Redefining indications and evaluation of dissection versus diathermy method of tonsillectomy

The current availability of randomized clinical trials have assessed the efficacy of the most common presumed indications for tonsillectomy, but the controversery still exists So, the present study was conducted to assess (1) Whether tonsillectomy leads to any significant benefits as compared to watchful waiting (2) evaluating the two most commonly used techniques for tonsillectomy i.e; cold dissection & diathermy. 170 patients were included,104 were assigned to the surgical group (Group A) & 66 patients acted as control (Group B).The surgical group underwent tonsillectomy.The efficacy of tonsillectomy viz-a-viz chronic tonsillitis related morbidity, school absenteeism, & work absenteeism, Group A beta hemolytic streptococcal pharyngitis, otitis media, Rhinosinusitis, obstructive sleep apnea & psoriasis was studied.The results of our study were as; Majority among children (7-15 years)& the mean age of adult population was 23.02 years.Tonsillectomy definitely provided benefit in case of chronic tonsillitis, mild to moderate obstructive sleep apnea on polysomnographic findings where as the Patients who had been included in this study to redefine otitis media & rhinosinusitis as an indication for tonsillectomy did not benefit much when compared to the watchful waiting groupThe three most commonly used techniques of tonsillectomy i.e; cold steel using ties & packs, cold steel using monopolar diathermy for hemostasis & using monopolar diathermy exclusively were evaluated.The operating time was least for the diathermy alone method. The intraoperative blood loss was minimal for the monopolar diathermy method. The primary hemorrhage rate was maximum in technique of cold steel with ties & packs as hemostasis.The secondary hemorrhage rate was maximum in monopolar diathermy method. The postoperative pain measured by using the verbal rating scale was considerable after using monopolar diathermy alone with 33% complaining of severe pain & 67% complaining of moderate pain

A prospective study of hearing impairment in school going children of Ghaziabad city attending a tertiary care hospital

Background:Overcrowding, poor hygiene, socio-economic status, climate, lack of resources to avail medical facilities, poor medical awareness have their bearing on the incidence of hearing loss. The family of each hearing-impaired child has its own cultural, social, educational, and financial background, and its own special needs. The aim of this study is to determine the percentage of hearing impaired school going children in Ghaziabad city.Methods:The material for the present study were a representative sample constituting 1000 school children selected from various localities of Ghaziabad city within age group of 6-12 years. The children belonged to all the strata of society and children from both sexes were evaluated for hearing loss and its underlying etiological factors. Children were subjected to detailed ENT examination in our OPD.  Results:In the present study sample the incidence of hearing loss is 9.3%. The maximum cases 60.22% belonged to the low socio-economic strata. A statistically significant difference of distribution by gender was noticed with a male preponderance (61.29%) as against 38.71% for females. The hearing loss in majority of cases was of a mild degree i.e., 26 to 45 dB (34.41%) of which majority of cases (87.10%) had conductive loss. Wax was the commonest cause of hearing loss (41.94%). CSOM was found in 21.50 % of all cases. Peak prevalence of hearing loss was found at 8 years of age, again declining after that from 20.43 % to 5.38 % by 12 years of age. Also it was observed that 59.14% children were living in crowded localities of city & 40.86% were living in non- crowded/open locality which is again statistically significant (P ≤0.05).Conclusion:The inferences drawn from the present study substantiates the view point of earlier workers that school screening is the most effective method of diagnosing deafness in school going children and should be extended to all schools in all the areas. Proper assessment and diagnosis of hearing loss in children at a very early age is important because an early diagnosis determines the efficacy of methods used for the correction of the hearing loss. Also early diagnosis of hearing impairment is a key to proper rehabilitation. The cases reporting to the hospital for treatment and rehabilitation can be regarded as the tip of the ice-berg and can have more management difficulties when compared to sub-clinical cases.

Surgical Outcome of Renal Cell Carcinoma with Tumor Thrombus Extension into Inferior Vena Cava and Right Atrium (Beating Heart Removal of Level 4 Thrombus): A Challenging Scenario

Aim: “To evaluate oncological and surgical outcomes of different levels of tumor thrombus and tumor characteristics secondary to renal cell carcinoma (RCC)”. Materials and Methods: Retrospective review from 2013 to 2020 of 34 patients who underwent radical nephrectomy with thrombectomy for RCC with tumor thrombus extending into the inferior vena cava (IVC) and right atrium (RA) at our center. Level I and most level II tumors were removed using straight forward occluding maneuvers with control of the contralateral renal vein. None of the patients had level III tumor extensions in our study group. For level IV thrombus, a beating heart surgery using a simplified cardiopulmonary bypass (CPB) technique was used for retrieval of thrombus from the right atrium. Results: “Of the 34 patients with thrombus”, 19 patients had level I, 12 patients had level II, none had level III, and three patients had level IV thrombus. Two patients required simplified CPB. Another patient with level IV thrombus CPB, was not attempted in view of refractory hypotension intraoperatively. Pathological evaluation showed clear-cell carcinoma in 67.64%, papillary carcinoma in 17.64%, chromophobe in 5.8%, and squamous cell carcinoma in 8.8% of cases. Left side thrombectomy was difficult surgically, whereas right side thrombectomy did not have any survival advantage. Mean blood loss during the procedure was 325 mL, ranging from 200 to 1000 mL, and mean operative time was 185 min, ranging from 215 to 345 min. The immediate postoperative mortality was 2.9%. Level I thrombus had better survival compared to level II thrombus. Conclusion: Radical nephrectomy with tumor thrombectomy remains the mainstay of treatment in RCC with inferior venacaval extension. The surgical approach and outcome depends on primary tumor size, location, level of thrombus, local invasion of IVC, any hepato-renal dysfunction or any associated comorbidities. The higher the level of thrombus, the greater is the need for prior optimization and the adoption of a multidisciplinary approach for a successful surgical outcome

India-Pakistan Composite Dialogue Process: Issues and Actions

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Recent insights into Nanoemulsions: Their preparation, properties and applications

The ever-increasing demand for healthy diet by consumers has prompted the research adopting cutting-edge methods that can maintain the quality of fruits and vegetables without the use of preservatives. Emulsion based coating approach has been regarded as a viable way to extend the shelf life of fresh produce. New opportunities are being created in a number of industries, (medicines, cosmetics and food) because of new advancements in the developing field of nanoemulsions. Nanoemulsion based methods are efficient for encapsulating the active ingredients including antioxidants, lipids, vitamins and antimicrobial agents owing to the small droplet size, stability and improved biological activity. This review provides an overview of recent developments in preserving the quality and safety of fresh-cut fruits & vegetables with nanoemulsion as a carrier of functional compounds (antimicrobial agents, antibrowning/antioxidants and texture enhancers). In addition, material and methods used for fabrication of the nanoemulsion is also described in this review. In addition, material and methods used for fabrication, of the nanoemulsion is also present