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This review paper is a study on various methods of performance improvement in domestic refrigeration systems, based on the vapor compression refrigeration VCRS cycle. Here air-cooled, water-cooled, fog cooled, evaporatively cooled condensers and nano-fluid lubricant /coolant methods their working and efficiency are reviewed, compared, analyzed and presented. The paper inspects the work done by different researchers for the maximization of heat loss from condenser & compressor and bringing about necessary modifications to reduce the overall power consumption of domestic refrigerators by improving Coefficient of Performance (COP). Numerous works have been done on improving the heat dissipation capacity of condenser but using nano-fluid in lubricant base as refrigerant and in the compressor shell as coolant is a new technology. Nano-fluid increase heat transfer due the high conductivity nano particles. It has been observed that water cooled condensers and compressors with nano-lubricants/coolants give the best performance improvements but they suit better for big or large refrigeration systems like centralized air conditioning systems or cold storage warehousing, whereas air cooled and evaporative condensers are optimal for small scale or low power appliances like domestic refrigerators, water coolers or split air conditioners to reduce overall power consumption by increasing the COP. Keywords: Refrigeration system, COP improvement, Condenser, Water mist, Evaporative cooling, Nano-fluid coolant, VCRS cycle.

Objective Locoregional recurrence in oral squamous cell carcinoma (OSCC) is a major concern that leads to metastasis. Its detection at earliest stage is very important to increase the overall survival of the patient. There is no any biomarker for locoregional recurrence in oral squamous cell carcinoma (OSCC). The aim of this study was to find a biomarker for locoregional recurrence in tissue and serum at gene and protein level. Methods This work studied the expression of protein tyrosine phosphatase nonreceptor type 14 (PTPN-14) and Wilms’ tumor 1 (WT-1) in patients and correlated their expression with locoregional recurrence and survival. Tissue expression was observed in formalin fixed tissue biopsies of 96 OSCC and 32 healthy controls by immunohistochemistry using antibody against PTPN-14 and WT-1 and serum level was estimated by enzyme-linked immunosorbent assay in pre- and post-chemoradiotherapy samples. mRNA expression was determined by using real-time polymerase chain reaction. Patients were followed for 3 years for locoregional recurrence. Results Expression of PTPN-14 and WT-1 in OSCC was upregulated (aberrant) in tissue and sera in both gene and protein level as compared with healthy controls. Locoregional recurrence was observed in 10 (23.80%) patients and significantly associated with PTPN-14 (p < 0.047) and WT-1 expression (p < 0.031). Conclusion PTPN-14 and WT-1 may be used as biomarker to identify patients for higher risk of locoregional recurrence. This study drove molecular aspect and phenotypic level to derive new emergent strategies in future for recurrent OSCC.

Laryngocele is very uncommon and no consensus regarding its surgical management is yet established. While traditional external approach is still being recommended some suggest a better microlaryngoscopic management assisted by CO2 laser that has gained popularity. Recurrence is better known with conservative surgery but this paper presents a modified single stage endolaryngeal technique for combined laryngoceles to overcome the same. The salient features are (1) A comparatively larger operculum is created and all the visible mucosa is excised; (2) the base of residual postoperative cavity is moistened with cotton soaked with concentrated carbolic acid for 1 min and (3) the residual ‘charred’ base with intermittent oozing is packed with single layer of surgicel. The reader is further encouraged to see surgical video of entire procedure.

Background-Otitis media (OM) is one of the most common childhood infections in pre-school aged children and a major cause of childhood morbidity. OM also represents the most frequent reason for antibiotic prescription in children. It is also the principal cause of childhood hearing loss in India. Objectives- We aimed to study the microbiological prole and their antimicrobial sensitivity pattern in children of otitis media with ear discharge in the tertiary care center in Lucknow and its application in the empirical treatment of otitis media. Methods: The study was conducted from September 2017 to September 2018 on 150 children attending the ENT OPD and Microbiology Department having ear discharge. Ear discharge samples were taken from 150 children (both male and female). Direct gram staining, KOH microscopy, and susceptibility testing were carried out. Results: Among 150 cases, 10 cases were found to be of ASOM, and 140 of CSOM. Predominant organisms were Staphylococcus species (22.67%), followed by Pseudomonas aeruginosa (22%), Klebsiella pneumoniae (10.7%), and Escherichia coli (10.7%). . Among Staphylococcus aureus,55% were Methicillin sensitive Staphylococcus aureus (MSSA) and 45% were Methicillin-resistant Staphylococcus aureus(MRSA). Only 1 Streptococcus pneumoniae was isolated among 10 ASOM cases. Staphylococcus species were found to be 100% sensitive to linezolid and vancomycin, 80% to amikacin and trimethoprim-sulfamethoxazole, 53% to erythromycin, and 46% to clindamycin and levooxacin. 91% isolates of Pseudomonas spp. were susceptible to piperacillin-tazobactam, 80% to cefepime, amikacin, and tobramycin, and 72% to gentamicin. Conclusion: The study of microbial patterns and their antibiotic sensitivity determines the prevalent bacterial organisms causing otitis media in children in the local area and to start empirical treatment of otitis media and its complications for successful outcome, thus to prevent the emergence of resistant strains.

