleaner surgical field and reduced operating time.

A survey of awareness, knowledge, attitude, and skills of telemedicine among healthcare professionals in India.

Background: Telemedicine Practice Guidelines were promulgated in India in 2020. There is little information about the awareness, knowledge, attitude and skills (AKAS) of the healthcare professionals regarding telemedicine and its practice guidelines a year after. The aim of the study was to study the awareness, knowledge, attitudes and skills of the healthcare workers of the country about telemedicine especially in the context of telemedicine practice guidelines 2020. Methods: An online survey was conducted over 12 weeks from active healthcare workers in India. A standard AKAS Questionnaire for telemedicine and other close and open ended questions were used. Results: A total of 602 active healthcare workers participated in the study. It was seen that a majority of participants had high scores for awareness, knowledge, and attitude toward telemedicine but a mere 39.53% scored high for skills related to telemedicine. A majority of the respondents had no knowledge of the existence of telemedicine practice guidelines and very few had seen or read them. A majority of the respondents were keen to attend a course or training to enhance their understanding and practice of telemedicine. Conclusion: The results of the study show that the basic awareness and background knowledge regarding telemedicine exists in the healthcare professionals in the country. The requirement is to train and educate them about the skills and provisions of the telemedicine practice guidelines 2020 to ensure optimal use of telemedicine and to avoid medico-legal issues.

A Randomised Controlled Trial on the Efficacy of Topical Application of Autologous Platelet Rich Plasma (PRP) on Graft Uptake Rate in Adults Undergoing Type 1 Tympanoplasty for Inactive COM Mucosal Disease.

To assess the efficacy of topical use of autologous platelet rich plasma (PRP) as a packing material in type 1 tympanoplasty in Mucosal Inactive COM disease by conducting a Randomized Controlled Trial in 80 patients. Prospective Randomized Controlled Trial. Total 80 patients were enrolled for the study after fulfilling the inclusion and exclusion criterion. Written and informed consent was taken from all patients. After taking detailed clinical history, the patients were divided in to two groups of 40 patients each by block randomization. Group A was the interventional group where topical autologous platelet rich plasma was applied on the graft during type1 tympanoplasty. In Group B, PRP not applied. Graft uptake rate was observed postoperatively after 1 month and 6 months. Successful graft uptake at 1st month was noted in 97.5% patients in Group A and 92.5% in Group B with a corresponding failure rate of 2.5% and 7.5% respectively. Successful graft uptake at 6th month was noted in 95% patients in Group A and 90% in Group B with a corresponding failure rate of 5% and 10% respectively. As observed from our study status of graft uptake and reperforations at 1st and 6th months subsequent to surgery and rate of post-operative infections were similar in both the groups irrespective of the status of receiving autologous platelet rich plasma. Trial registration Trial registered with CTRI (Clinical Trial Registry -India) (Reg. no CTRI/2019/02/017468 dated 05/02/2019). Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03681-w.

The Use of a Low-Cost Gaming Platform as a Substitute to Medical-Grade Force Plate in Objective Evaluation of Balance.

Posturography is a tool for quantitative measurement of balance in various static and dynamic test conditions. Current medical grade Posturography systems are very costly and rare outside research institutes. The Wii Balance Board is an inexpensive gaming device which works on similar principles and uses the center of pressure of an individual as an input for motion-controlled gaming. The aim of this study was to assess the validity of using a gaming platform (Wii Balance Board) as a substitute to medical grade Posturography machine. The objectives were to compare the measures of postural sway obtained from a gaming platform with those from a medical grade Posturography machine and to demonstrate a low-cost method of analysis of balance using the gaming platform. Descriptive Observational study. Individuals aged 18-65 years and having no apparent dysfunction of balance were assessed objectively using Wii Balance Board and Medical-grade Posturography machine. A program was developed in Scilab for computation of sway parameters. The results were compared in terms of correlation coefficient, Bland-Altmann plots, and ability to detect abnormal sway. A Pearson's correlation coefficient ranging from 0.53-0.91 was observed in various test conditions, with an overall value of 0.62 between the results of the two machines. The sensitivity was 69.39%, specificity was 73.16%, positive predictive value 24.29%, negative predictive value 95.07%, and accuracy 72.75%. Thus, we can conclude that the Wii Balance Board can be used as a low-cost substitute to medical grade Posturography machine for quantification of balance in situations where precise measurement of balance is not required.

