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

First simulation study of trackless events in the INO-ICAL detector to probe the sensitivity to atmospheric neutrinos oscillation parameters

The proposed India-based Neutrino Observatory will host a 50 kton magnetized iron calorimeter (ICAL) with resistive plate chambers as its active detector element. Its primary focus is to study charged-current interactions of atmospheric muon neutrinos via the reconstruction of muons in the detector. We present the first study of the energy and direction reconstruction of the final state lepton and hadrons produced in charged current interactions of atmospheric electron neutrinos at ICAL and the sensitivity of these events to neutrino oscillation parameters $\theta_{23}$ and $\Delta m_{32}^2$. However, the signatures of these events are similar to those from neutral-current interactions and charged-current muon neutrino events in which the muon track is not reconstructed. On including the entire set of events that do not produce a muon track, we find that reasonably good sensitivity to $\theta_{23}$ is obtained, with a relative $1\sigma$ precision of 15% on the mixing parameter $\sin^2\theta_{23}$, which decreases to 21%, when systematic uncertainties are considered

The international WAO/EAACI guideline for the management of hereditary angioedema - The 2021 revision and update.

Hereditary Angioedema (HAE) is a rare and disabling disease for which early diagnosis and effective therapy are critical. This revision and update of the global WAO/EAACI guideline on the diagnosis and management of HAE provides up-to-date guidance for the management of HAE. For this update and revision of the guideline, an international panel of experts reviewed the existing evidence, developed 28 recommendations, and established consensus by an online DELPHI process. The goal of these recommendations and guideline is to help physicians and their patients in making rational decisions in the management of HAE with deficient C1-inhibitor (type 1) and HAE with dysfunctional C1-inhibitor (type 2), by providing guidance on common and important clinical issues, such as: 1) How should HAE be diagnosed? 2) When should HAE patients receive prophylactic on top of on-demand treatment and what treatments should be used? 3) What are the goals of treatment? 4) Should HAE management be different for special HAE patient groups such as children or pregnant/breast feeding women? 5) How should HAE patients monitor their disease activity, impact, and control? It is also the intention of this guideline to help establish global standards for the management of HAE and to encourage and facilitate the use of recommended diagnostics and therapies for all patients

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. METHODS: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. FINDINGS: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2-11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75-1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58-1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91-1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70-1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11-0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50-0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38-0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45-0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. INTERPRETATION: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. FUNDING: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Student Traveler : Let’s Explore Indonesia

Learning English is a must-have skill, particularly for the millennial generation, which will compete globally with people from all over the world. Mastering English is no longer a choice; it is an unavoidable must. Language, particularly English, serves as a portal to the rest of the world. Reading and writing are essential skills for all students, especially as they strive to become more insightful students who will be fully useful and knowledgeable human beings in the future. As a result, students will have the insight and knowledge necessary to construct and govern this country as future leaders. Writing, in addition to reading, is a requirement for demonstrating students’ linguistic competence. Writing is one of our methods for ensuring the survival and continuance of our information. This book chapter includes information that will help everyone to travel either all around Indonesia or the world