The central pathologies present with perverted auditory perception and compromised postural control. Considering the existing controversy this study involves assessments of 100 cases of post fossa tumefactions in which a detailed clinical and neuro-otological (pure tone audiometry, electronystagmography, brainstem evoked response audiometry) profile is compared with their imaging patterns. The CP angle schwannomas (N = 26) presented with abnormal speech tests (N = 18), abnormal auditory adaptation (N = 7) and ABR with pathologically increased latency of wave V (N = 32), poor formation of wave I (N = 31) along with abnormal inter-wave interval (N = 32). In lesions (N = 32) compressing deeper nuclei, vermis and axial parts of brain stem, a gross truncal ataxia, incoordination, nystagmus, speech defects, subtotal deafness and bilateral ABR abnormalities were observed. The abnormal optomotor activities were seen as saccadic (N = 44) and deformed slow pursuit eye movements (N = 20). Inability to sustain holding function resulted in gaze nystagmus (N = 71), and poor timing manifested as fixation overshoots (N = 42). The midline cerebellar and upper brain stem lesions revealed bilateral OKN abnormalities whereas paramedian pathology showed only ipsilateral distortion. Caloric tests revealed culmination frequency as the most sensitive parameter for assessment of the hypo-reflexia in diffuse cerebellopathies while slow phase velocity in cases of posterior fossa lesion. The caloric hypo-activity appears to be of a better localizing value than the directional preponderance. The slow pursuit tracking revealed Type III curve perhaps due to defective regulation of slow movements in partially intact cerebellum (N = 15), while gross cerebellar dysfunctioning resulted into Type IV curve (N = 5).

Women in India are the major workforce in agriculture and perform almost all the agricultural activities. Women constitute 25.51% of the total work force in the country. The rural women play a vital role in agriculture and other agro based processing activities. They spent more time on post-harvest activities than those pre-harvest activities. Environmental and occupational health issues among agricultural workers expressed high levels of concern about working in hot weather, agricultural injuries, pesticides, awkward posture and drudgery prone activities. User Eco-friendly tools can increase the working efficiency and reduce the working load health hazards on farm activities during agricultural activities.

The histological and electron-microscopic (EM) characteristics of juvenile nasopharyngeal angiofibroma (JNA) have been described but no study has compared them with one another or with clinical features. The objective is to compare ultrastructural characteristics of JNA with clinical parameters. This prospective study included histology of 21 samples of which only 13 underwent transmission-EM. Four clinical parameters (age, duration, epistaxis, recurrence), three radiological-staging, 13 histological and 15 EM characteristics were considered. A descriptive analysis for association of these characteristics and also with clinical parameters was attempted. Furthermore statistical analysis of clinical and radiological categories with respect to frequencies of ultrastructural characteristics was also undertaken. Dense-intranuclear-inclusions (DNI) and peripheral-nuclear-irregularities were universally encountered while other very prominent features were nuclear-blebs-and-pockets, myoid-features, thin-vessel-wall (TnVW), irregular-vascular-contour (IVC) and fibrous-stroma (FS). Statistical significance was obtained between recurrence with histology (p = 0.04) and Fisch staging with EM (p = 0.001). While muscle-in-vessel-wall, thick-vessel-wall, mast-cells, stellate-stromal-cells and cellular-stroma predominated in recurrent cases, the upfront disease showed predominance of scar-like-stroma, fusiform-stromal-cells, IVC, TnVW, FS, organised-collagen-bundles and less-cellular-stroma. A very unique Rod-like-structures were appreciated in the cytoplasm of the fibroblast for the first time. While histological parameters of recurrence need further validation, a larger sample may better define histopathological surrogate for predicting intracellular dynamics that may further correlate with underlying cellular stresses. Hence an ‘ultrastructural staging’ may better customise treatment protocol and prognosis. Furthermore ‘characteristic’ unique rods need to be further investigated along with validation of viral aetiology for DNI.

The various surgical options for lacrimal tract reconstruction include canaliculodacryocystorhinostomy; fundal transposition; Conjunctivodacrocystorhinostomy with Jones tube; and in extreme cases conjunctivo-rhinostomy (CR) for total lacrimal bypass. The first three require partial lacrimal tract presence/ integrity while CR is indicated when the canaliculi and/or sac are nonfunctional. This report describes a novel technique of minimally invasive CR through a predominantly endoscopic endonasal approach and further discusses its advantages over other established techniques.

In this chapter, the aim is to provide the design of an automatic vacuum cleaner that will help to make household work convenient and much easier. This vacuum cleaner operates in both autonomous and manual mode, along with additional features such as time scheduling and dirt container with auto-dirt disposal mechanism. They are seen as more convenient to use because they can suck dust on their own. This work can be very useful in improving lifestyle of modern humans. The purpose of this project is to design automatic vacuum cleaners using digital image processing with the help of OpenCv technique. Vacuum cleaner robot is designed to make cleaning process much easier rather than by using manual vacuum.

INTRODUCTION:Insomnia is a risk factor for various physical and mental disorders as well can affect the academic performance of a student(s). AIM:To assess the prevalence of insomnia among university going students (medical, dental and nursing streams) in the South Asian continent during the lockdown due to the COVID-19 pandemic MATERIALS AND METHOD:The present study was conducted amongst 743 medical, dental and nursing undergraduate students residing in South Asia using convenience sampling. Data was collected using a pre-tested and pre-validated questionnaire [the Athens Insomnia Scale (AIS)] using google forms and had a total of 8 questions (score range 0-3) . Final scores (the individual AIS score) were obtained by adding the scores for each question (range 0 -24). The higher the score was, the worse was the sleep quality; students with score of ≥ 6 were considered insomniac. Data Analysis was done using SPSS version 21.012 by using the independent samples t-test, and multiple logistic regression. RESULTS:A total of 921 entries were recorded, out of which 743 were complete and hence, were included in the study (response rate: 80.7%). Insomnia was reported in 421 (56.7%) students, out of which, the highest was seen among dental (62.7%), followed by medical (59.8%) and nursing (45.3%) undergraduates. The highest range of AIS was observed among females (6-22) and dental students (6-21). Gender differences revealed a significant association among females in both range obtained (t-test) (p=0.03) as well as the multiple linear regression analyzing insomnia in relation to gender (p=0.03). CONCLUSION:There is a need to regularly assess insomnia among students and to take preventive measures incase of high prevalence is found among them, especially while pursuing academics online and from their homes due to the pandemic.

