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Background: Intercoronary communication also known as coronary arcade or coronary cascade is a rare coronary artery anomaly with an incidence of only 0.002% in patients undergoing angiography. This case emphasizes the importance of recognizing this rare anomaly and highlights its clinical significance., Case Presentation: We report a case of intercoronary communication in a 56-year-old female who presented with acute chest pain and ST-segment depression in the lateral leads. High-sensitivity troponin-T was elevated and transthoracic echocardiography revealed normal left ventricular function with no regional wall motion abnormality. Hence, the diagnosis of acute coronary syndrome - non-st-elevation myocardial infarction was considered. Coronary angiography revealed a 95% focal stenosis in the major obtuse marginal artery (OM). The right coronary artery (RCA) angiogram revealed a single abnormal channel communicating the right posterolateral branch (PLV) and the distal left circumflex artery (LCX) with retrograde opacification of the proximal LCX, left main coronary artery (LMCA) and left aortic sinus. After she underwent revascularization with the drug-eluting stent to the OM. CT-coronary angiography confirmed the presence of intercoronary communication (ICC) between the right posterolateral branch and the distal LCX artery. No active intervention was done for the ICC. Over a year of follow-up, our patient remained asymptomatic., Conclusions: Angiographically and anatomically, collaterals and intercoronary communications should be differentiated. Obstructive coronary artery disease leads to the development of collaterals, which are typically less than 1 mm in diameter, multiple and tortuous. However, ICC tends to be single and straight, usually seen without obstructive disease with unidirectional or bidirectional flow. Histologically, collaterals consist of endothelium supported by poorly organized collagen, muscle and elastic fibers. Meanwhile, ICCs resemble epicardial vessels in that they have a well-defined muscular layer. This case emphasizes the importance of recognizing this rare coronary anomaly and distinguishing it from collaterals to help in accurate diagnosis. Although they can provide an efficient blood supply to the jeopardized myocardium and can aid as a channel during coronary interventions, they can also cause myocardial ischemia by coronary steal., (© 2024. The Author(s).)

Objective: Rathke's cleft cysts (RCCs) exhibit variable growth patterns, thus posing a challenge in predicting progression. While some RCCs may not cause symptoms, others can insidiously cause pituitary dysfunction, which is often irreversible, even following surgery. Hence, it is crucial to identify asymptomatic RCCs that grow rapidly and pose a higher risk of causing endocrinologic dysfunction. This enables timely surgical intervention to prevent permanent damage. Our study examines the growth rate of RCCs, identifies factors that accelerate growth, and discusses the clinical implications of these findings., Methods: A retrospective analysis of a prospectively maintained electronic database revealed 45 patients aged 18-80 years who underwent endoscopic endonasal surgery (EEA) for RCCs between 2010 and 2022 at our center. Of these, 20 required early operative intervention. The remaining 25 patients were followed closely clinically and radiologically before requiring surgery (initial conservative management group). We conducted an analysis of the factors predicting growth over time in this group. Using a regression model, we constructed a risk score system to predict RCC growth over time., Results: Patients in the initial conservative group had smaller cysts and were generally older than those in the early surgery group. Patients with preoperative pituitary dysfunction showed a higher median growth of 1.0 mm in the longest diameter compared to those with normal pituitary function, with an increase of 0.5 mm. A sum of annual cyst growth of all (z, y, x) diameters, at a rate of 3 mm or greater, was associated with a clinically significant increase in the risk of pituitary dysfunction, exceeding 50%.The most significant factors predicting rapid growth in RCCs were smoking status, age, and T1-weighted magnetic resonance imaging (MRI) intensity of cysts. Smoking was the most critical risk factor for rapid cyst growth (p =  < .001). Our risk score system accurately predicted RCC growth with a 74% accuracy rate, 73% sensitivity, and 75% specificity., Conclusion: Our analysis showed a strong link between active smoking and the rapid growth of RCC. This novel finding has significant preventive implications but needs validation by a large population database. Surgical intervention for RCC currently is often reserved for symptomatic cases. However, utilizing our risk-based scoring system to predict rapidly growing cysts may indicate early surgery in minimally symptomatic patients, thereby potentially preserving pituitary function., (© 2024. The Author(s).)

Air pollution has become a major health concern, particularly for vulnerable populations such as the elderly, children, and pregnant women. Studies have reported a strong association between prenatal exposure to air pollutants and adverse pregnancy outcomes, including lower birth weight, reduced fetal growth, and an increased frequency of preterm births. This review summarizes the harmful effects of air pollutants, such as particulate matter, on pregnancy and outlines the mechanistic details associated with these adverse outcomes. Particulate pollutant matter may be able to cross the placenta barrier, and alterations in placental functions are central to the detrimental effects of these pollutants. In addition to associations with preeclampsia and gestational hypertension, air pollutants also induce oxidative stress, inflammation, and epigenetic alteration in the placenta. These pollutants can also affect placental homeostasis and endocrine function, contributing to pregnancy complications and possible transgenerational effects. Prenatal air pollution exposure has been linked to reduced cognitive and motor function in infants and newborns, increasing the predisposition to autism spectrum disorders and other neuropsychiatric disorders. This review also summarizes the use of various animal models to study the harmful effects of air pollution on pregnancy and postnatal outcomes. These findings provide valuable insight into the molecular events associated with the process and can aid in risk mitigation and adopting safety measures. Implementing effective environmental protocols and taking appropriate steps may reduce the global disease burden, particularly for developing nations with poor regulatory compliance and large populations of pregnant women., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Cardiac myxomas are the most common primary benign tumors of the heart usually presenting as an oval mass attached to the interatrial septum. Mild heterogenous enhancement is typically seen upon contrast administration. Myxomas are benign, however can present with embolic episodes necessitating prompt diagnosis and treatment., Case Presentation: A middle-aged woman presenting with acute ischemic stroke was detected to have a complex cystic mass in the left atrium on echocardiography. Further evaluation with cardiac magnetic resonance imaging narrowed a differential diagnosis to hemangioma, hemangioendothelioma, sarcoma, hydatid cysts, bronchogenic cysts, and cystic variant of cardiac myxoma. CTA demonstrated arterial supply from the left circumflex artery supplying the lesion. Following surgical excision, histopathology analysis suggested a cystic cardiac myxoma with secondary degeneration., Conclusion: Cystic masses in the heart are challenging to diagnose due to similar imaging characteristics, and misdiagnosis may lead to further major downstream complications such as stroke, hemorrhage, and hemodynamic alterations causing syncope. Therefore, surgical excision of a cystic cardiac mass is justified to establish a definitive histopathological diagnosis and prevent further downstream complications. We hereby report a rare case of cystic cardiac myxoma in the left atrium showing intense progressive enhancement in CMR and CTA in a middle-aged woman presenting with acute stroke. This case highlights an exceedingly rare variant of cystic cardiac myxoma., (© 2024. The Author(s).)