Development of a portfolio framework for implementation of an outcomes-based healthcare professional education curriculum using a modified e-Delphi method.

BACKGROUND: The explicit declaration of Entrustable Professional Activities (EPA) and milestones are an essential component of a competency based medical education curricula. The present study attempts to develop a portfolio framework to document them for adaptation in any healthcare professional education curriculum development. METHODS: A modified e-Delphi method was used after incorporation of a study group of medical education experts (MEDEX-G). Consensus was defined as 75% agreement. Both qualitative and quantitative data was collected and analysed to conduct three rounds of the Delphi. RESULTS: The draft template was prepared by the core faculty of medical education centre. The final template was approved by the experts after 03 iterations of anonymous online voting and presentation of summary results by the moderator. The final template lists out the milestones of each EPA separately with provision for expected expertise and level, suggestive teaching learning activities and assessments, reflections by the students and feedback by facilitator for each EPA. CONCLUSION: The MEDEX-G consensus template is an important development to encourage the adoption of portfolios in a competency based medical education curriculum. It can be freely adopted by various healthcare professional education bodies in various disciplines.

Entrustable Professional Activities (EPAs) and milestones for MD sports medicine: A proposed portfolio.

BACKGROUND: Sports Medicine is an upcoming postgraduate speciality in India. A MD Sports Medicine specialist is expected to contribute in the prevention of sports injuries, sportsmen training and enhancement of performance apart from being involved in planning of conduct of sports events amongst many other roles and responsibilities. This requires hands-on training and acquisition of skill sets required to perform these roles. The National Medical Council of India highlights the need for a competency based curriculum and has laid down guidelines for the course. There was a felt need to develop Entrustable Professional Activities (EPAs) and milestones based on the prescribed curricula and develop a portfolio for continuous monitoring of the achievement of these EPAs. METHODS: A five step model was done by experts in the field to prepare the EPAs, milestones and portfolio. This consisted of faculty development, identification of the EPAs and milestones and portfolio preparation. RESULTS: 114 EPAs and 961 milestones were identified by the subject experts. The portfolio was developed with the help of specialists and faculty of the field of sports medicine, and medical educationists. CONCLUSION: Post graduate medical education is mandated to be competency based. A portfolio has been developed in the current exercise for use in a competency based post-graduate curriculum in sports medicine. This will help in the better implementation of CBME in the country.

Identifying entrustable professional activities for post-graduation in ENT: What should an ENT specialist be able to do?

BACKGROUND: Though regulatory bodies of medical education in India mandate post graduate medical education to be competency based, the implementation of the same has not kept pace. The present study aims to develop and propose a set of entrustable professional activities for a masters degree in the discipline of ENT. It also attempts to present it in the form of a portfolio. METHODS: Experts in the subject went through a series of activities including brainstorming, discussions and internal peer review to shortlist and enumerate EPAs. RESULTS: 335 EPAs were identified and are presented. They were further classified as per need and expected expertise. CONCLUSION: The EPAs may serve as a guideline to medical colleges/institutions aiming to adopt competency based medical education in the post graduate curriculum in the subject of ENT.

Characterization of the ability of a, second-generation SST-DA chimeric molecule, TBR-065, to suppress GH secretion from human GH-secreting adenoma cells.

CONTEXT: Somatostatin (SST) and dopamine (DA) inhibit growth hormone (GH) secretion and proliferation of GH-secreting pituitary adenomas (GHomas) through binding to SSTR2 and D2R receptors. Chimeric SST-DA compounds (Dopastatins) display increased potency in inhibiting GH secretion, as compared with individual SST or DA analogs (alone or combined). OBJECTIVE: To assess the efficacy of a second-generation dopastatin, TBR-065, in suppressing GH secretion from human GH- and GH/prolactin(PRL)-omas. DESIGN: We compared the ability of TBR-065 to inhibit GH secretion from primary cultures of human GH- or GH/PRLoma cells to that of the first generation dopastatin, TBR-760 (formerly BIM-23A760), octreotide (OCT) and cabergoline (CAB), the later either alone or combined. We investigated whether there was any impact of BIM-133, the metabolite of TBR-065, on the ability of TBR-065 to inhibit GH in these cultures. METHODS: 17 GH- and GH/PRLomas were included in this study. Inhibition of GH secretion by TBR-065, TBR-760, OCT and CAB (0.1 pM to 0.1 µM) was assessed over a period of 8 h. RESULTS: All tumors expressed SSTR2 and D2R mRNAs. GH suppression was higher with TBR-065 as compared with TBR-760 (Emax = 57 ± 5.6% vs. 41.1 ± 12.5%, respectively, p < 0.001) or with OCT + CAB (Emax = 56.8 ± 7.2% vs. 44.4 ± 9.4%, p < 0.001). BIM-133 did not have any impact on the activity of TBR-065. CONCLUSION: TBR-065 has significantly improved efficacy in suppressing GH secretion as compared to current available therapies and may represent a new promising option for the treatment of acromegaly.