With ongoing Corona-pandemic, the quality of personal protection equipment (PPE) across the globe is creating controversy. This article presents a novel design of a facial mask that seems suitable to deal with short airway procedures protecting the surgeon from aerosol infection. The concept, design advantages and limitations are discussed. In absence of good quality PPEs this is an excellent option to deal with airway emergencies.

This pilot observation intends to stress on web-based hearing assessment (WBHA) as somewhat parallel to clinical pure tone audiometry. While WBHA was comparable with PTA in context of severity of deafness particularly in symmetrical hearing loss, it was inconclusive for a gross asymmetry despite multiple trials. With increasing COVID transmission, more need for social distancing and lack of audiologists in developing countries, the self-participation by patients in WBHA model will prove to be a very safe model of deafness-screening.

Objective To assess olfactory and clinical morbidity in primary (idiopathic)–type atrophic rhinitis and its course following treatment. Study Design Prospective nonrandomized controlled cohort study with follow-up. Setting Department of Otorhinolaryngology and Head and Neck Surgery of a university hospital (tertiary heath care center). Methods Sixty-one patients with atrophic rhinitis underwent assessment of clinical severity with baseline olfaction with the Brief Smell Identification test, while the improvement of their status following surgical versus nonsurgical treatment was further assessed. Results Olfaction was universally deranged with bimodal age presentation and female predominance (61%). Clinical improvement was significantly associated with surgical treatment but did not reveal any relation with up-front severity of disease. A near-significant association of age with severity did not reveal significance when stratified by age group. Baseline olfaction or its change following treatment did not reveal any significance with severity of disease or clinical improvement. Radiologic atrophy also did not reveal any significant relation with severity criteria. Conclusions Olfactory functions as compared with clinical parameters provided better reflection of underlying (systemic) pathology with environmental interaction, while later it mainly signified localized condition. Accordingly, olfaction was affected early and recovered slowly (or not at all), independent of clinical morbidity, which in turn is affected rather late but recovers early. Olfactory dysfunction at the initial stage may be a surrogate marker of potential worsening clinical condition, since bacteria often superinfect underlying susceptible nasal environment. While surgery mainly improved clinical parameters without affecting olfaction directly, a true improvement would include recovery of both.

Introduction Oral Submucous fibrosis (OSMF) occurs in young adults, who are in the habit of chewing tobacco mixed with areca nut and its various commercially available preparations. The disease results in progressive inability to open the mouth due to the submucosal fibrosis initiated by chronic inflammation affecting mainly oral mucosa. Authors undertook the present study to correlate the clinical features of OSMF to histopathological features and to find out aetiopathological factors of this condition. Materials and Methods A total of 123 clinically diagnosed OSMF patients, in the age range of 17 to 70 years were studied. Mouth opening was measured using a scale and was recorded in millimeters. Incisional biopsy was taken from the representative areas in the oral cavity. The patients were graded clinically and histopathologically and results were analyzed and discussed. Result Most of the patients were in the age group of 20-30 years (37.4%) with male predominance. The duration of either tobacco or areca nut chewing ranged from 1 to 35 yrs. Most patients had these habits for 6-19 yrs. Majority (55.3% & 54.5%) of the patients belonged to grade-2 (clinical grading) and intermediate grade (HPE grading) respectively. The HPE grading showed significant and direct association with duration of ill habits. The HPE grading showed significant and direct association with clinical grading (χ2=204.08, p

BackgroundJuvenile nasopharyngeal angiofibroma often attaches firmly to the adjoining bony region around the sphenopalatine foramina–sphenopalatine fossa–pterygomaxillary fissure. This can result in hourglass-shaped constriction and predispose to incomplete resection (residual disease) with a transpalatal approach. This paper describes attempts to address this ‘inaccessible’ area with a novel instrument, used since 2012.MethodsMeasurements of the sphenopalatine foramen, nasal septum, posterior nasopharyngeal wall and hard palate were undertaken in 20 skulls and 10 computed tomography scans (lateral extension). A device was designed (in terms of angulation and length) following several trials with malleable wire. A search of patents was also undertaken. Recurrence rates were compared in cases of device use and non-use.ResultsThe novelty of the sphenopalatine fossa dissector was established and the device was patented. This device has significantly improved our 17.59 per cent recurrence rate of the past 4 decades; of 63 cases over 3 years, there were only 3 recurrences and 2 residual disease cases. Findings of our previous studies with or without the device are compared.ConclusionExisting evidence supports the incorporation of this inexpensive instrument in the armamentarium for resecting lateral extension of juvenile nasopharyngeal angiofibroma during a transpalatal approach.

Background:Molecular categorisation may explain the wide variation in the clinical characteristics of juvenile nasopharyngeal angiofibroma.Methods:Variations in molecular markers in juvenile nasopharyngeal angiofibroma in an Indian population were investigated and compared with global reports.Results:Variable molecular marker expression was demonstrated at the regional and global levels. A wide variation in molecular characteristics is evident. Molecular data have been reported for only 11 countries, indicating a clear geographical bias. Only 58 markers have been studied, and most are yet to be validated.Conclusion:Research into the molecular epidemiology of juvenile nasopharyngeal angiofibroma is still in its infancy. Although the molecular variation is not well understood, data obtained so far have prompted important research questions. Hence, multicentre collaborative molecular studies are needed to establish the aetiopathogenesis and establish molecular surrogates for clinical characteristics.