Objectives: The aim of this study was to explore the factors that could predict long term clinical outcomes in SA., Methods: A retrospective study was conducted wherein SA patients undergoing surgical resection with a minimum follow up of 12 months were included in this study. Modified Mccormick Scale (MMS) was utilized to record the neurological status of the patients both preoperatively and at last follow up. Outcomes were assessed as: long term neurological status, that is final MMS grade and neurological deterioration, defined as increase in MMS score as compared to preoperative MMS score. Survival analysis was performed using the kaplan meier curves., Results: 71 patients were included in this study with mean age of 33.07years. At a mean follow up of 57 months, preoperative MMS was the single independent predictor for moderate-severe neurological deficit (MMS III to V) on multivariate analysis (OR: 30.2, p < 0.001) and had an outstanding AUC of 0.91. Six patients had neurological deterioration at long term follow up. Absence of spasticity (p = 0.028), thoracic-thoracolumbar tumors (p = 0.006), low MMS score (p = 0.01) and hypointense T1 weighted MRI (p = 0.009) were significant predictors of long term neurological deterioration. The median overall survival was 48 months and was significantly higher in low grade tumors (p < 0.001)., Conclusion: The study highlights the efficacy of clinical features as a predictor of long term functional outcomes in SA patients. Role of spasticity as a prognostic factor was explored for the first time in this study., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This study aimed to examine the barriers and facilitators of the public toward deceased organ donation in Chandigarh, and Chennai, India, from three major religious groups, Hinduism, Islamism, and Christianity. Twenty-five focus groups were conducted (n = 87) stratified by study region, religion, sex, and age. Data were analysed using framework analysis. The results revealed that individuals were primarily willing to donate their organs. However, their religious views regarding death, after-life beliefs, funeral ritual practices, and lack of knowledge regarding their religion's position toward deceased organ donation created tension and ambiguity in the decision-making. However, younger age groups (18-30 years) appeared more open and positive toward deceased organ donation. The conclusion demands a clear need for religious leaders and stakeholders to address their religion's stance, which creates tension and ambiguity in any uncertainties surrounding cultural and religious-based views among the Indian population., (© 2024. The Author(s).)

Chronic osteomyelitis resulting from foreign body entrapment in the pediatric mandible presents unique challenges in diagnosis and management. Habitual insertion of objects into the oral cavity by children can lead to serious complications such as discharging sinuses and osteomyelitis. We present a case of a 12-year-old boy with extra-oral pus discharge originating from the mandible, ultimately traced to an embedded iron nail adjacent to a carious first molar. Radiographic imaging played a crucial role in diagnosis, revealing the foreign object and. Long-term follow-up showed successful healing with prompt treatment. Prevention through parent education, meticulous examination, and interdisciplinary collaboration are emphasized to avoid such complications., Competing Interests: Conflict of InterestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

This systematic literature review aims to study the role and impact of artificial intelligence (AI) in transforming Ear, Nose, and Throat (ENT) healthcare. It aims to compare and analyse literature that applied AI algorithms for ENT disease prediction and detection based on their effectiveness, methods, dataset, and performance. We have also discussed ENT specialists' challenges and AI's role in solving them. This review also discusses the challenges faced by AI researchers. This systematic review was completed using PRISMA guidelines. Data was extracted from several reputable digital databases, including PubMed, Medline, SpringerLink, Elsevier, Google Scholar, ScienceDirect, and IEEExplore. The search criteria included studies recently published between 2018 and 2024 related to the application of AI for ENT healthcare. After removing duplicate studies and quality assessments, we reviewed eligible articles and responded to the research questions. This review aims to provide a comprehensive overview of the current state of AI applications in ENT healthcare. Among the 3257 unique studies, 27 were selected as primary studies. About 62.5% of the included studies were effective in providing disease predictions. We found that Pretrained DL models are more in application than CNN algorithms when employed for ENT disease predictions. The accuracy of models ranged between 75 and 97%. We also observed the effectiveness of conversational AI models such as ChatGPT in the ENT discipline. The research in AI for ENT is advancing rapidly. Most of the models have achieved accuracy above 90%. However, the lack of good-quality data and data variability limits the overall ability of AI models to perform better for ENT disease prediction. Further research needs to be conducted while considering factors such as external validation and the issue of class imbalance., Competing Interests: Conflict of interestThe authors have no conflict of interest to declare relevant to this article’s content., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Introduction: Head and neck malignancies are associated with poor prognosis and poor quality-of-life if detected late. Narrow-Band-Imaging(NBI) is one of the important tools, which helps in detecting these lesions earlier. By using narrow-wavelength(400-550 nm) it enhances the mucosal and submucosal vascularity against the pale mucosal background which helps us detecting benign, pre-malignant and malignant lesions., Objective: The objective of this study was to evaluate the accuracy of NBI in the diagnosis of various mucosal lesions of head and neck region and its correlation with the histopathology reports., Materials and Methods: This was a prospective diagnostic study conducted between June 2020 - June 2022 where 118 patients(oral cavity-28, laryngeal-87,and hypopharyngeal-3) who fulfilled the inclusion and exclusion criteria were recruited. All-118-patients underwent NBI endoscopy under local/general anaesthesia followed by biopsies from the most suspicious-areas. Type of vascular-pattern noted from NBI and their respective histopathological reports were correlated., Results: The mean age was 53.28 ± 1.24 years ranging from 16 to 88 years. The sensitivity, specificity, Positive-Predictive-Value(PPV) and Negative-Predictive-Value(NPV) in detecting benign lesions were 100%, 90%, 74% and 100% respectively. The sensitivity, specificity, PPV and NPV in detecting premalignant lesions were 70%, 92%, 56% and 96% respectively. The sensitivity, specificity, PPV and NPV in detecting malignant lesions were 83%,97.5%, 98.5% and 97.5% respectively. NBI has a strong association with the histopathological reports, which is statistically significant(p-value < 0.001)., Conclusion: NBI has high specificity and negative predictive value in detecting and classifying various mucosal lesions of head-neck region. Its findings had a strong correlation with histopathological reports., Competing Interests: Financial Disclosure and Conflict of InterestThere was no conflict of interest amongst the authors. The project was not funded by any funding agent. There is no link with Olympus in carrying out this project and its publication., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

The dizziness handicap inventory (DHI) is a widely used questionnaire for assessing the impact of dizziness on daily life. There is a need for validated translations of the DHI to accommodate diverse linguistic populations, enabling clinical and research comparisons. This study aimed to translate and validate the DHI into Hindi language. The DHI was translated into Hindi following established guidelines. The translated version underwent validation among Hindi-speaking patients presenting with dizziness at an outpatient ENT clinic in this cross-sectional study. Reliability and validity analyses were conducted, including Cronbach's alpha, split-half reliability, and factor analysis. A total of 153 participants completed the DHI-Hindi, with a mean score of 37.28 (SD = 15.63). Ceiling and floor effects were absent. The Cronbach's alpha coefficient for the overall scale was 0.785, indicating good reliability. Factor analysis revealed a three-factor solution, consistent with previous studies, indicating good construct validity.The translation and validation process yielded a reliable and valid version of the DHI in Hindi language, suitable for assessing the impact of dizziness in Hindi-speaking population., Competing Interests: Conflict of interestAuthors have no potential conflict of interest (financial and non-financial)., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

The hobnail variation of papillary thyroid cancer (PTC) is an uncommon, aggressive variety with hobnail characteristics on more than 30% of the tumour cells. Because of the entity's rarity, the clinical behaviour and pathologic characteristics of these tumours are still unknown. The purpose of this case study was to look at the cytologic, clinical, and pathological aspects of the hobnail variant of PTC, because of its severe clinicopathologic features and poor outcome, the unusual hobnail type of PTC may necessitate more aggressive treatment than traditional PTCs. The cytologic features of the hobnail variety are distinctive, and FNAC specimens can be used to provide a preoperative diagnosis. Diagnostic parameters for proportion of hobnail morphology need to be refined further. More research is needed to understand how detection of this high-risk variation affects clinical treatment., Competing Interests: Conflict of interestThe authors declare no conflict of interest., (© Association of Otolaryngologists of India 2024.)

