Epley’s maneuver versus Semont’s maneuver in treatment of posterior canal benign positional paroxysmal vertigo

Background: Benign paroxysmal positional vertigo (BPPV) is characterized by brief but violent attacks of paroxysmal vertigo provoked by certain positions of the head. BPPV is the most common cause of vertigo, resulting from migration of otoconia into the semicircular canals. Majority of patients have posterior canal BPPV. Epley’s Canalith Repositioning and Semont Liberatory Maneuver have been shown to be highly efficacious in the successfultreatment of posterior canal BPPV. The main objective of this study was to compare the efficacy of Epley’s maneuver versus Semont’s maneuver in the management of benign paroxysmal positional vertigo.Methods: This study was conducted in the Department of Otorhinolaryngology of a rural Medical College in Kerala, for a period of one and half year, from January 2015 to June 2016. It was an observational prospective cohort study. 200 patients with posterior canal BPPV were enrolled in this study based on inclusion and exclusion criteria. Patients were allotted alternatively to Epley’s group and Semont’s group, 100 patients in each group based on the treatment maneuvers they underwent. Efficacy of maneuvers were assessed at the end of 1st week, 1st month and 3rd month on the basis of resolution of symptoms and Dix-Hallpike negativity.Results: Of the 100 cases managed by Epley’s maneuver 95 cases showed complete relief of symptoms after 3 months. Out of 100 cases managed by Semont’s maneuver, 94 cases showed complete recovery after 3 months. The results were compared by Chi square test, as the data was mainly qualitative in nature. The results of both the groups were compared at the end of 1st week, 1st month and 3rd month, which revealed that both the Semont’s and Epley’s maneuver are equally effective in the treatment of posterior canal BPPV.Conclusions: Both Epley’s and Semont’s maneuver are equally effective for treating the patients of posterior canal benign paroxysmal positional vertigo

Effect of strain on the phase separation and devitrification of the magnetic glass state in thin films of La<SUB>5/8-y</SUB>Pr<SUB>y</SUB>Ca<SUB>3/8</SUB>MnO<SUB>3</SUB> (y= 0.45)

We present our study of the effect of substrate induced strain on La5/8 - yPryCa3/8MnO3 (y = 0.45) thin films grown on LaAlO3, NdGaO3 and SrTiO3 substrates that show large scale phase separation. It is observed that unstrained films grown on NdGaO3 behave quite similarly to bulk material but the strained films grown on SrTiO3 show melting of the insulating phase to the metallic phase at low temperatures. However, the large scale phase separation and metastable glass-like state is observed in all the films despite differences in substrate induced strain. The measurements of resistivity as a function of temperature under a cooling and heating in unequal field (CHUF) protocol elucidate the presence of a glass-like metastable phase generated due to kinetic arrest of the first order transformation in all the films. Like structural glasses, these magnetic glass-like phases show evidence of devitrification of the arrested charge order antiferromagnetic insulator (CO-AFI) phase to the equilibrium ferromagnetic metallic (FMM) phase with isothermal increase of magnetic field and/or iso-field warming. These measurements also clearly show the equilibrium ground state of this system to be FMM and the metastable glass-like phase to be AFI phase

P16 expression and clinicopathological features of oral and oropharyngeal squamous cell carcinoma

Background: There is an epidemiological shift in head and neck squamous cell carcinoma (HNSCC) attributable to HPV infection. HPV positive HNSCC has unique biology, risk factors, clinicopathological characteristics and outcome. There is a large variation in the published prevalence of HPV-related HNSCCs in India ranging from 7 to 78.7%. This study aims to find the P16 expression in the oral cavity and oropharyngeal SCC, thereby prevalence of HPV in our setting and to define the clinicopathological characteristics of HPV positive tumours in our setting.Methods: 210 specimens of primary Oral squamous cell carcinoma (OSCC) and Oropharyngeal Squamous cell carcinoma (OPSCC) were included. Immunohistochemistry was done using monoclonal mouse p16 antibody. Clinical details of each case were collected. Analysis was done using SPSS software and the association of P16 and clinicopathological variables were calculated using Fishers exact test.Results: P16 positive expression is observed only in 1/122 (0.82%) of OSCC and 8/88 (9%) of OPSCC. P16 positivity showed significant association with Grade of tumor (p= 0.008) and histological variant of SCC (p=0.00). 77.7% of P16 positive tumours are Grade 2 and 66.6% of Basaloid SCC was P16 positive. There is no significant association between p16 expression and other variables (subsite, age, gender, alcoholism, smoking, betel chewing and stage).Conclusions: P16 positivity was higher in oropharyngeal than in oral cancer. However, the HPV positivity rates are lower than other parts of India

A study on the effect of adenoidectomy with tonsillectomy in otitis media with effusion in children