Recent HIV prevention trials required use of effective contraceptive methods to fulfill eligibility for enrollment. We compared pregnancy rates in a subset of participants enrolled in the Microbicide Trials Network protocol (MTN-003), a randomized trial of chemoprophylaxis to prevent HIV acquisition among women aged 18-45 years who initiated depot medroxyprogesterone acetate (DMPA) or combined oral contraceptives (COCs) at enrollment, relative to those already using DMPA or COCs.Data were analyzed from MTN-003 participants from Uganda. Before enrollment, information on contraceptive type and initiation date was obtained. Urine pregnancy tests were performed at monthly follow-up visits. Cox proportional hazards models were used to compare pregnancy incidence among new users (initiated ≤60 days before enrollment) and established users (initiated60 days before enrollment).Of 322 women enrolled, 296 were COC or DMPA users, 82 (28%) were new users, and 214 (72%) were established users. Pregnancy incidence was higher among new contraceptive users compared to established users (20.70% vs. 10.55%; adjusted hazard ratio [HR] = 1.66; 95% confidence interval [95% CI] 0.93-2.96). Among DMPA users, pregnancy incidence was 10.20% in new users versus 3.48% in established users (HR = 2.56; 95% CI 0.86-7.65). Among new COC users, pregnancy incidence was 42.67% in new users versus 23.67% in established COC users (adjusted HR = 1.74; 95% CI 0.87-3.48).New contraceptive users, regardless of method, at the Uganda MTN-003 site had an increased pregnancy risk compared to established users, which may be due to contraceptive initiation primarily for trial eligibility. New users may benefit from intensive contraceptive counseling and additional contraceptive options, including longer acting reversible contraceptives.

The extranasopharyngeal angiofibroma is a separate clinical entity but those involving infratemporal fossa and cheek resemble juvenile nasopharyngeal angiofibroma (JNA) and hence have been labelled as juvenile perinasal angiofibroma (JPA) in this paper. This paper presents a 7th case of JPA and attempts to review the world literature on JPA, along with a proposal of staging the disease. A 16 year male presented with a painless compressible facial swelling since 7 months without any epistaxis or nasal obstruction. Initially a vascular lesion was suspected but JNA without nasal extension was strongly suspected on imaging. A deep trucut biopsy confirmed the histopathology. The vascular enhancement was significant and the tumour was excised through open approach (Weber Fergusson). JPA that can be regarded as a variant of JNA that fails to extend medially. Imaging demonstrates classical JNA findings with a clear nose/nasopharynx. A deep trucut biopsy under control in inpatient settings may sometimes help. JPA presents most commonly in Stage II where an open facial approach preferably following selective preoperative embolization is indicated. Hence with painless compressible (or non-compressible) cheek swelling suspected to be of a vascular etiology, a high degree of clinical suspicion for JPA needs to maintained in order to prevent a misdiagnosis.

Computerization of health care is the only model to sustain safe health care in this COVID era particularly in overpopulated nations with limited health care providers/systems like India. Accordingly incorporation of computer-based algorithms and artificial intelligence seems very robust and practical models to assist the physician. The advantages of Computerized algorithms to facilitate better screening, diagnosis or follow-up and use of Artificial Intelligence (AI) to aid in medical diagnosis are discussed.

Reducing commercial aviation fatalities is just one of the complex problems that has been solving for business, government, and military leaders for over 100 years. Through devotion, candor, courage, and character, original solutions were produced where there are no road maps. Most flight-related fatalities stem from a loss of “airplane state awareness.” That is, ineffective attention management on the part of pilots who may be distracted, sleepy or in other dangerous cognitive states. This work focuses on predicting one of these cognitive states, thereby helping the pilot to manage the flight effectively. This work applies machine learning algorithm, Support Vector Machine (SVM) to predict the cognitive state of the pilot during flight.

To study the pattern of olfactory dysfunction/recovery in juvenile nasopharyngeal angiofibroma (JNA).Olfactory assessment was undertaken in 30 patients (category1) both pre-post-operatively and in another 18 (category 2) only postoperative. All patients underwent transpalatal excision and variables of interest included age, radiological stage/parameterstumor size.Objective olfactory dysfunction was seen in 60% while involvement of olfactory strip was suggested in 50%. Despite some marginal trends only noted between size/age with change of olfaction, Pearson's correlation test did not reveal any significance amongst multiple variables. However a better recovery of olfaction following surgery was evident in Category-2 where Chi-Square test (p 0.05) significantly revealed this to be a function of postoperative duration. This regenerative course in JNA suggests an optimum period of 4 years for full recovery after surgery.In this first study of olfaction in JNA many new trends have been appreciated. In general, deteriorations of olfaction were seen due to 'vascular-concussion' effect in early postoperative phase where post-surgical clearance of airway showed minimal effect in terms of improvement. The hypervascularity of olfactory epithelium with possible hormonal effects may be responsible for the unique pattern of olfactory function and recovery in JNA.

The incorporation of telemedicine and artificial intelligence for early screening and assessment of severity of life-style disorders has a great potential for better assessment in a busy outpatient clinic and thereby curtail down the related morbidities. A computer based algorithm based upon standardized questionnaire (from established assessment tools) is designed to assess the risk of obstructive sleep apnoea syndrome (OSAS). In addition the incorporation of basic screening questions of anamnesis help in suggesting a probable diagnosis of sleep related disorder as well. The overall data at our center has been analyzed to establish the existing pattern of sleep related disorders. Of 850 healthy subjects screened, prevalence of snoring was 20.47% while OSAS was seen in 4.20% (N = 25) in males and 2.64% (N = 8) in females. The parasomnia was most prevalent (14.71%), followed by insomnia (10.24%), periodic leg movement (6.59%), bruxism (1.65%) and narcolepsy (0.59%). Hypertension, laryngopharyngeal reflux and obesity were the common co-morbidities in OSAS while family history of hypertension and diabetes were common in snorers. A significant association with OSA was seen with diabetes mellitus, neck circumference and nasal obstruction, while, obesity and apnoeic episodes were more significantly associated with OSA than snorers. Increased waist to hip ratio was appreciated in both the OSAS and snorers. The algorithm based online assessment is likely to diagnose the occult clinical cases as well as assess the risk of OSAS. In routine outpatient clinic, a clinician may better assess the patient morbidity with a comprehensive availability of symptoms and moreover enhance the post-treatment compliance. In addition a smartphone based computerized assessment for general population may be designed for other lifestyle disorders as well.