Introduction: The skin prick test (SPT) is a standard method for diagnosing allergic diseases, while sudden sensorineural hearing loss (SSNHL) remains a perplexing condition often of unknown etiology. We present a unique case of SSNHL emerging shortly after an SPT, suggesting a potential link between allergic reactions and inner ear disorders., Case Report: A 27-year-old male presented with unilateral hearing loss following an SPT for allergic rhinitis. Audiometric findings revealed SSNHL in the affected ear. Treatment with corticosteroids led to a full recovery of hearing function., Conclusion: This case highlights the rare occurrence of SSNHL possibly triggered by a type 1 allergic reaction to an SPT. Prompt corticosteroid therapy proved effective in restoring hearing. Further research is needed to understand the relationship between allergies and SSNHL and explore alternative treatment options., Competing Interests: Conflicts of InterestThe authors declare that there are no potential conflicts of interest concerning the research, authorship, and/or publication of this article., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Cochlear implant surgery has revolutionized the management of profound hearing loss, with a growing focus on preserving residual hearing, particularly low-frequency hearing. This review synthesizes existing literature on cochlear implantation techniques, surgical principles, and emerging therapies aimed at reducing post-implantation hearing loss. Methodologically, a comprehensive narrative literature review was conducted, encompassing various study designs and participant demographics. The search strategy involved major biomedical databases, focusing on articles in English. Surgical techniques such as "soft surgery" emphasize minimizing mechanical stress on the cochlea, while advancements in pharmacological agents explore the use of corticosteroids, neurotrophins, and growth factors to enhance hearing preservation. Electrode design and insertion strategies are evolving to minimize trauma and optimize hearing outcomes, including consideration of insertion forces and electrode array designs. Evaluating residual hearing loss involves sophisticated techniques like electrocochleography and radiological imaging. The impact of residual hearing on auditory verbal outcomes is variable, with studies indicating positive correlations with language development, particularly in speech production. Emerging strategies in electrode design, surgical techniques, and drug delivery hold promise for improving outcomes in cochlear implantation. However, challenges such as the lack of standardized guidelines and the need for further clinical trials remain. Future directions include the exploration of nanotechnologies, gene therapies, and stem cells for constructing bionic ears, although ethical and technical hurdles persist. This review underscores the ongoing efforts to enhance cochlear implant functionality and the need for continued research to optimize outcomes for patients with hearing loss., Competing Interests: Competing InterestsAll authors declare that they have no conflicts of interest., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Introduction: Conventional nasolabial flap has been widely used for reconstruction for head and neck defects. Recent decades witnessed modification of this flap like islanded version based on subcutaneous pedicle or facial artery and vein. The later modification obviated a need for pedicle division, secondary procedures and facilitates reach of the flap to distant sites. Especially, the islanded nasolabial flap pedicled on facial artery and vein can have a long pedicle to conveniently reach the tongue, floor of mouth when the flap is routed through retromandibular area., Methods: A retrospective analysis was done on 14 patients analyzing the functional outcome like deglutition, speech, and aesthetic outcome of flap donor area, recruiting patients in which islanded nasolabial flap was done based on facial vessels for early stages of cancer tongue and lip., Results: In our series of 14 operated cases, all flaps survived. All the flaps were islanded over the skeletonized facial artery and vein. Tip necrosis occurred in one case. The donor site was closed primarily in all cases. The average speech scoring was grade five, Vancouver scar score of the flap donor area was 2.5 and intelligible speech was difficult in only three cases in follow up., Conclusion: We found this flap useful for reconstruction of small to moderate size defects of oral malignancy following excision with acceptable aesthetic and functional outcome in most of the patients., Competing Interests: Competing interestsAuthors have no financial interests that are directly or indirectly related to the work submitted for publication., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Tinnitus refers to the perception of sound without any external stimuli which can be pulsatile or non-pulsatile. Dilated mastoid emissary vein (MEV) can cause pulsatile tinnitus. Herein, we report a case of persistent pulsatile tinnitus with dilated MEV managed successfully with percutaneous coiling of MEV in a 36 years male., Competing Interests: Conflict of interestNone declared., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Mucoepidermoid carcinoma (MEC) is a malignant locally invasive tumour of salivary glands, presumed to arise from reserve cells of salivary gland ducts. It accounts approximately 35% of all malignancies of major and minor salivary glands [1]. MEC arising in minor salivary glands can be located in different areas such as palate, retromolar trigone, floor of mouth, buccal mucosa, lips and tongue. MEC of tongue base are not common but they constitute around 50% of malignant lesions of salivary glands in this region. It presents in fifth and sixth decades of life mostly [1]. We present a rare case of 29 year old woman with low grade mucoepidermoid carcinoma of base of tongue operated by the Trotter procedure with harmonic scalpel - median labio-mandibular glossotomy approach. It's an interesting approach first described by William Trotter in 1920s. It's used by head and neck surgeons for accessing tongue base lesions, pharyngeal wall and cervical spine., Competing Interests: Conflict of interestAuthors are having no financial interests that are directly or indirectly related to the work submitted for publication. The research involved human participants and well-informed consent was taken from each individual. The exemption from the ethical committee review was obtained in view of case report., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

COVID-19 pandemic, which has exhibited a wide clinical spectrum and an unexpected surge in mucormycosis cases, understanding various biomarkers' roles becomes pivotal. As mucormycosis leads to clinical morbidity and mortality through angioinvasion and thromboembolism, unveiling the correlation between these markers and disease progression can shed light on the reasons behind mucormycosis's emergence as an epidemic, especially following the second wave of COVID-19. This long term ambispective observational study, conducted from May 2020 to July 2023, aimed to assess specific biomarkers as predictors of severity in COVID-19-associated mucormycosis (CAM). Biomarkers measured included ESR, CRP, D-dimer, IL-8, PCT, serum ferritin, and neutrophil-lymphocyte ratio (NLR) at different time points. Data analysis employed descriptive statistics, repeated measure ANOVA, Spearman correlations, ROC curve analysis, and logistic regression. Of 290 patients, 198 completed the 2-year follow-up. Elevated baseline biomarker levels significantly decreased with treatment initiation. CRP and NLR emerged as significant predictors of severe CAM, with odds ratio 2.926 (95% CI 1.466-4.360) and 2.203 (95% CI 0.863-1.040) respectively. Factors influencing CAM progression included age, CRP, and NLR, while all biomarkers independently predicted mortality. A death prediction model using CRP, PCT, D-dimer, NLR, and IL-8 demonstrated exceptional performance, with a sensitivity of 83.1% and specificity of 100%. Elevated inflammatory markers in CAM patients showed a decline with treatment, with NLR and CRP proving crucial for predicting severity. Serial monitoring of IL-8, CRP, PCT, NLR, D-dimer, and ferritin provides insights into disease progression and prognosis. The study underscores the importance of biomarker assessment in managing CAM, especially in the context of the unpredictable clinical spectrum of COVID-19 and the subsequent mucormycosis surge., Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04921-3., Competing Interests: Competing InterestsAll authors declare that they have no conflicts of interest., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: This prospective, double-blinded, randomized study aimed to compare the efficacy of dexmedetomidine and fentanyl infusions in maintaining hemodynamics during head and neck free flap surgery, as well as their impact on the relative amount of blood loss., Methods: Twenty patients with American Society of Anesthesiologists physical status I and II scheduled for elective head and neck free flap surgery were enrolled. The patients were randomly assigned to receive either dexmedetomidine (1 µg/kg over 10 min at anesthesia induction, followed by 0.2 to 0.75 µg/kg per hour infusion during maintenance) or fentanyl (1 to 2 µg/kg per hour infusion during maintenance). Intraoperative hemodynamic parameters, blood loss, blood transfusion requirements, surgeon satisfaction, adverse drug effects, and free flap survival up to 7 days were recorded., Results: The dexmedetomidine group achieved a mean arterial pressure (MAP) value between 60 and 70 mmHg at multiple time points (15 min, 3rd, 4th, 5th, and 6th hours), while the fentanyl group did not reach this range at any time point. The intergroup statistical analysis revealed a significant difference only at the 5th hour with (95% CI: -16.17 to -0.62) and P  = 0.036. Additionally, the dexmedetomidine group exhibited lower heart rates (< 70/min) at several time points (15 min, 2nd, 3rd, 4th, 5th, and 6th hours) compared to the fentanyl group. The intergroup comparison indicated a statistically significant difference only at the 3rd hour with (95% CI: -20.94 to -0.45) and P  = 0.042., Conclusion: Dexmedetomidine can be a useful adjuvant of GA for inducing controlled hypotension and decreasing bleeding in free flap surgery of the head and neck region without any detrimental effect on the free flap survival., Competing Interests: Competing interestNone., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Thymus is a paired organ which develops during the sixth week of fetal life, attains maximum size by three years and involutes in adult life. Anatomically it is situated in superior mediastinum. Thymus can be present at ectopic sites like neck, skull base, middle ear, submandibular gland and tonsil. Ectopic Cervical Thymus (ECT) is very rare in adults and can present as a solid mass, cyst or thymoma. ECT occurs due to failure of descent during embryonic development. ECT can mimic any pathologic mass, metastatic deposit or lymph node enlargement. We report a case of ECT discovered incidentally in an adult during histopathological examination of thyroid carcinoma. In addition, we described the role of immunohistochemistry markers to confirm the various thymic components., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Manipulation of the collagen membrane has always been cumbersome in the oral cavity because of its rolling tendency. We present a new technique for easy handling and manipulation of the collagen membrane., Competing Interests: Conflict of InterestThere are no conflicts of interest., (© Association of Otolaryngologists of India 2024.)

