Chemoradiation in locally advanced Ca Cx: Effect on NGAL levels.

INTRODUCTION: Neutrophil gelatinase-associated lipocalin (NGAL) has been reported to be unregulated in many cancers and to suppress tumor suppressor genes like p53 leading to cell proliferation. Studies to report its relationship with carcinoma cervix (Ca Cx) are still scant. MATERIALS AND METHODS: Serum NGAL levels were analyzed in 30 patients of histopathologically proven locally advanced Ca Cx at the time of diagnosis and 3 weeks after standard chemoradiation by enzyme-linked immunosorbent assay. These patients underwent either brachytherapy or supplementary external beam radiotherapy (EBRT) depending on the response of treatment. The results were analyzed statistically by applying Student's paired t-test. RESULTS: No statistically significant difference (P > 0.05) was observed in patients of Ca Cx before and after treatment or when compared stage wise, histopathological grade wise, or response wise. But the levels were found to increase when duration of treatment was ≥8 weeks (P = 0.040) and to decrease significantly when duration of treatment was <8 weeks (P = 0.0052). The NGAL levels also increased significantly after treatment in patients who received EBRT and supplementary radiotherapy (P = 0.019) while the pre- and post-treatment difference in NGAL levels was not statistically significant in patients who received EBRT + intracavitary brachytherapy (P > 0.05). CONCLUSION: As the duration as well as modality of treatment is quite important in Ca Cx, shorter duration associated with better results and lower NGAL levels, NGAL might prove to be a useful biomarker although further studies are needed to support the claim.

Intravenous paracetamol infusion versus intramuscular tramadol as an intrapartum labor analgesic.

OBJECTIVES: To compare intravenous paracetamol and intramuscular tramadol as labor analgesics. METHODS: This prospective-randomized study conducted in 200 primigravidae in active labor, distributed into two groups of 100 women each with one receiving intravenous 1,000 mg Paracetamol and other 100 mg intramuscular tramadol. Pain intensity is recorded by McGills scale before, one and 3 h after drug administration. Perinatal outcome is recorded. RESULTS: No difference in pain intensity is seen before drug administration. After 1 h of drug administration, in paracetamol group, 4 % women had horrible pain, and 29 % had distressing pain, while in tramadol group, 30 % women had horrible pain, and 60 % had distressing pain. After 3 h of drug administration, in paracetamol group, 26 % had distressing pain, while in tramadol group, 51 % women had horrible pain, and 35 % had distressing pain. Labor duration in paracetamol and tramadol group was 4.3 and 5.9 h, respectively. In paracetamol group, nausea is seen in 2.2 % and vomiting in 1.1 %, while in tramadol group, nausea is seen in 6.4 % and vomiting in 4.3 %. CONCLUSIONS: Intravenous paracetamol is more effective labor analgesic with fewer maternal adverse effects and shortens labor as compared to intramuscular tramadol.

Traumatic ossicle extrusion into the external auditory canal.

We report a rare case of incus dislocation into the external auditory canal following a head injury. The patient was a 35-year-old man who presented to the surgical emergency unit with a head injury that he had sustained during a traffic accident. An x-ray of the skull detected a longitudinal fracture of the right temporal bone. The ENT examination revealed the presence of a bony structure and a blood clot in the right external auditory canal. Computed tomography identified a disruption of the ossicular chain, with an incus-like bony shadow in the external canal. The wide opening of the fracture line and the impact of the accident were believed to have pushed the incus through the fracture and into the external canal. The patient was successfully treated with exploratory tympanotomy and ossiculoplasty.

Idiopathic sphenoid sinus CSF rhinorrhoea.

Cerebrospinal fluid (CSF) rhinorrhoea results from a direct communication between the CSF-containing subarachnoid space and the mucosa-lined space of the nasal cavity and paranasal sinuses. We present a case of 40-year-old woman, presenting with clear, watery discharge through the right nostril spontaneously. The CT cisternography confirmed the diagnosis of sphenoid sinus CSF rhinorrhoea, with no intracranial pathology. The patient was managed by transnasal endoscopic procedure, wherein bath plug technique was followed using temporalis fascia and overlay grafting with fascia lata and fibrin glue. The patient has been symptom free for the last year.

Central giant cell granuloma of the maxilla.

Central giant cell granuloma (CGCG), formerly called giant cell reparative granuloma, is a non-neoplastic proliferative lesion of an unknown aetiology. It occurs most commonly in the mandible. The case reported here resembled a wide variety of conditions that led to a misdiagnosis both on clinical and radiographic examinations but was histopathologically diagnosed as CGCG. We managed this case by endoscopic excision and curettage via nasal route without producing external scar and avoiding damage to the un-erupted tooth.

