Endoscopic Tympanomastoid Surgery - Our Experience

Introduction In last few decades medical science has seen resurgence of minimally invasive surgery by development of endoscopes with adequate illumination, magnification and image quality. Although operating microscope made a significant advance in ear surgery but it has a drawback of unobservable blind angles in cavities of middle ear. Objective To demonstrate the effectiveness otoendoscope along with operating microscope in tympanomastoid surgeries. Materials and methods In this prospective study conducted between January 2012 to January 2014, a total of 67 ears with chronic otitis media of mucosal and/or squamosal disease were operated. Twenty eight were operated using canal wall up (CWU) technique, 26 underwent canal wall down (CWD) surgery, 13 cases had tympanoplasty with endoscopic disease clearance .Intraoperative Otoendoscopic evaluation for disease clearance was done in all cases. Results Out of 28 CWU mastoidectomy, 21 cases had disease medial to incus & aditus, that was cleared completely with otoendoscopic assistance. Rest Seven cases had disease limited to attic & they underwent also had otoendoscopic disease clearance. Twenty six patients underwent CWD procedure with intraoperative otoendoscopic evaluation & clearance of residual disease. Thirteen cases undergoing tympanoplasty, which harboured disease in the middle ear also underwent cleared endoscopic clearance.We followed up all patients for at least 6 months and no recurrence has been detected. Conclusion Otoendoscope provides a panoramic view of middle ear cavity and endoscopic ear surgery preserves much of normal anatomy as possible by minimizing unnecessary dissection of bone & soft tissue. In addition there is more chances of ossicular preservation without jeopardizing disease clearance, hence it should be added to surgical armamentarium for better disease clearance and superior surgical outcome

Microscopic Phonosurgery in Benign Vocal Fold Lesions

Abstract Introduction : Although Phonosurgery has been the mainstay of treatment for benign vocal fold lesions for decades, advanced diagnostic modalities improved techniques of voice therapy and vocal hygiene have helped managing them in a more precise and better way. Objective : To study the role of phonomicrosurgery in benign vocal fold lesions. Methods : This prospective study was under taken in a tertiary health care centre for a period of one-year (October 2012) to September 2013, thirty two patients had undergone phonosurgery for vocal fold polyps (n = 14), vocal fold cysts (n=8), vocal fold nodules(n=3), Sulcus vocalis (n=2), vocal fold papilloma (n=l), vocal fold angioma (n=l), keratotic patch (n=2) and vocal fold oedema (n=1). Their average age was 41 years of which 62% werewomenand 69% were smokers. Postoperative voice therapy was given to sixteen patients. Post-operative clinical evaluation was available for data analysis in 30 patients (92%). Voice quality was assessed using the voice handicap index-10 questionaire (VHI-10), direct laryngoscopy was performed pre & post-operatively and self-reported assessment. The median follow-up time was 4 months. Result : Thirty out of 32 patients showed objective improvement in fibreoptic laryngoscopy post treatment. Two patients were noncompliant to voice therapy and showed recurrence of their pathologies.Mean VHI 10 score showed significant improvement from 8 in the preoperative period to 3 in the postoperative period. Conclusion : Phonosurgery is a quick and effective treatment with uncommon and transient post-operative complications. Pre and postoperative voice therapy plays an integral role in combination with phono-micro surgery enhances the outcome in patients with benign vocal fold lesions. Objective assessment of the voice pre- and postoperatively should be used consistently to evaluate the additional impact of pre- and postoperative voice therapy

HPV Serology Testing Confirms High HPV Immunisation Coverage in England.

BACKGROUND:Reported human papillomavirus (HPV) vaccination coverage in England is high, particularly in girls offered routine immunisation at age 12 years. Serological surveillance can be used to validate reported coverage and explore variations within it and changes in serological markers over time. METHODS:Residual serum specimens collected from females aged 15-19 years in 2010-2011 were tested for anti-HPV16 and HPV18 IgG by ELISA. Based on these results, females were classified as follows: seronegative, probable natural infection, probable vaccine-induced seropositivity, or possible natural infection/possible vaccine-induced seropositivity. The proportion of females with vaccine-induced seropositivity was compared to the reported vaccination coverage. RESULTS:Of 2146 specimens tested, 1380 (64%) were seropositive for both types HPV16 and HPV18 and 159 (7.4%) positive for only one HPV type. The IgG concentrations were far higher for those positive for both HPV types than those positive for only one HPV type. 1320 (62%) females were considered to have probable vaccine-induced seropositivity. Among vaccine-induced seropositives, antibody concentrations declined with increasing age at vaccination and increasing time since vaccination. CONCLUSIONS:The proportion of females with vaccine-induced seropositivity was closest to the reported 3-dose coverage in those offered the vaccination at younger ages, with a greater discrepancy in the older females. This suggests either some under-reporting of immunisations of older females and/or that partial vaccination (i.e. one- or two-doses) has provided high antibody responses in 13-17 year olds