Anterior and high septal deviation can severely affect the functional and cosmetic outcomes of a patient. Conventional septoplasty would not be sufficient in these conditions to restore the functionality and aesthetics of a nose, and the majority of the patients require L-shaped grafts for the reconstruction of the septum. In the present study, we shared our experience in using an L-strut cartilage graft in functional rhinoplasty. It is a retrospective study of 60 patients who underwent septorhinoplasty from March 2020 to January 2023 using an L-strut cartilage graft for functional and aesthetic abnormality. The functional and aesthetic outcomes have been evaluated and compared before and 12 months after the surgery. L-strut cartilage graft was used in 60 cases of functional rhinoplasty. There was a significant improvement in the functional and aesthetic outcomes in all the cases ( p  < 0.05). No significant intraoperative and postoperative complications were detected in any of the patients until 12 months of follow-up. L-strut cartilage graft could be a versatile graft that can be successfully utilized in patients with gross anterior/dorsal septal deviation. It provides a stable, straight midline fixation of the neoseptum, ensuring good functional and aesthetic results without major complications., Competing Interests: Conflict of interestThere are no conflicts of interest among the authors., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

CO 2 Laser and Coblation are widely used in Head and neck Surgeries. This study compares the tissue changes produced by these two techniques. 50 Patients who underwent complete excision of benign and malignant pathologies in the Oral Cavity, Oropharynx, and Larynx with Coblation and CO 2 Laser were included in the study. The primary excised specimen and another separate specimen from the base of the excised lesion were evaluated histologically based on criteria by Vescovi et al. (1). On histopathological examination, thermal effects (epithelial, connective tissue and vascular) produced by both techniques were comparable. However vascular changes were seen more in tissues CO 2 Laser ( P  = 0.727). Incision margins were more regular in the CO 2 Laser group (73%) than in Coblation (55%) but not statistically significant ( P  = 1.80). Depth of thermal damage ( P  = 0.171) and connective tissue changes( P  = 0.279) was more with Coblation. Both Coblation and CO 2 Laser can be used effectively in Head and Neck cases. CO 2 Laser, when available, is a better option because of its precise excision, and less collateral tissue damage., Competing Interests: Conflict of interestThere are no conflicts of interest among the authors., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Identifying and localizing the site of post-renal transplantation urine leaks is important for patient management and treatment planning. Renal scintigraphy is a proven modality for confirming urine leaks after complicated post-renal transplantation. Routinely, renogram studies are performed with a clamped extraperitoneal drain. This results in the spread of radioactivity in the abdominal region, which makes localization of the leak site difficult in the planar images. Here we are trying to give an insight into minimalizing the accumulated urine volume by an unclamped extraperitoneal drain in order to precisely localize the site of the leak., Competing Interests: Competing InterestsDr Althaf K Majeed, Dr Om Kumar Yadav, Dr Sameer Taywade, Dr Rajesh Kumar and Dr Arjun Singh Sandhu declare that they have no competing interests., (© The Author(s), under exclusive licence to Korean Society of Nuclear Medicine 2024.)

This study investigated arsenic (As) concentrations in diverse environmental components and their potential impact on the health risks faced by residents of the arsenic (As)-contaminated Nadia district in West Bengal, India. A random selection of 182 cattle and 255 goats from 40 livestock farmers in the district revealed that both animals and humans were naturally exposed to elevated arsenic levels through contaminated drinking water, foods, grasses, concentrate feeds, various fodder tree leaves, and other food/feed resources. The mean As concentration in roughages (483.18 µg/kg DM) was significantly higher (p < 0.001) than in tree leaves (391.53 µg/kg DM), and concentrate feed/ingredients (186.66 µg/kg DM). Pond water exhibited higher arsenic levels (106.11 µg/L) compared to shallow tube well water (47.96 µg/L) and deep tube well water/tap water (10.64 µg/L and 10.04 µg/L, respectively). The mean arsenic concentration in soils DM of fodder fields, crop fields, and grassland was 10.25, 10.58, and 10.20 mg/kg, respectively. It was observed that protein-rich feeds had lower levels of arsenic accumulation (p < 0.048), while fiber-rich feeds containing more cellulose, hemicellulose, and lignin had higher arsenic levels (p < 0.017). Goats consumed 73.46% more arsenic per kg body weight compared to dairy cows. Although chronic and sub-chronic arsenic exposure in the district did not typically manifest symptoms or visible signs in ruminant animals, concentrations in the hair and feces of both cattle and goats exceeded normal values. Cattle feces had significantly higher arsenic (410.43 µg/kg DM) levels (p < 0.001) than goat feces (227.00 µg/kg DM), and arsenic concentration in cattle hair (1917.74 µg/kg DM) was also significantly greater (p < 0.001) than goat hair (1435.74 µg/kg DM). Arsenic levels in milk samples from both species were below 10 µg/kg. Liver (356.02 µg/kg DM) and kidney (317.22 µg/kg DM) contained significantly higher (p < 0.001) levels of arsenic compared to muscle (204.23 µg/kg DM), and bone (161.98 µg/kg DM) in local meat-type adult male goats. The skin accumulated the highest amount of arsenic (576.24 µg/kg DM) among the non-edible parts of the goat carcass. The cumulative cancer risk value for adults was 4.96 × 10 -3 , exceeding the threshold value (1 × 10 -6 ). This suggests a significant risk of cancer development for the population in arsenic-affected areas. Non-cancer risks (hazard indexes) were estimated at 11.01 for adults. Our observations revealed that the highest bioaccumulation of arsenic occurred in the hair of cows, and goats in the examined localities. The biotransformation factor (BTF) for hair was much higher compared to other excreted samples from both species. The calculated BTF followed the order: hair > feces > milk for cows and goats. Livestock farmers in Nadia district are advised to carefully select feed resources, prioritizing those high in crude protein and low in neutral detergent fiber, and they should provide drinking water from deep aquifers to ensure the safety of milk and meat for human consumption., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Timely diagnosis and management of pediatric acute liver failure (PALF) is of paramount importance to improve survival. The Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition invited national and international experts to identify and review important management and research questions. These covered the definition, age appropriate stepwise workup for the etiology, non-invasive diagnosis and management of cerebral edema, prognostic scores, criteria for listing for liver transplantation (LT) and bridging therapies in PALF. Statements and recommendations based on evidences assessed using the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) system were developed, deliberated and critically reappraised by circulation. The final consensus recommendations along with relevant published background information are presented here. We expect that these recommendations would be followed by the pediatric and adult medical fraternity to improve the outcomes of PALF patients., (© 2024. Asian Pacific Association for the Study of the Liver.)