Postoperative airway management after nasal endoscopic sinus surgery: A comparison of traditional nasal packing with nasal airway.

BACKGROUND: Nasal packing after the nasal surgery can be extremely hazardous and can lead to airway complications such as dyspnea and respiratory obstruction. OBJECTIVE: The present study aimed at comparing the traditional nasal packing with nasal airway during the immediate postoperative period in patients undergoing fibreoptic endoscopic sinus surgery (FESS) under general anaesthesia (GA) with regards to airway management. MATERIALS AND METHODS: The study groups consisted of 90 ASA grade I and II patients aged 16 to 58 years who underwent FESS under GA. Patients were randomly assigned into three groups: Group NP, UA and Group BA of 30 patients each. At the end of surgery, Group NP patients were managed with traditional bilateral nasal packing while a presterilized 5 mm ID uncuffed ETT was cut to an appropriate size and inserted into one of the nostrils in UA and bilaterally in BA group patients. During postoperative period following parameters and variables were observed over the next 24 hours: Any respiratory distress or obstruction, pain and discomfort, oxygen saturation, heart rate, blood pressure, bleeding episode, ease of suctioning through nasal airway, anaesthesiologists and surgeons satisfaction during postoperative period, discomfort during removal of nasal airway and any fresh bleeding episode during removal of nasal airway. The data was compiled and analyzed using Chi-square test and ANOVA with post-hoc significance. Value of P < 0.05 was considered significant and P < 0.0001 as highly significant. RESULTS: The post-op mean cardio-respiratory parameters showed significant variations among NP group (P < 0.05) and the patient of UA and BA groups while intergroup comparison between UA and BA was non-significant (P > 0.05). Pain and discomfort, bleeding episode, ease of suctioning through nasal airway, pain and bleeding during removal of nasal airway (P < 0.0001) as well as surgeons and anaesthesiologists satisfaction criteria showed significant results among the NP group as compared to UA and BA groups (P < 0.05). CONCLUSION: The present intervention to maintain airway patency can be termed as excellent with additional benefits like ease of suctioning; oxygen supplementation and a possible haemostatic effect due to pressure on the operated site. The low cost of the modified nasal airway and easily replicable design were the standout observations of the present study.

Lingual thyroglossal duct cyst treated by intraoral marsupialisation.

The authors report a rare case of lingual thyroglossal duct cyst (TGDC) which is being treated by non-conventional technique of intraoral marsupialisation and the authors also review the embryology of TGDC and its diagnosis. The patient was operated upon by intraoral route and the cyst was marsupialised. There is no recurrence in the past 2-year follow-up. This approach avoids unnecessary scar and postoperative morbidity associated with opening neck planes and removing the central hyoid as indicated in conventional technique.

Antidiarrhoeal activity of leaf extract of celosia argentea in experimentally induced diarrhoea in rats.

In order to scientifically apprise some of the anecdotal, folkloric, ethno medical uses of celosia argentea, the present study was undertaken to examine the antidiarrhoeal properties of alcoholic extract of leaves of Celosia argentea on diarrhoea by using different experimental models. Anti-diarrhoeal effect was evaluated by castor oil induced diarrhoea, charcoal meal test and PGE(2) induced diarrhoea. Loperamide (2 mg/kg) and atropine (0.1mg/kg) were used as standard drugs. Extract was used in 100 and 200 mg/kg dose. It produced dose related anti-diarrhoeal effect. Results suggest that it may act centrally and may inhibit the PGE(2) to give anti-diarrhoeal effects. Result of charcoal meal test also suggests its anti-muscarinic activity.

Prospective study of myringoplasty using different approaches.

BACKGROUND: Myringoplasty is one of the various surgical techniques for the management of chronic supurative otitis media of tubotympanic type (CSOM-TT). The presence of a perforation of tympanic membrane with intermittent discharge and hearing loss of conductive nature are the indications of myringoplasty. Myringoplasty can be performed by any of the three approaches, i.e. permeatal, endaural, or post-aural. It is a beneficial procedure done for closing tympanic membrane perforation and improving hearing. OBJECTIVE: The aim of this study was to evaluate and compare different approaches of myringoplasty and various factors influencing surgical outcome. MATERIALS AND METHODS: Myringoplasty was done in 90 cases of tympanic membrane perforation with temporalis fascia graft by underlay or onlay technique through one of the three approaches, i.e. permeatal, endaural and post-aural. RESULTS: The overall success rate in this study was 81.11% with majority of patients had improvement in hearing. Statistically there was no significant difference in results with different approaches. Age, sex, site, size and duration of disease had no bearing on graft take in this study. CONCLUSION: In repairing tympanic membrane perforations similar success rates are achieved with postaural or endaural approaches. A permeatal approach is most limited in the exposure obtained. What is important in choosing the appropriate approach is the location and size of the perforation and size of external auditory canal.