The worldwide population of diabetic patients is increasing alarmingly with India claiming number one position. It causes irreversible damage to cochlear hair cells, vestibular apparatus, visual pathway, nephrons, nerves, if not checked in time. A total of 188 patients of diabetes mellitus were included in this prospective study. The patients underwent routine anamnesis, hearing handicap inventory and dizziness handicap inventory assessment along with clinical examination for audiological, vestibular, neurological and ophthalmological (fundoscopy) status. In our study a sensorineural hearing loss, retinopathy, neuropathy, vestibulopathy was seen in diabetic patients.

Background Head and neck squamous cell cancer (HNSCC) is maximally encountered in India across the globe, and the environmental influences/interactions leading to cancer particularly education and income are very different in the developed countries than the third world. Material and methods A prospective assessment of 707 histologically proven HNSCC patients was undertaken regarding the possible role of 2 determinants viz. education and income on cancer prevalence. Standard questionnaires were filled up for the outpatients in the department of otolaryngology and variables such as demographics, site of involvement, the education and family income were analyzed accordingly. Observations The cancer was seen more among those with the education status of less than grade V (58%), than between VI and VIII grade (21%) or between IX and XII grade (8.5%) and higher. Of those with the education category of less that grade V, oral cavity was the most common site involved (29%). The cancer rates among income category of less than Rs. 1000/- (46%) was significantly more than those of Rs. 1001–2000 (29%) and Rs. 2001–4000 (10%). Thereafter there was a drastic fall in the cancer rates among the further higher income categories. Conclusions Two points have emerged from this study; that is likely to have the highest impact on cancer control: (1) implementing compulsory education till class VI and (2) Enhancing family income to Rs. 4000/INR per month. These are likely to have a complicated interaction with various procarcinogenic practices and environment and their correction is very likely to reduce the cancer occurrence through prevention.

Background An analysis of time distribution of juvenile nasopharyngeal angiofibroma (JNA) from the last 4 decades is presented. Methods Sixty recurrences were analyzed as per actuarial survival. SPSS software was used to generate Kaplan–Meier (KM) curves and time distributions were compared by Log-rank, Breslow and Tarone–Ware test. Results The overall recurrence rate was 17.59%. Majority underwent open transpalatal approach(es) without embolization. The probability of detecting a recurrence was 95% in first 24 months and comparison of KM curves of 4 different time periods was not significant. Conclusion This is the first and largest series to address the time-distribution. The required follow up period is 2 years. Our recurrence is just half of the largest series (reported so far) suggesting the superiority of transpalatal techniques. The similarity of curves suggests less likelihood for recent technical advances to influence the recurrence that as per our hypothesis is more likely to reflect tumor biology per se.

Background:Juvenile nasopharyngeal angiofibroma often presents with lateral extensions. In countries with limited resources, selection of a cost-effective and least morbid surgical approach for complete excision is challenging.Methods:Sixty-three patients with juvenile nasopharyngeal angiofibroma, with lateral extensions, underwent transpalatal, transpalatal-circumaxillary (transpterygopalatine) or transpalatal-circumaxillary-sublabial approaches for resection. Clinico-radiological characteristics, tumour volume and intra-operative bleeding were recorded.Results:The transpalatal approach was suitable for extensions involving medial part of pterygopalatine fossa; transpalatal-circumaxillary for extensions involving complete pterygopalatine fossa, with or without partial infratemporal fossa; and transpalatal-circumaxillary-sublabial for extensions involving complete infratemporal fossa, even cheek or temporal fossa up to zygomatic arch. Haemorrhage was greatest with the transpalatal-circumaxillary-sublabial approach, followed by transpalatal approach and transpalatal-circumaxillary approach (1212, 950 and 777 ml respectively). Tumour size (volume) was greatest with the transpalatal-circumaxillary approach, followed by transpalatal-circumaxillary-sublabial approach and transpalatal approach (40, 34 and 29 mm3). There was recurrence in three cases and residual disease in two cases. Long-term morbidity included small palatal perforation (n = 1), trismus (n = 1) and atrophic rhinitis (n = 2).Conclusion:These modified techniques, performed with endoscopic assistance under hypotensive anaesthesia, without embolisation, offer a superior option over other open procedures with regard to morbidity and recurrences.

Background:The occurrence of juvenile nasopharyngeal angiofibroma is reportedly higher in India than in some other parts of the world, and our centre has seen a four-fold increase in its occurrence across seven decades.Methods:This paper reports a retrospective archival analysis of 701 juvenile nasopharyngeal angiofibroma cases from 1958 to 2013, and considers probable environmental factors in an Indian context that may affect its biology and the global distribution, as reported in the literature.Results:A continuously progressive increase in occurrence was evident, but the rapid rise observed in the current decade was alarming. The world map of juvenile nasopharyngeal angiofibroma incidence does not reflect true global distribution given the paucity of reporting. Our centre has dealt with approximately 400 cases in the last 24 years.Conclusion:With the alarming increase in juvenile nasopharyngeal angiofibroma incidence, there is a need for a registry to define its epidemiology. The world literature needs to reflect the status of juvenile nasopharyngeal angiofibroma incidence in the third world as well. Environmental factors known for hormone disruptive actions may influence its occurrence. Such aspects need to be considered to plan specific prevention policies.

Timely detection of fault and taking corrective measures reduces the downtime of any industry. It also increases the reliability and efficiency of the system. Nowadays, many industries have implemented condition monitoring (or condition based maintenance) techniques as a part of maintenance strategies. Condition based maintenance monitors the health condition of machine and diagnose the defect if any. Though there are various condition monitoring techniques, vibration analysis is one of the strongest and widely used technique for fault identification. It is used to diagnose the fault of rotating machine element. In a big power plant, condition monitoring techniques play an important role to reduce the downtime of primary system and its auxiliaries, which in turn leads to reduction in productivity loss. Therefore, it is desirable to ensure system availability.