Purpose: Cardiac perfusion MRI is vital for disease diagnosis, treatment planning, and risk stratification, with anomalies serving as markers of underlying ischemic pathologies. AI-assisted methods and tools enable accurate and efficient left ventricular (LV) myocardium segmentation on all DCE-MRI timeframes, offering a solution to the challenges posed by the multidimensional nature of the data. This study aims to develop and assess an automated method for LV myocardial segmentation on DCE-MRI data of a local hospital., Methods: The study consists of retrospective DCE-MRI data from 55 subjects acquired at the local hospital using a 1.5 T MRI scanner. The dataset included subjects with and without cardiac abnormalities. The timepoint for the reference frame (post-contrast LV myocardium) was identified using standard deviation across the temporal sequences. Iterative image registration of other temporal images with respect to this reference image was performed using Maxwell's demons algorithm. The registered stack was fed to the model built using the U-Net framework for predicting the LV myocardium at all timeframes of DCE-MRI., Results: The mean and standard deviation of the dice similarity coefficient (DSC) for myocardial segmentation using pre-trained network Net&#95;cine is 0.78 ± 0.04, and for the fine-tuned network Net&#95;dyn which predicts mask on all timeframes individually, it is 0.78 ± 0.03. The DSC for Net&#95;dyn ranged from 0.71 to 0.93. The average DSC achieved for the reference frame is 0.82 ± 0.06., Conclusion: The study proposed a fast and fully automated AI-assisted method to segment LV myocardium on all timeframes of DCE-MRI data. The method is robust, and its performance is independent of the intra-temporal sequence registration and can easily accommodate timeframes with potential registration errors., (© 2024. CARS.)

Background: Behcet's disease (BD) has a heterogeneous and unpredictable phenotype that differs in various geographical areas., Objective: To describe the clinical phenotype & outcome of Behcet's disease(BD) from Karnataka, India and compare them with large cohorts from endemic regions., Methods: Databases of practising rheumatologists from Karnataka were reviewed to retrieve clinical characteristics, course of illness, prescribing information and outcome at last follow-up of patients clinically diagnosed as BD. The classification criteria, namely revised International criteria for Behcet's disease (rICBD) and International study group (ISG) criteria were applied. Outcome was defined as complete or partial remission, persistent disease or relapse., Results: We included 72 patients, equal gender distribution and mean age 37.4 ± 12.8 years from 8 rheumatology centres. Commonest presentations were recurrent oral aphthosis 58(80.6%), genital ulcers 36(50%) and ocular manifestations 40(55.6%). Three-quarters [51/72(70.8%)] fulfilled rICBD criteria whereas only half [36/72(50%)] fulfilled ISG criteria. Apart from glucocorticoids [53/72(73.6%)], frequently prescribed therapies were colchicine 39(54.2%) and azathioprine 35(48.6%). Eleven-patients received biologics(anti-TNF-α) and JAK inhibitors to treat severe organ involvement. HLA-B*51 and pathergy tests were positive in 27/45(60%) and 12/34(35.3%) patients respectively. Outcomes were documented in 94.4%(68/72) patients at median follow-up of 24 (12;36) months. Majority [46/68(67.6%)] had complete remission, 17/68(25%) had partial remission, 4/68(5.9%) had persistent while 1/68(1.5%) had relapsing course., Conclusion: Majority of BD patients had orogenital aphthosis and ocular manifestations and an excellent response to treatment. Key Points • In our region, Behçet's Disease primarily manifests with recurrent oral aphthae and ocular involvement, with comparatively lower incidence of severe genital ulcers and neurological involvement than in endemic regions. • Apart from glucocorticoids, colchicine and azathioprine are the most commonly used agents. Biologics and JAK inhibitors are prescribed infrequently, primarily in cases of severe organ involvement. • A significant proportion of patients achieved either complete or partial remission during follow-up, with no observed mortality suggesting a milder disease course and better outcome compared to endemic regions. • Gender, HLA-B*51 status, and pathergy response did not exert any significant influence on the clinical profile or outcome in BD patients in Karnataka., (© 2024. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Purpose: To non-invasively quantify pancreatic fibrosis and grade severity of chronic pancreatitis (CP) on dual-energy CT (DECT) and multiparametric MRI (mpMRI)., Methods: We included 72 patients (mean age:30years; 59 men) with suspected or confirmed CP from December 2019 to December 2021 graded as equivocal(n = 20), mild(n = 18), and moderate-marked(n = 34) using composite imaging and endoscopic ultrasound criteria. Study patients underwent multiphasic DECT and mpMRI of the abdomen. Normalized iodine concentration(NIC) and fat fraction(FF) on 6-minute delayed DECT, and T1 relaxation time(T1Rt), extracellular volume fraction(ECVf), intravoxel incoherent motion-based perfusion fraction(PF), and magnetization transfer ratio(MTR) on mpMRI of pancreas were compared. 20 renal donors(for DECT) and 20 patients with renal mass(for mpMRI) served as controls., Results: NIC of pancreas in controls and progressive grades of CP were 0.24 ± 0.05, 0.80 ± 0.18, 1.06 ± 0.23, 1.40 ± 0.36, FF were 9.28 ± 5.89, 14.19 ± 5.29, 17.31 ± 5.99, 29.32 ± 12.22, T1Rt were 590.11 ± 61.13, 801.93 ± 211.01, 1006.79 ± 352.18, 1388.01 ± 312.23ms, ECVf were 0.07 ± 0.03, 0.30 ± 0.12, 0.41 ± 0.12, 0.53 ± 0.13, PF were 0.38 ± 0.04, 0.28 ± 0.07, 0.25 ± 0.09, 0.21 ± 0.05 and MTR were 0.12 ± 0.03, 0.15 ± 0.06, 0.21 ± 0.07, 0.26 ± 0.06, respectively. There were significant differences for all quantitative parameters between controls and mild CP; for NIC, PF, and ECVf between controls and progressive CP grades (p < 0.05). Area under curve for NIC, FF, T1Rt, ECVf, PF, and MTR in differentiating controls and mild CP were 1.00, 0.86, 0.95, 1.00, 0.90 and 0.84 respectively and for NIC, FF, ECVf and PF in differentiating controls and equivocal CP were 1.00, 0.76, 0.95 and 0.92 respectively., Conclusion: DECT and mpMRI were useful in quantifying pancreatic fibrosis and grading the severity of CP. NIC was the most accurate marker., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: The current study explores the application of 3D U-Net architectures combined with Inception and ResNet modules for precise lung nodule detection through deep learning-based segmentation technique. This investigation is motivated by the objective of developing a Computer-Aided Diagnosis (CAD) system for effective diagnosis and prognostication of lung nodules in clinical settings., Methods: The proposed method trained four different 3D U-Net models on the retrospective dataset obtained from AIIMS Delhi. To augment the training dataset, affine transformations and intensity transforms were utilized. Preprocessing steps included CT scan voxel resampling, intensity normalization, and lung parenchyma segmentation. Model optimization utilized a hybrid loss function that combined Dice Loss and Focal Loss. The model performance of all four 3D U-Nets was evaluated patient-wise using dice coefficient and Jaccard coefficient, then averaged to obtain the average volumetric dice coefficient (DSC avg ) and average Jaccard coefficient (IoU avg ) on a test dataset comprising 53 CT scans. Additionally, an ensemble approach (Model-V) was utilized featuring 3D U-Net (Model-I), ResNet (Model-II), and Inception (Model-III) 3D U-Net architectures, combined with two distinct patch sizes for further investigation., Results: The ensemble of models obtained the highest DSC avg of 0.84 ± 0.05 and IoU avg of 0.74 ± 0.06 on the test dataset, compared against individual models. It mitigated false positives, overestimations, and underestimations observed in individual U-Net models. Moreover, the ensemble of models reduced average false positives per scan in the test dataset (1.57 nodules/scan) compared to individual models (2.69-3.39 nodules/scan)., Conclusions: The suggested ensemble approach presents a strong and effective strategy for automatically detecting and delineating lung nodules, potentially aiding CAD systems in clinical settings. This approach could assist radiologists in laborious and meticulous lung nodule detection tasks in CT scans, improving lung cancer diagnosis and treatment planning., (© 2024. CARS.)