Background: The aural symptoms attributed to adenoid hypertrophy are Eustachian tube block (ET) and otitis media with effusion (OME). It is thought that adenoid hypertrophy causes a block in air flow through the ET, thus creating a negative pressure in the middle ear leading to effusion which acts as a focus of infection. The role of hypertrophied tonsils in the aetiology of OME is controversial. Adenoid and tonsillar hypertrophy and associated inflammation continue to be a major problem in paediatric age group despite the advances in medicine. Otitis media with effusion is a treatable cause of deafness which may hamper the learning ability of a child. This study was undertaken to study the effect of adenoidectomy with tonsillectomy on established otitis media with effusion in children.Methods: 35 children presenting to the department of ENT, Government Medical College, Thrissur, Kerala, India over one and a half years with features suggestive of secretory otitis media, tonsillar and adenoid hypertrophy who underwent adenoidectomy with tonsillectomy in Government Medical College, Thrissur, Kerala, India were included in the study. A predesigned questionnaire was prepared which included details on clinical symptoms, relevant investigations and preoperative and postoperative evaluation of hearing after 6 weeks and 3 months. Data collected was analyzed using paired t-test and chi square test to determine the improvement in hearing after 6 weeks and 3 months following surgery.Results: Out of the 35 children included in the study, it was seen that 56% of cases, after 6 weeks showed complete resolution of OME which improved to 67% after 3 months. This was assessed by PTA and tympanometry. 33% showed partial improvement with Type C curve in tympanometry and improvement in PTA values.Conclusions: All cases of OME associated with adenoid and tonsillar hypertrophy responded to our treatment with 67% showing complete cure of the condition. It can be assumed that, in the 33% partial responders there may be other factors like allergy, anatomical deformities, immunological which prevented the complete resolution of symptoms in OME.

Effect of Chelating Agents on Push-Out Bond Strength of NeoMTA Plus to Root Canal Dentin

Objective:&nbsp;To evaluate and compare the effect of 17% Ethylenediaminetetraacetic Acid (EDTA), 9% Etidronic acid (HEDP), and 7% Maleic acid (MA) on the push-out bond strength of NeoMTA Plus sealer to the coronal, middle, and apical thirds of root canal dentin.&nbsp;Material and Methods:&nbsp;Forty single-rooted human maxillary central incisors were selected and decoronated to 12 mm long root fragments. Working length was established and root canals were then enlarged up to rotary Protaper F3. After each instrumentation, the root canal was irrigated with 2.5% NaOCl. For the final irrigation regimen, the specimens were divided into 4 groups (n=10) and treated with EDTA, HEDP, MA or Saline. Root canals were coated with NeoMTA Plus sealer, and obturation was done with single cone obturation technique. Subsequently, three horizontal sections were taken from the coronal, middle and apical thirds of each specimen, and POBS was measured using a universal testing machine. The type of bond failures was assessed under a stereomicroscope. Statistical analysis was done with One-way ANOVA with Tukey’s Post hoc analysis.&nbsp;Results:&nbsp;MA and EDTA showed the highest POBS. There was no significant difference in bond strength between MA and EDTA (p&gt;0.05). HEDP and Saline showed lower POBS. Among all the four groups, the coronal third showed the highest values, followed by middle and apical thirds.&nbsp;Conclusion:&nbsp;The type of chelating agent used during the root canal treatment significantly affects the bond strength of NeoMTA Plus to the root canal dentin

Microperforate hymen and labial fusion: an unusual case

Genital tract abnormalities are uncommon, occurring in approximately 7% of female population. Among these cases, hymenal abnormalities are the most frequent, with imperforate hymen occurring in 1 in 2000 girls. Imperforate and microperforate hymen is a congenital disorder of hymenal configuration which does not permit normal menstrual flow. We report a case of 26 year old primigravida at 28 weeks gestation with threatened preterm labor and was incidentally found to have fused labia minor and microperforate hymen. Scope examination through the hymen revealed a normal looking vagina and cervix. Urethral meatus was not made out. She was taken up for elective caesarean section at 37 weeks of gestation with hymenectomy. Intraoperatively, urethral orifice was identified after incising the fused labia minora. A uterine angle fibroid was found, myomectomy done. No uterine anomalies were noted

Cerebrospinal fluid adenosine deaminase activity: A complimentary tool in the early diagnosis of tuberculous meningitis

BACKGROUND: Tuberculous meningitis (TBM) is the commonest form of neurotuberculosis caused by Mycobacterium tuberculosis bacilli (MTB). The diagnosis of TBM is often difficult. A reliable, cost-effective and rapid diagnostic test, which can be performed in any standard pathology laboratory, could be of help in the diagnosis of TBM. In the present study we measured the adenosine deaminase (ADA) activity in cerebrospinal fluid (CSF) of TBM and non-TBM patients. METHOD: ADA activity in CSF was determined according to a method based on the Berthlot reaction, which is the formation of a colored indophenol complex from ammonia liberated from adenosine, and quantified spectrophotometrically. RESULTS: The CSF ADA activity from TBM patients was compared with CSF ADA from non-TBM infectious meningitis patients, and from patients with non-infectious neurological disorders. The mean CSF ADA activity was found to be significantly higher in CSF of TBM patients, 14.31 ± 3.87 (2.99–26.94), mean ± SD with range, than in the CSF from non-TBM infectious meningitis, 9.25 ± 2.14 (4.99–13.96) and from the non-infectious neurological disorders group, 2.71 ± 1.96 (0.00–7.68), P < 0.0001 for both comparisons. A cut-off value of 11.39 U/L/min for the TBM patients was calculated from the mean + SD of the non-TBM patients. The ADA test gave a sensitivity of 82% and a specificity of 83% for infectious TBM when this cut-off value was used. CONCLUSION: This study demonstrated that ADA activity in the CSF of TBM patients, using a cut-off value 11.39 U/L/min, can be useful for the early differential diagnosis of TBM. This test can be performed in any pathology laboratory where more sophisticated methods are not available