Assessment of Energy Budgeting and Its Indicator for Sustainable Nutrient and Weed Management in a Rice-Maize-Green Gram Cropping System

Sustainability and climate change are the two major challenges to the agricultural production system. The trade-off between them is essential for higher profitability. The energy assessment is essential for judging the sustainability and vulnerability of a production system. Besides, nutrient management and weed management are equally imperative to sustainability. Thus, the present study was executed to assess the energy balance, key energy indicators and profitability of rice–maize–green gram system under different nutrient and weed management practices. Application of Brassicaceous seed meal (BSM) along with mineral fertilizer attributed the highest rice (5.62 t ha−1) and maize (6.48 t ha−1) yield which was 11.6%, 8.3% and 3.7% in maize and 10.0%, 6.2% and 8.7% in rice for the conjoint application with vermicompost, farmyard manure (FYM) and neem cake, respectively. Moreover, BSM recorded the highest net energy gain, energy use efficiency and energy efficiency ratio and the lowest specific energy in all the crops. Application of pre-emergence herbicides followed by hoeing was found to be best in all respects including yield, profitability, energy use efficiency, energy effectiveness, etc. The appropriate combination of integrated nutrient management with BSM and pre-emergence herbicide application followed by hoeing provided an additional advantage not only in terms of yield but also an efficient use of energy, profitability and environmental safety. BSM and neem cake could be the alternative organic manure in the integrated nutrient-cum-weed management module and they could be able to compensate the paucity of FYM and vermicompost in the country

Assessment of Energy Budgeting and Its Indicator for Sustainable Nutrient and Weed Management in a Rice-Maize-Green Gram Cropping System

Sustainability and climate change are the two major challenges to the agricultural production system. The trade-off between them is essential for higher profitability. The energy assessment is essential for judging the sustainability and vulnerability of a production system. Besides, nutrient management and weed management are equally imperative to sustainability. Thus, the present study was executed to assess the energy balance, key energy indicators and profitability of rice–maize–green gram system under different nutrient and weed management practices. Application of Brassicaceous seed meal (BSM) along with mineral fertilizer attributed the highest rice (5.62 t ha−1) and maize (6.48 t ha−1) yield which was 11.6%, 8.3% and 3.7% in maize and 10.0%, 6.2% and 8.7% in rice for the conjoint application with vermicompost, farmyard manure (FYM) and neem cake, respectively. Moreover, BSM recorded the highest net energy gain, energy use efficiency and energy efficiency ratio and the lowest specific energy in all the crops. Application of pre-emergence herbicides followed by hoeing was found to be best in all respects including yield, profitability, energy use efficiency, energy effectiveness, etc. The appropriate combination of integrated nutrient management with BSM and pre-emergence herbicide application followed by hoeing provided an additional advantage not only in terms of yield but also an efficient use of energy, profitability and environmental safety. BSM and neem cake could be the alternative organic manure in the integrated nutrient-cum-weed management module and they could be able to compensate the paucity of FYM and vermicompost in the country

Flow chart of eligible samples.

<p>Flow chart of eligible samples.</p

Integrated Weed and Nutrient Management Improve Yield, Nutrient Uptake and Economics of Maize in the Rice-Maize Cropping System of Eastern India

Increasing productivity of maize while decreasing production costs and maintaining soil health are emerging challenges for the rice&ndash;maize system in South Asia. A range of integrated nutrient and weed management practices were tested in winter maize for their effects on yield, profitability, and soil health. The nutrient management treatments were a partial substitution of nitrogen with bulky (Farmyard manure; vermicompost) and concentrated organic manures (Brassicaceous seed meal, BSM; neem cake), whereas weed management practices compared chemical controls only versus an integrated approach. The N supplementation through BSM diminished the weed growth by reducing weed N uptake, and enhanced the maize crop uptake of nutrients. As compared to the sole chemical approach, atrazine-applied pre-emergence followed by hoeing reduced weed density by 58 and 67% in years 1 and 2, respectively. The N supplementation through BSM resulted in the maximum yield of maize grain (6.13 and 6.50 t ha&minus;1 in year 1 and year 2, respectively) and this treatment increased yield in year 2 compared to N application through synthetic fertilizer. Hoeing in conjugation with herbicide enhanced the maize grain yield by 9% over herbicide alone. The maximum net return and economic efficiency were achieved with the application of BSM for N supplementation, together with the integrated weed management practice

Definition of natural infection and vaccine-induced seropositivity.

<p>Abbreviations: EU/mL = ELISA units per millilitre per mililitre; GMC = Geometric mean concentration.</p

Seropositivity for HPV16 and 18 by clinical setting and laboratory sending specimens

<p>Seropositivity for HPV16 and 18 by clinical setting and laboratory sending specimens</p