A severe and progressive interstitial lung disease (ILD) known as idiopathic pulmonary fibrosis (IPF) has an unknown etiology with poorly defined mechanisms of development. Among the currently prescribed pharmacological interventions for IPF, nintedanib demonstrates the ability to decelerate the deterioration of lung function and yield positive clinical outcomes. Multiple randomized placebo-controlled trials have confirmed the efficacy and acceptable safety profile of nintedanib. Real-world evidence studies also support the use of nintedanib in IPF, being an efficient and well-tolerated treatment option. It has the potential to stabilize the disease progression in patients with ILD. Patients with IPF frequently have comorbidities like diabetes and hypertension, which can exacerbate the course of disease, reduce quality of life, and decrease treatment adherence. For well-informed decision-making, it is important for healthcare professionals to recognize the position of nintedanib therapy in IPF with comorbidities. The gastrointestinal adverse effects, notably diarrhea, dominate the nintedanib safety profile. These can be effectively controlled by closely monitoring side effects, administering anti-diarrheal and anti-emetic drugs, reducing the nintedanib dose, and discontinuing it in case of severe symptoms with an option to reintroduce the treatment after side effects subside. Symptomatic interventions and monitoring of liver enzymes may reduce the occurrence of permanent treatment discontinuations., (© 2024. The Author(s).)

Budd Chiari syndrome is a potentially treatable disease, and imaging is the key to its diagnosis. Clinical presentations may vary, ranging from asymptomatic to fulminant disease. Subacute BCS is the most common type encountered in clinical practice, characterized by ascites, hepatosplenomegaly, dilated abdominal wall veins, and varicosities in the lower limb and scrotum. While hepatic vein thrombosis is the leading cause in the West, membranous and short segmental occlusion are predominant in the Asian populations. These geographical variations have an impact on the treatment algorithm in managing BCS. Anticoagulation alone often fails to prevent disease progression, demanding further interventional therapy. Interventional therapy carries a lower morbidity and mortality than surgery. Anatomical recanalization and portosystemic shunting form the basis of endovascular management. Membranous or short-segment occlusion are best treated by angioplasty, which restores the physiological venous outflow and possibly disease reversal. Suboptimal results with angioplasty require stenting. Transjugular intrahepatic shunt (TIPS) or direct IVC to portal vein shunt (DIPS) decompresses the portal pressure and reduces the sinusoidal congestion, which in turn diminishes hepatocellular damage and hepatic fibrosis. Despite its ability to modify the disease course, TIPS carries several procedure and shunt-related complications, mainly hepatic encephalopathy. Thus, anatomical recanalization precedes TIPS in the traditional step-up approach in managing BCS. However, this concept is challenged by some authors, necessitating future reseach. TIPS is a valid bridge therapy in BCS with acute live failure awaiting liver transplantation. Despite all, interventional therapies fail in a subset of BCS patients, leaving them with only option of liver transplantation., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Screening tests are the cornerstone for early detection and optimal management of cancers. Most of the present cancer-screening tests are intrusive, time-consuming, and specifically target a particular anatomical site or cancer type. Only a few studies have reported the objective measures of 18 F-FDG PET-based cancer screening in asymptomatic individuals. This review and meta-analysis is an attempt to assess the applicability and performance of 18 F-FDG PET-based modalities for whole-body cancer screening., Materials and Methods: The systematic review and meta-analysis were performed following PRISMA guidelines. Literature searches in PubMed, Scopus, and Embase were conducted using relevant MeSH terms and keywords, for articles published in the last 2 decades (2000-2022). Pooled estimates of diagnostic test accuracy-including sensitivity, specificity, positive-likelihood ratio, negative-likelihood ratio, and hierarchical summary ROC (HSROC) curve were generated using bivariate random-effects meta-analysis., Results: Seventeen studies were included in the systematic review and 13 studies were deemed eligible for meta-analysis. The mean estimates of pooled sensitivity, specificity, positive-likelihood ratio, negative-likelihood ratio, and Odds ratio using 18 F-FDG PET with a 95% confidence interval were 0.47 (0.25-0.69), 0.97 (0.95-0.98), 18.8 (6.8-51.5), 0.45 (0.27-0.76), 41.0 (7.9-211.8) and for 18 F-FDG PET/CT were 0.83 (0.75-0.88), 0.98 (0.97-0.99), 49.7 (29.2-84.5), 0.15 (0.8-0.28), 329.9 (125.0-870.8), respectively. Among screening modalities, 18 F-FDG PET/CT had a higher accuracy i.e., the area under the HSROC curve (AUC): 0.91 (0.87-0.95) compared to 18 F-FDG PET: 0.72 (0.61-0.82)., Conclusion: This study demonstrates that currently 18 F-FDG PET-based screening has limited applicability for population-based cancer-screening programs. However, it has a promising role as a combined screening strategy for at-risk individuals and allows for comprehensive diagnostic and prognostic evaluation in high-resource settings., (© 2024. The Author(s) under exclusive licence to Japan Radiological Society.)

Congenital absence of ribs is a quite unusual entity that can present as an isolated finding or as a part of syndrome. Rib defects may be associated with maldevelopment of vertebral column or thoracic musculature. The congenital rib agenesis has been reported postnatally in a few case reports. We present a case of a primigravida referred for an anomaly scan at 20-weeks gestational age. On ultrasonography (USG), the fetus showed unilateral absence of left 5th-8th ribs with associated dysmorphism of other ipsilateral ribs, a right-sided lumbar supernumerary rib, and vertebral segmentation anomalies. The bony defects were well demonstrated by three-dimensional (3D) transabdominal USG. In our case, the unilateral rib agenesis was detected antenatally with no such report published earlier in the scientific literature., (© 2024. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Purpose: To observe the variability in the plasma concentrations and pharmacokinetic-pharmacodynamic (PK-PD) profiles of first-line antitubercular drugs in pulmonary tuberculosis (TB) patients with and without diabetes mellitus (DM)., Methods: Newly diagnosed pulmonary TB patients aged 18-60 years with or without DM were included in the study. Group I (n = 20) included patients with TB, whereas group II (n = 20) included patients with both TB and DM. After 2 weeks of therapy, plasma concentrations and other PK-PD parameters were determined. Improvements in clinical features, X-ray findings, sputum conversion, and adverse drug reactions (ADRs) were assessed after 2 months of therapy., Results: Isoniazid displayed non-significantly higher plasma concentrations in diabetic patients, along with a significantly (P < 0.05) longer elimination half-life (t 1/2 ). Rifampicin plasma concentrations at 4, 8, and 12 h were significantly (P < 0.05) lower, and it displayed significantly (P < 0.05) lower area under the curve (AUC 0-12 and AUC 0-∞ ), shorter t 1/2 , higher clearance (Cl), and a lower AUC 0-∞ /MIC ratio in diabetic patients. Pyrazinamide and ethambutol showed non-significantly higher plasma concentrations, AUC 0-12 , AUC 0-∞ , and t 1/2 in diabetic patients. The improvements in clinical features, X-ray findings, sputum conversion, and ADRs were comparable in both groups., Conclusions: The presence of DM in TB patients affects the PK-PD parameters of isoniazid, rifampicin, pyrazinamide, and ethambutol variably in the Indian population. Studies with a larger number of patients are required to further elucidate the role of DM on the PK-PD profile of first-line antitubercular drugs and treatment outcomes in TB patients with concomitant DM., Trial Registration: CTRI/2021/08/035578 dated 11/08/2021., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