A few studies have reported incomplete resection of juvenile nasopharyngeal angiofibroma (JNA) following embolization. The likely effects of embolization, viz. shrinkage/reduced tensile strength may have increased the fragility of tumour, leaving remnants postoperatively particularly across hour-glass constriction of sphenopalatine foramina. This paper describes the likelihood of residual disease being left following embolization and hence the importance of extended surgery for complete excision.

Introduction: Pain is one of the most dreaded side effects of surgery for the patient during as well as after the surgery. Effective postoperative pain control is an essential component of the care of the surgical patient. Inadequate pain control may result in increased morbidity or mortality. Aim: To compare Thoracic Para Vertebral Block (TPVB) and IV PCA (fentanyl) and with IV PCA alone, for postoperative analgesia and also to compare intraoperative and postoperative haemodynamic changes and side effects in patients undergoing open nephrectomy. Materials and Methods: Patients were randomised into two groups, 30 patients in each group. GROUP A: Received preoperative single thoracic paravertebral block (20 mL 0.25% bupivacaine) + General Anaesthesia + PCA with iv fentanyl (2 microgm/mL), Basal infusion-20 microgm/hour, Demand dose -12 microgm, Lockout interval- 20 minutes. GROUP B: Received General Anaesthesia + PCA with iv fentanyl (2 microgm/mL), Basal infusion-20 microgm/hour, Demand dose-12 microgm, Lockout interval-20 minutes. Postoperative pain score, amount of fentanyl consumption, Demand dose and haemodynamic stability was assessed. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical analysis software. The values were represented in Number (%) and Mean±SD. Results: Group A which received preoperative TPVB and IV PCA showed less analgesia, less fentanyl consumption, less demand dose and better haemodynamic stability in comparison to the Group B which received IV PCA alone (p

The molecular profile of juvenile nasopharyngeal angiofibroma (JNA) is extremely variable. In absence of established molecular signature the molecular targeting seems difficult for this heterogeneous disease. To establish a basic molecular signature, this paper analyses the interaction of 7 markers according to their ranks as per the decreasing scale of molecular expression. Fourteen samples of JNA were obtained following surgical excision and mRNA expressions were established through real-time polymerase chain reaction (RT-PCR) for vasculoendothelial growth factor (VEGF), fibroblastic growth factor (FGF), c-Kit, c-myc, Ras, platelet-derived growth factor (PDGF) and tumor suppressor gene p53. Nasal polyp was taken as control. The quantitative expressions for every marker were ranked on a decreasing scale and were compared by Spearman’s rank correlation test to define the statistically significant interaction. An attempt was also made to overview the basic clinical parameters (age, duration of symptoms, radiological staging, intraoperative haemorrhage and tumor-volume/weight) associated with enhanced molecular expressions for every marker. Results: Five significant molecular interactions were identified on the basis of rank-correlation: (1) FGF/VEGF (p

A molecular surrogate may exist for the clinical behaviour of juvenile nasopharyngeal angiofibroma (JNA). In 9–14 cases, a ‘correlation’ of clinical behaviour with molecular expression (m-RNA expression through RT-PCR) of VEGF, FGF, PDGF, Ras, c-Myc, c-Kit and p53 was undertaken. A comparison of the two extremes of expressions characterized some specific clinical phenotypes for every marker except c-Myc. A higher FGF was associated with post-adolescent presentation, smaller tumour size, enhanced haemorrhage and recurrence. A higher c-Kit was associated with adolescents, rapid growth, skull base involvement and recurrence. Enhanced Ras was associated with post-adolescence, smaller tumour size, skull base involvement and recurrence. Enhanced p53 and PDGF were associated with adolescents, early presentation and rapid progression. Higher VEGF expression was associated with skull base involvement and enhanced haemorrhage. This study is currently the only evidence revealing a clinical molecular association in JNA and larger multicentric studies need to be performed to show a statistical significance.

The evolution of the packing of postnasal space following transpalatal excision of JNA in the last 7 decades is described and a modification is presented for minimizing the immediate postoperative morbidity.

Radioresistance is one of the main determinants of treatment outcome in oral squamous cell carcinoma (OSCC), but its prediction is difficult. Several authors aimed to establish radioresistant OSCC cell lines to identify genes with altered expression in response to radioresistance. The development of OSCC is a multistep carcinogenic process that includes activation of several oncogenes and inactivation of tumour suppressor genes. TGM-3 is a tumour suppressor gene and contributes to carcinogenesis process. The aim of this study was to estimate serum and tissue expression of TGM-3 and its correlation with clinico-pathological factors and overall survival in patients of OSCC undergoing chemo-radiotherapy. Tissue expression was observed in formalin fixed tissue biopsies of 96 cases of OSCC and 32 healthy controls were subjected to immunohistochemistry (IHC) by using antibody against TGM-3 and serum level was estimated by ELISA method. mRNA expression was determined by using Real-Time PCR. Patients were followed for 2 year for chemo radiotherapy response. In OSCC, 76.70% cases and in controls 90.62% were positive for TGM-3 IHC expression. TGM-3 expression was cytoplasmic and nuclear staining expressed in keratinized layer, stratum granulosum and stratum spinosum in controls and tumour cells. Mean serum TGM-3 in pre chemo-radiotherapy OSCC cases were 1304.83±573.55, post chemo-radiotherapy samples were 1530.64±669.33 and controls were 1869.16±1377.36, but difference was significant in pre chemo-radiotherapy samples as compared to controls (p

Hemoglobin is an important part of the human blood, the deficiency of which causes anemia. Anemia poses a serious problem among women and children across the world. Hemoglobin can be measured invasively and non-invasively. Current diagnostic pathological methods are mostly Invasive which include drawing of blood. Invasive methods pose certain problems like patients discomfort and chances to spread blood communicable diseases. An approximate content of hemoglobin can directly be identified by observing the color of patients target area like nails, palpebral conjunctiva, palms, tongue etc. This paper highlights image segmentation algorithms for extracting the palpebral conjunctiva from the image of a patient’s eye. Different algorithms are tried upon the eye image to precisely segment the palpebral conjunctiva region. This segmented palpebral conjunctiva region can further be subjected to feature extraction and classification to estimate the hemoglobin level of the person whose image is taken into consideration which can further indicate whether the patient is anemic or not.