The infodemics of COVID-19 amongst healthcare professionals in India.

BACKGROUND: There is a deluge of information and misinformation about COVID-19. The present survey was conducted to explore the sources of information /misinformation for healthcare professionals from India. METHODS: A cross-sectional online survey using snowballing technique was conducted from 24 Mar to 10 Apr 2020. The questionnaire was pretested and developed using standard techniques. It was circulated among medical students and physicians. Data were analysed using the STATA software. RESULTS: Data of 758 participants were analysed. A total of 255 (33.6%) medical students, 335 (44.2%) nonspecialists and 168 (22.1%) specialists participated. The most common source of formal and informal information was official government websites and online news, respectively. A total of 517 (68.2%) participants accepted receiving misinformation. Social media and family and friends were the most common sources of misinformation. Seventy-two percent of participants agreed that spread of information helped to contain COVID-19, but more than that 75% agreed to having received inaccurate information. Seventy-four percent of respondents felt the need for regulation of information during such times; 26% and 33% felt that information about COVID-19 made them feel uncomfortable and distracts routine decision-making, respectively, and 50% felt it was difficult to differentiate correct from incorrect information about COVID-19. CONCLUSION: The study explored the sources of information and misinformation and found a high prevalence of misinformation, especially from social media. We suggest the need to better manage the flow of information so that it can be an effective weapon against SARS-CoV2. There is a need for doctors to adapt to the changing times of infodemics accompanying pandemics.

Vestibular Dysfunction in Children Suffering from Otitis Media with Effusion: Does Grommet Help? An Observational Study Using Computerized Static Posturography.

Otitis media with effusion (OME) has a detrimental effect on balance, which may not present as a clear symptom in children. This effect can be improved by the insertion of ventilation tubes. This study assesses balance in children suffering from OME pre and post operatively using computerized static posturography. 50 children of 3-6 years, suffering from OME were included in this observational descriptive study. These patients underwent myringotomy and grommet insertion. The balance was evaluated pre and post operatively after 3 months using computerized static posturography with Modified Clinical Test of Sensory Interaction on Balance under four conditions, namely eyes open/closed on firm surface/foam. Posturography mean sway velocity was deranged in these children preoperatively and it showed statistically significant improvement post operatively at 3 months. There is occult vestibular dysfunction in children with OME as assessed by static posturography which improves significantly 3 months after myringotomy and grommet insertion.

Unilateral Sudden Sensorineural Hearing Loss: A Rare Presentation of Cerebral Venous Thrombosis.

Sudden sensorineural hearing loss (SNHL) is postulated to be caused due to a multitude of factors, but a definitive cause is seldom found despite extensive investigations. We present a rare case of sudden SNHL in which central venous thrombosis was found on magnetic resonance imaging. The case highlights the importance of neuroimaging in all cases of sudden SNHL before being labelled as "idiopathic" so that targeted therapy can be given.

Voice Quality in Cochlear Implant Recipients: An Observational Cross Sectional Study.

Children with hearing loss are more likely to suffer from voice and speech disorders than with normal hearing due to their poor and less robust auditory feedback mechanisms. Prelingually deaf children are not able to supervise their own voice due to lack of auditory feedback. Cochlear implanted children achieve better hearing and consequently enhanced speech intelligibility. Various parameters of voice improve with continous usage of cochlear implant. However all the vocal parameters do not show similar degree of change. Previous studies have assessed the voice quality of cochlear implantees and have given inconsistent results. The aim of the study is to compare the voice quality of cochlear implant children with normal subjects using objective and subjective methods. The study was undertaken after obtaining clearance from the Institutional Ethics committee. Written informed consent for carrying out voice analysis was taken from the parents. The voice analysis of 42 normal and 42 cochlear implant children were done using the Dr Voice software by Tiger Inc. All the children were age and sex matched. The parameters assessed were fundamental frequency, maximum phonation time, jitter%, shimmer% and harmonics to noise ratio. The findings of both the group were compared. The cochlear implanted children showed significant deviation of all the measured parameters as compared to the normal children. The voice quality of the implanted children is poor and deviant from the normal. Even after continuous usage of cochlear implant for 1 year the voice quality of these children did not reach to the levels of their normal hearing peers.