We aimed to investigate the potential role of biomarkers of transmethylation, oxidative stress, and mitochondrial dysfunction in children with Autism Spectrum Disorder (ASD) by comparing them with that of typically developing children (TDC) controls. We also tried to correlate them with severity of autism, sensory issues, behavioural comorbidities and developmental quotients 119 with ASD and 52 age and sex matched typically developing children (TDC) controls were enrolled excluding those with chronic-illness or on any antioxidant therapy/multivitamins/anti-epileptic drugs. Median levels of biomarkers - serum homocysteine, cysteine, methionine, urine uric acid-to-creatinine ratio, arterial lactate, serum vitamin E, vitamin B12, folate, Nε-carboxymethyllysine, Nω- carboxymethylarginine (CMA), dityrosine and MTHFR C677T polymorphism were calculated. Children with ASD were further characterised using Childhood Autism Rating Scale-2, Childhood behavioural checklist, child sensory profile 2 caregiver questionnaire, Developmental Profile 3 for any correlation with the various biomarker levels. The median level of serum homocysteine in ASD group was 9 μmol/L(Range, 7- 16μmol/L), which was significantly higher than controls 7 μmol/L(Range, 4- 11μmol/L)(p=0.01). The prevalence of hyper-homocystinemia(>15μmol/L) was 13.4% in ASD as compared to 3.8% in controls with a significant difference(p=0.04). Dityrosine level was higher among ASD children when compared to TDC (9.8 vs 2.2 counts per second(cps), p<0.001). No significant correlation was found between prevalence of hyperhomocysteinemia and severity of autism/DQ/behavioural issues. No significant difference was found between the median levels of other biomarkers. Results support possible role of transmethylation defects and oxidative stress in ASD pathogenesis. Further studies are warranted for a better understanding of ASD pathogenesis., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Recently, research in the field of caries prevention is emphasizing upon identification of edible non-toxic compounds that can interfere with the formation of cariogenic biofilm., Aim: This trial aimed to assess the effectiveness of non-dialyzable material (NDM) containing cranberry mouth rinse (C-MR) on the Streptococcus mutans (S. mutans) counts and compare with that of a sodium fluoride (F-MR) mouth rinse., Methods: 280 children (8-12 years old) were enrolled in this double-blind single center, parallel, one-month, IRB/IEC approved non-inferiority trial. The participants fulfilling the inclusion criteria were randomly allocated into one of the two groups: C-MR and F-MR. All participants were given verbal and written instructions about at-home mouth-rinsing regimen under parental supervision for a month. Dental plaque samples were collected before and after a month of mouth-rinsing and subjected to culture techniques. S. mutans counts were assessed and compared in both groups. Primary outcome was the difference in the S. mutans counts between two interventions. Both intention-to-treat (ITT) and per-protocol analysis were carried out using two-sample t test with equal variance., Results: The mean S. mutans counts (after log transformation) in C-MR group were: 14.66 (90% CI 14.4,14.9) at baseline and 12.85 (90% CI 12.5, 13.2) colony-forming units/ml (CFU/ml) at one-month post intervention (p = 0.001); while these counts were 14.69 (90% CI 14.5, 14.9) at baseline and 12.71 (90% CI 12.3, 13.1) at one-month intervention in F-MR groups (p = 0.001). ITT analysis showed an inter- group difference of 0.14 CFU/ml (90% CI - 0.32,0.59) in post-SM counts between groups (p = 0.629)., Conclusion: The study demonstrated that the cranberry mouth rinse was non-inferior to the fluoride mouth rinse in terms of S. mutans levels change. Cranberry-based mouth rinse can be used effectively to reduce the S. mutans counts in children., Trial Registration: Registration number in case of Clinical Trials-CTRI/2019/05/019395., (© 2024. The Author(s), under exclusive licence to European Academy of Paediatric Dentistry.)

Introduction: In remote communities, maternal and child health is often compromised due to limited access to healthcare. Simultaneously, these communities historically rely greatly on traditional birth attendants (TBAs). However, optimal integration of these traditional methods with modern healthcare practices remains a topic of debate. We assessed the effect of maternal and child health training of traditional birth attendants on adverse pregnancy outcomes., Methods: We conducted a systematic review and meta-analysis to answer the above research question. We independently screened studies using databases like PubMed, Scopus, and CENTRAL, extracted data, and assessed the study quality. Due to fewer original studies in this field, we considered both pre-post and between-group differences to assess the effect of differences. These were synthesised separately, assessed against a p-value function, and subjected to sensitivity analyses., Results: We included six interventional studies. Training TBAs reduced the risk of perinatal mortality [0.69, 0.61-0.78] and 7-day neonatal mortality [0.65, 0.53-0.80] but not stillbirth [0.70, 0.39-1.26]. In randomized controlled trials, there is a lower risk of perinatal mortality [0.73, 0.67-0.79] and neonatal mortality [0.70, 0.62-0.80] but not stillbirth [0.81, 0.56-1.18] with trained traditional birth attendants. There are methodological concerns with most existing studies, including domains like allocation concealment., Discussion: There is some evidence of the benefit of training TBAs, though of a low to very low certainty. Due to fewer studies, inconsistent estimates for different critical outcomes, and concerns with the existing studies, further well-designed studies can give more insights. They can also help optimize the contents of TBA training interventions., Protocol: CRD42023412935 (PROSPERO)., (© 2024. The Author(s).)

Purpose: In the context of medical literature, a significant lacuna exists in understanding median arcuate ligament syndrome (MALS). While clinical aspects are well documented, literature lacks a robust exploration of the anatomical relationship between the celiac trunk and the median arcuate ligament (MAL)., Methods: Morphometric parameters, including the vertebral level of MAL origin, MAL thickness, celiac trunk (CeT) origin level, diameter, and distances between CeT/Superior Mesenteric Artery (SMA) and the MAL center were observed on 250 CT angiograms. Cadavers (n = 11) were dissected to examine the same parameters and histo-morphological examination of MAL tissue was done., Results: Radiological findings established average MAL thickness of 7.79 ± 2.58 mm. The celiac trunk typically originated at T12. The average distance between the celiac trunk and the MAL center was 1.32 ± 2.04 mm. The angle of the celiac trunk to the abdominal aorta was primarily obtuse. The average celiac trunk diameter was 5.53 ± 1.33 mm. Histological examinations revealed a diverse MAL composition, indicating variable mechanical properties., Conclusion: This study provides comprehensive morphometric data on the anatomical relationship between the MAL and the celiac trunk. In contrast to available literature which says the average MAL thickness of > 4 mm is an indicator of increased thickness, we observed much higher average thickness in the studied population. The findings contribute to a better understanding of normal anatomical variations which can serve as reference values for accurate radiological diagnosis of MALS. The histological examination revealed the heterogeneous nature of the MAL tissue composition, suggesting variable mechanical properties and functions in different regions., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: A significant proportion of breast cancer cases are hereditary and are potentially preventable. However, adoption of the preventive measures remains a significant challenge, particularly because of to lack of knowledge and awareness in low- to middle-income countries., Methods: This prospective study conducted at a high-volume tertiary care cancer center in North India to assess the knowledge, awareness, and attitudes of female breast cancer patients and impact of a brief educational intervention. The study involved three phases: pre-interventional assessment, educational intervention, and post-interventional assessment utilizing a structured questionnaire., Results: The study involved 300 newly diagnosed breast cancer patients; 16.7% were familial. At the outset, 87.0% patients had low knowledge of risk factors, 90.3% about screening, and 32.7% about treatment. Awareness levels were low: 13.7% aware of familial risk and 2.7% of breast cancer genes. Affordability of genetic testing was low (15.2%), and interest in testing for self and family members was limited (32.0% and 26.3%). Following educational intervention, a significant positive percentage change was noticed in knowledge (risk factors: 12.8%, screening: 36.2%, treatment: 82%), awareness (familial risk: 66.7%, BRCA gene: 12.3%), and attitude (testing for self: 17.8%, family: 19.5%)., Conclusions: This study highlights the significant knowledge gaps among breast cancer patients regarding genetics. The educational intervention led to notable improvements in knowledge, awareness, and attitudes, underscoring the importance of tailored patient education in breast cancer care., (© 2024. Society of Surgical Oncology.)