Deep neck space infections (DNI) has been a common and serious disease, involving several spaces created by planes of greater and lesser resistance between the fascial layers of the neck. Infection of deep neck space has been dangerous due to its potential ease of spread from one space to other space, associated sepsis and upper airway obstruction. This prospective study was done in 45 patients of DNI over a period of 1 year. Patients with age of 1 month to 80 years of both the sexes were included. Patient’s particular, clinical presentation and associated co-morbid conditions, physical examination, routine laboratory investigations and radiological investigations were analyzed. Patients were treated, response to the treatment was assessed and follow-up was done. In present study, DNI was more commonly seen in rural population (67%) with a male predominance (69%). Mean age of presentation was 34.4 years. Odontogenic infection (64.11%) was the commonest etiological factor and diabetes mellitus (26.66%) was the commonest co-morbid condition. Most common presenting symptom was neck pain and neck swelling (91.1%) and submandibular space (66.6%) was the most commonly involved space followed by sublingual space (44.6%). Both medical and surgical treatment was needed in most of the cases (77.77%). 77.7% cases showed complete regression, 15.5% showed partial regression and they lost to follow-up, 4.4% expired and 2.2% showed progressive deterioration. DNI is a common and life-threatening disease. Early diagnosis and management is necessary for complete cure and to prevent complications associated with DNIs.

The actual burden of head and neck cancer in India is much greater than reflected through the existing literature and hence can be regarded as a 'tip of iceberg' situation. This has further been evident by the recent reports of 'Net-based Atlas of Cancer in India'. South-east Asia is likely to face sharp increases of over 75% in the number of cancer deaths in 2020 as compared to 2000. Since the percentage increase of Indian population has been nearly twice that of the world in last 15 years there is a likelihood of increase in cancer burden with the same proportion. The distribution of population based cancer registries is grossly uneven with certain important parts of the country being not represented at all and hence the current cancer burden is not reflected by registry data. However, the pathetic situation of health care system in major parts of the country as also emphasized by the World Bank, is not suitable to provide anywhere near accurate data on cancer burden. Head and neck cancer (including thyroid lesions) is third most common malignancy seen in both the sexes across the globe but is the commonest malignancy encountered in Indian males. Also oral cavity cancer is the most prevalent type amongst the males and one of the highest across the globe. This article reviews the latest global and national situation with an especial emphasis on head and neck cancer. Furthermore this review focuses on burden in different sub sites at national and global levels.

Balance disorders are often difficult to diagnose and treat using traditional methods, the reason being that balance disorders do not represent a single disease, but rather reflect a combination of multiple disorders, Balance requires integration of interactive components of sensory (Vision, vestibular, proprioception) motor and central nervous systems. Hence diagnosing a balance problem requires knowledge of these individual components. Still many clinicians prefer a traditional approach to diagnose and treat balance disorders with specialized services to be focused on localizing and treating specific pathologies. Because a typical balance disorder associated with multiple causes cannot be isolated to a single pathology on accurate diagnosis, requires a combination of tests to assess individual components along with their integrative actions. Even a specific pathology may show variations in the functional performance because of the brain’s adaptive response. Hence it is essential for the diagnostic process to determine if imbalance involves misinterpretations of sensory cues. Testing summary systems individually may not reveal the problem.

Objective:A possible role of the APC/beta-catenin pathway in the pathogenesis of sporadic juvenile nasopharyngeal angiofibroma has been suggested. This paper presents its current status and clinical association in our patients.Method:A prospective observational study was conducted at King George Medical University and Central Drug Research Institute, in Lucknow, India. Western blot analysis was undertaken in 16 cases to examine beta-catenin expression. The clinical details were recorded along with follow up observations, to determine associations.Results:Up-regulation of beta-catenin expression was seen in 69 per cent of cases. The clinical variables did not reveal significant differences between patients with extremes of expression (extreme under-vsover-expression). However, absent expression was shown exclusively in young adults aged over 18 years, while enhanced expression was associated with an altered facial profile.Conclusion:Although a beta-catenin association was seen in a subset of our sporadic juvenile nasopharyngeal angiofibroma cases, its expression was not homogeneous. This is in contrast to the Western literature that suggests a universal (homogenous) enhanced expression in the majority. Hence, further research is required to better define its molecular cascade.

Recurrent respiratory pappillomatosis is a rare condition with unpredictable nature of disease presentation and behaviour. This write up highlights our institutional experience and the importance of having a national registry for the same. An existing registry created by our team is introduced to facilitate maximum participation by our national otolaryngologists.

Background: Allergic rhinitis (AR) is a type-I hypersensitivity reaction of the nasal mucosa to the airborne allergens, primarily mediated by immunoglobulin E (IgE) characterized by nasal obstruction, watery rhinorrhea, sneezing and itching at the nose, palate and nasopharyngeal region. Various studies have been done to study the relationship between middle ear afflictions and allergic rhinitis and majority of them incriminate nasal allergies as a probable factor to the development of otitis media.Methods: A total of 70 patients, affected by allergic rhinitis, were recruited for the study after fulfilling the inclusion and exclusion criteria. Complete audiological work up including tympanometry studies was performed. Patients’ data was then compiled and analyzed using statistical analyses. Results: It was observed that disease is more common in age group of 21 to 30 years. 63% patient had perennial allergic rhinitis and rest 37% had seasonal allergic rhinitis. Otoscopic examination of the participants revealed that abnormal tympanic membrane findings such as retracted, congested, bulged and dull TM is more common in PAR than SAR. Hearing impairment is more common in PAR than SAR. Tympanometry study showed that in PAR ‘B’ type of tympanogram was found in 20% cases and ‘C’ type curve was found in 19% cases while in SAR these value were 4% and 8% respectively.Conclusions: Allergic rhinitis whether seasonal or perennial adversely affect the eustachian tube functions which in turn may lead to increased incidence of middle ear effusion and otitis media. Diagnosis and proper management of allergic rhinitis is the key to avoid these middle ear diseases.