Genotypic differences in water status, membrane integrity, ionic content, N2-fixing efficiency and dry matter of mungbean nodules under saline irrigation.

A pot experiment was conducted under natural conditions of screen house to evaluate the effect of saline irrigation given at flowering stage (30-35 DAS) on nodule functioning and their tolerance in two mungbean genotypes viz. Asha and Muskan based on various physiological traits. The pots containing sandy soil (Typic Torrispamments) were saturated with Cl-dominated saline irrigation to maintain ECe of 2.5, 5.0, 7.5 dS m(-1) as compared to control. In both the genotypes osmotic potential (Ψs) and relative water content (RWC %) of nodules decreased significantly, while a sharp rise in proline and total soluble sugars contents were observed with the increasing level of saline irrigation after 10 and 20 days of treatment. A marked increase in hydrogen peroxide (H2O2), lipid peroxidation (MDA content) and relative stress injury (RSI %) was noticed in nodules which were much higher in Muskan. The decrease in Ψs of nodules was more pronounced in Asha than in Muskan, while reverse was true for RWC and proline accumulation. A sharp decline in acetylene reduction assay (ARA) for N2-fixation, leghemoglobin content and dry matter of the nodules was observed, but was more in Muskan than in Asha. Nitrogen (N) content declined while Na(+)/K(+) ratio and Cl(-) content increased significantly. The genotype Asha maintained better N2-fixing efficiency but lower Na(+)/K(+) ratio and Cl(-) content in nodules than Muskan. Though the nodule functioning was further deteriorated at 20 DAT in both the genotypes yet the tolerance capacity of nodules in Asha was better than in Muskan under saline conditions which is correlated with the compensatory mechanism i.e. osmoregulation in nodules.

Plant water status, ethylene evolution, N(2)-fixing efficiency, antioxidant activity and lipid peroxidation in Cicer arietinum L. nodules as affected by short-term salinization and desalinization.

Salinity induced changes in ethylene evolution, antioxidant defense system, N(2)-fixing efficiency and membrane integrity in relation to water and mineral status in chickpea (Cicer arietinum L.) nodules were studied under screen house conditions. At vegetative stage (55-65 DAS) plants were exposed to single saline irrigation (Cl(-) dominated) of levels 0, 2.5, 5.0 and 10.0dSm(-1) and sampled after 3d. The other set of treated plants was desalinized by flooding and the plants were sampled after further 3d. Water potential (Psiw) of leaf and osmotic potential (Psis) of leaf and nodules significantly decreased from -0.44 to -0.56MPa and from -0.65 to -1.15MPa and from -0.75 to -1.77MPa, respectively upon salinization. RWC of leaf and nodules also reduced from 86.05% to 73.30% and 94.70% to 89.98%, respectively. The decline in Psis of nodules was due to accumulation of proline and total soluble sugar. In comparison to control, the increase in ethylene (C(2)H(4)) production was 35-108% higher and correspondingly increase in 1-aminocycloprane-1-carboxylic acid (ACC) content (37-126%) and ACC oxidase activity (31-118%) was also noticed. Similarly, marked increase in H(2)O(2) (25-139%) and thiobarbituric acid substances (TBRAS, 11-133%) contents was seen. N(2)-fixing efficiency i.e. N(2)-ase activity, leghemoglobin and N contents of nodules declined significantly after saline irrigation. The induction in specific activity of antioxidant enzymes was confirmed by the increase in activity of superoxide dismutase, peroxidase, ascorbate peroxidase, glutathione reductase and glutathione transferase, whereas reverse was true for catalase. These activated enzymes could not overcome the accumulation of H(2)O(2) in nodules. Ascorbic acid content also declined from 20 to 38%, whereas Na(+)/K(+) ratio and Cl(-) content were significantly enhanced. Upon desalinization, a partial recovery in all above metabolic processes and water relations parameters was noticed. It is suggested that ethylene in relation to water status and lipid peroxidation and along with other metabolic processes has an important role in induced nodules senescence under salinity.