Post Stapedotomy Vestibular Deficit: Is CO2 Laser Better than Conventional Technique? A Non-randomized Controlled Trial.

The current standard of care for surgical management of Otosclerosis is small fenestra stapedotomy, which can be done by CO2 Laser assisted as well as conventional techniques. Vertigo is the commonest complication after stapes surgery. The use of CO2 Laser has been rising recently owing to its no touch principle, high precision and possibly lower risk of vertigo post operatively. To compare the post-operative vestibular deficit in patients of Otosclerosis having undergone small fenestra stapedotomy by conventional versus CO2 Laser assisted technique. 80 clinically diagnosed Otosclerosis patients fulfilling the inclusion criteria were enrolled. They underwent small fenestra stapedotomy by either conventional or CO2 Laser assisted technique. Vestibular function was assessed objectively by measuring sway velocity using modified clinical test of sensory interaction on balance by static posturography. Subjective measurement of balance was done using Vestibular balance subscore of Vertigo Symptom Score (VSS-sf-V). The outcome measures were compared pre-operatively and at first and fourth week post-operatively. All patients had vestibular deficit 1 week post-operatively in the form of increased sway velocity and symptom scores, which reduced by 4 weeks after Stapedotomy. The vestibular deficit in the two groups was similar at 1 week after surgery. 4 weeks after surgery, the sway velocity in conventional group was significantly greater than Laser group though there was no significant difference in the symptom scores. The use of CO2 Laser for Stapedotomy results in lesser post-operative vestibular deficit as compared to conventional method.

Leadership challenges in multinational medical peacekeeping operations: Lessons from UNIFIL Hospital.

Commanding a military multinational and multilingual healthcare facility can be a formidable task with very little margin for error. The authors were in leadership positions of UNIFIL Hospital, unique in its diversity of both staff and clientele. Experience about the challenges faced and methods adopted to overcome them will be shared. Troops from diverse backgrounds differ in their competency, and also in their attitudinal approach to situations. It is imperative for the medical commanders to identify these differences, and work towards harnessing individual strengths to form a cohesive unit. Frequent rotation of team members and thereby difficulty in adapting to new environment makes the tasks more challenging. Challenges can be broadly categorized in those dealing with functional roles (providing medical support) and command and control issues. Linguistic challenges especially in situations where professionals have to work as a coordinated unit remains a major challenge. The threat of medical errors arising out of misunderstandings is very real. Gender sensitization is essential to avoid potential unpleasant situations. Interpersonal conflict can easily go out of hand. The leadership has to be more direct and deliberate relying less on hierarchy and more on direct communication. A strict enforcement of UN standards for equipment and competence, frequent joint medical drills help to overcome interoperability issues and develop mutual confidence. Leadership in multinational UN hospitals is a demanding task with its peculiar set of challenges. A systematic and deliberate approach focused on mutual respect, flexibility and direct leadership can help medical commanders in such situations.

Voice and endocrinology.

Voice is one of the advanced features of natural evolution that differentiates human beings from other primates. The human voice is capable of conveying the thoughts into spoken words along with a subtle emotion to the tone. This extraordinary character of the voice in expressing multiple emotions is the gift of God to the human beings and helps in effective interpersonal communication. Voice generation involves close interaction between cerebral signals and the peripheral apparatus consisting of the larynx, vocal cords, and trachea. The human voice is susceptible to the hormonal changes throughout life right from the puberty until senescence. Thyroid, gonadal and growth hormones have tremendous impact on the structure and function of the vocal apparatus. The alteration of voice is observed even in physiological states such as puberty and menstruation. Astute clinical observers make out the changes in the voice and refer the patients for endocrine evaluation. In this review, we shall discuss the hormonal influence on the voice apparatus in normal and endocrine disorders.