Background: There are a lot of anatomical variations in para-nasal sinuses that are responsible for various sinus pathologies. CT scan of paranasal sinuses prior to functional endoscopic sinus surgery has become extremely important to know the anatomy and its variations to avoid complications during surgery.Methods: This study was performed in 100 patients at King George’s Medical University, Lucknow UP, India to compare the anatomical variations between nasal endoscopy and CT scan findings. The outcome measures were deviated nasal septum, paradoxical middle turbinate, concha bullosa, medialized/lateralised uncinate process, pneumatized uncinate process, large ethmoid bulla, accessory ostium, Agger nasii cells, Haller’s cells and Onodi cells. Results: In this study the age of the patients were 30.00±9.56 yrs. with male to female ratio 1.9:1. Deviated nasal septum was the most common anatomical abnormality (70%) followed by large bulla ethmoidalis 17%. Occurrence of different types of special cells were studied which are better visualized on coronal CT scan images. Among these cells Agger nasi was the most common variety (15%) followed by Haller’s cells (11%) and Onodi cell (3%). Concha bullosa was present in 8%.Conclusions: The importance of CT and nasal endoscopy can be seen in patients with persistent symptoms to identify the anatomical variations that may responsible for the development of chronic sinus disease. In cases of sinusitis patients all the para-nasal sinus should be properly investigated to avoid complications.

Background: Total or superficial parotidectomy, when a reconstructive technique is not used, usually leads to Frey’s syndrome, preauricular and retromandibular depression. These together with the scar from a classic or modified Blair incision limit the final aesthetic outcome. The superiorly based sternocleidomastoid muscle (SCM) flap or superficial musculo-aponeurotic system (SMAS) flap can be used for reconstruction of the defect to achieve better facial contour restoration. The aim and objective of the study was to evaluate the functional and cosmetic outcome of patients after reconstruction in parotid surgeries.Methods: This study was done in the department of Otorhinolaryngology & Head-Neck Surgery. Total number of patients with parotid tumours were 24 in each group namely- Group A: Patients undergoing parotid surgery without reconstruction. Group B: Patients undergoing parotid surgery with reconstruction using superiorly based sternocleidomastoid muscle flap. All patients were followed and analyzed on 6 weeks, 6 months and 1 year postoperatively on the basis of patient’s satisfaction, cosmesis, subjective Frey’s syndrome, retromandibular and pre-auricular depression using visual analogue scale. Results: In Group A, subjective Frey’s syndrome was present in 8.3% patients from 6 month to 1 year. In contrast, in Group B, it remain absent in all patients at all periods. In Group A, preauricular depression was present in 79.2% patients in immediate postop and 95.8% patients from 6 week to 1 year. In contrast, in Group B, it was present in only 4.2% patients at all periods. In Group A, retromandibular depression was present in 70.8% patients while in Group B, it was absent in all patients.Conclusions: The superiorly based SCM flap for reconstruction of defect following superficial or total parotidectomy improves the final outcome in terms of the facial deformity (pre-auricular, retro-auricular depression) and lowers the incidence of Frey’s syndrome.

Obstructive sleep apnea (OSA) is a life-threatening condition that is diagnosed and evaluated primarily by polysomnography (PSG). The procedure is time consuming, expensive, and inconvenient for the patient, and may not be universally available.The purpose of this pilot study was to evaluate posttreatment results on lateral cephalograms in patients with OSA.Lateral cephalograms of 16 patients diagnosed with OSA were made at the beginning of treatment and 4-6 weeks following treatment. Treatment modalities used in the study were the mandibular advancement device (MAD) and continuous positive airway pressure (CPAP) therapy (n=8). Pharyngeal dimensions, soft palate area and angle, and hyoid bone position were recorded for the comparisons. The data were analyzed using Student's t test for the parametric analysis (alpha=.05).A significant increase in the pharyngeal area (P.001), a significant decrease in the soft palate area (P.001), and vertical changes in the hyoid position were observed, with no significant change in the anteroposterior position of the hyoid bone.Within the limitations of this pilot study, lateral cephalograms were shown to be useful in evaluating treatment efficacy in subjects with OSA.

Background. Cervical lymphadenectomy is fre- quently performed in patients with lateral cervical lymph node metastases to improve regional control of disease. However, there is no consensus regarding the appropriate levels of the neck that need to be dissected. Treatment options that have been advocated include the modified radical neck dissection, limited neck dissections, and selective nodal excisions. In par- ticular, the routine dissection of level V remains controversial due to the attendant morbidity to the spinal accessory nerve. To iden- tify clinical and pathological predictors of cervical node metasta- ses to level V in differentiated thyroid carcinoma, we reviewed our experience at The University of Texas M. D. Anderson Cancer Center for the management of metastatic well-differentiated thy- roid cancer. Methods. We retrospectively analyzed 70 patients who underwent thyroidectomy and neck dissection for well-differenti- ated thyroid cancer at M. D. Anderson Cancer Center. Results. In our series, 53% of neck specimens harbored metastatic thyroid carcinoma at level V. Additionally, 13 level V contralateral neck dissections were performed, and 57% were found positive for metastases. The presence of ipsilat- eral level V metastases was significantly associated with multifocal disease (p

We present a very unique case of a premaxillary chondrosarcoma arising in a relatively 'younger' female with apparently much 'better' disease free 7-year survival. The literature has been reviewed and a meaningful discussion regarding diagnosis and treatment is highlighted.