Background: Enteral nutrition is the preferred mode of nutrition following esophagectomy. However, the preferred mode of enteral nutrition (feeding jejunostomy (FJ) vs. nasojejunal (NJ) tube) remains contentious. In this randomized controlled trial (RCT), we compared FJ with NJ tube feeding in terms of safety, feasibility, efficacy, and quality-of-life (QOL) parameters in Indian patients undergoing trans-hiatal esophagectomy (THE) for carcinoma esophagus., Materials and Methods: This single-center, two-armed (FJ and NJ tube), non-inferiority RCT was conducted from March 2020 to January 2024. Forty-eight patients underwent THE with posterior-mediastinal-gastric pull-up and were randomized to NJ and FJ arms (24 in each group). The postoperative complications, catheter efficacy, and QOL parameters were compared between the two groups till the 6-week follow-up., Results: In this RCT, we found no significant difference in the occurrence of catheter-related complications, postoperative complication rate, catheter efficacy, and visual analog pain scores between patients with NJ tube and FJ, following THE for esophageal cancer. There was a significantly better self-reported physical domain QOL score noted in the NJ group, both at the time of discharge (44.7 ± 6.2 vs 39.8 + 5.6; p value, 0.005) and at the 6-week follow-up (55.4 ± 5.2 vs 48.6 ± 4.5; p value, < 0.001)., Conclusion: Based on the findings of our RCT, we conclude that both enteral access methods (NJ vs. FJ) exhibit comparable incidences of catheter-related complications. The use of NJ tube is a viable alternative to a surgical FJ, has the benefit of early removal, and saves the distress associated with a tube per abdomen., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: The primary objective was to detect the number of women developing isthmocele following lower segment caesarean section. The secondary objectives included analysing the risk factors associated with developing isthmocele and measuring the agreement between Transvaginal Ultrasonography (TVS) and Saline infusion Sonohysterography (SIS) in diagnosing Isthmocele., Methods: This study was conducted in the Department of Obstetrics and Gynecology and focused on women who had undergone Lower Segment cesarean Section (LSCS). The study aimed to detect any indentation of at least 2 mm in the scar site, known as isthmocele, using Transvaginal Ultrasound (TVS) and Saline Infusion Sonography (SIS) between 6 weeks and 6 months after delivery. Along with the primary objective, the study also evaluated several secondary outcomes such as maternal comorbidities, closure techniques, and labor details. The evaluation of isthmocele followed the 2019 modified Delphi consensus approach., Results: In our study, we found that 30% of our study population had isthmocele. We also observed that the number of previous caesarean deliveries, maternal BMI, duration of surgery, and characteristics of the previous CD scar were significantly associated with the development of isthmocele. When we compared the diagnostic methods, we found that TVS and SIS had similar limits of agreement for clinically important isthmocele parameters. However, we noticed a difference in the length and distance of isthmocele from the internal os, which we observed through Bland Altman plots., Conclusion: Our research has shown that women who have undergone multiple caesarean deliveries, have a higher maternal body mass index (BMI), and experienced longer surgery duration are at a significantly higher risk of developing isthmocele. To prevent its development, it is recommended to promote vaginal birth after caesarean delivery whenever feasible, manage maternal obesity early on, and provide adequate surgical training to medical professionals. Additionally, transvaginal ultrasound (TVS) is an effective method for detecting isthmocele and can be used interchangeably with saline-infused sonography (SIS)., (© 2024. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

The 2023 International Subarachnoid Hemorrhage Conference identified a need to provide an up-to-date review on prevention methods for delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage and highlight areas for future research. A PubMed search was conducted for key factors contributing to development of delayed cerebral ischemia: anesthetics, antithrombotics, cerebrospinal fluid (CSF) diversion, hemodynamic, endovascular, and medical management. It was found that there is still a need for prospective studies analyzing the best methods for anesthetics and antithrombotics, though inhaled anesthetics and antiplatelets were found to have some advantages. Lumbar drains should increasingly be considered the first line of CSF diversion when applicable. Finally, maintaining euvolemia before and during vasospasm is recommended as there is no evidence supporting prophylactic spasmolysis or angioplasty. There is accumulating observational evidence, however, that intra-arterial spasmolysis with refractory DCI might be beneficial in patients not responding to induced hypertension. Nimodipine remains the medical therapy with the most support for prevention., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Imaging is a key component of diagnosis and treatment response evaluation of urinary tract tuberculosis (UT TB). Tuberculosis can have a long latency, but if found early, one may have the opportunity to prevent complications such as ureteral strictures, obstructive nephropathy, contracted (thimble) bladder, renal parenchymal destruction/calcification, and renal failure. Imaging can aid in diagnosis and differential diagnoses, evaluate the extent of disease and complications, and guide image-directed biopsy, surgical planning, and evaluation of treatment response. Imaging abnormalities in the renal parenchyma and urinary tract at different stages of the disease, lymphadenopathy, and extra-urinary tract organ involvement are suggestive of UT TB. Recent advances in imaging modalities aid in UT TB diagnosis, follow-up, and guiding treatment., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Following an initial recovery, COVID-19 survivors struggle with a spectrum of persistent medical complications, including fatigue, breathlessness, weight loss, hair loss, and attention deficits. Additionally, there is growing evidence of adverse effects of COVID-19 on the male reproductive system. This investigation seeks to understand the long-term ramifications on male fertility by examining hormonal profiles, semen parameters, and sperm proteome of recovered COVID-19 patients compared to controls. The serum hormone profiles between the two groups showed minimal variations except for prolactin, cortisol, and testosterone levels. Testosterone levels were slightly lower, while prolactin and cortisol were elevated in COVID-19 cases compared to controls. Though semen parameters exhibited no significant disparities between the COVID-19 and control groups, quantitative proteomics analysis revealed changes in sperm proteins. It identified 190 differentially expressed proteins, of which 161 were upregulated and 29 downregulated in COVID-19 cases. Western blotting analysis validated the differential expression of serpin B4 and calpain 2. Bioinformatics analysis signifies cellular stress in the spermatozoa of COVID-19 recovered patients and thus, SOD and MDA levels in semen were measured. MDA levels were found to be significantly elevated, indicating lipid peroxidation in COVID-19 samples. While the effects of COVID-19 on semen parameters may exhibit a potential for reversal within a short duration, the alterations it inflicts on sperm proteome are persisting consequences on male fertility. This study paves the path for further research and emphasizes the significance of comprehending the complex molecular processes underlying the long-term consequences of COVID-19 on male reproductive health., (© 2024. The Author(s), under exclusive licence to Society for Reproductive Investigation.)

The inner ear is responsible for balance and auditory function. Sensorineural hearing loss (SNHL) affects auditory function across various age groups. Vestibular apparatus, particularly the otolith organ can also be affected in cases of SNHL because of the close proximity of the otolith organs with the cochlea inside the bony labyrinth. The otolith organs can be assessed with Subjective Visual vertical test (SVV), which is a simple, rapid, non-invasive test with high sensitivity and specificity. Present study was conducted with the objective to compare the SVV parameters between normal and SNHL patients and to correlate between the degree of tilt in SVV with severity of SNHL. A convenient sample size of 60 was taken of which 30 were control and 30 were SNHL patients. PTA and SVV were performed on both groups and results were analysed in IBM SPSS version 26. Age stratified analysis between the control group and SNHL group for the age group 20-40 years and for > 40 years revealed a significant statistical difference in the average static SVV ( P  = 0.019 and P  = 0.009 for age group 20-40 years and > 40 years respectively) and dynamic anti clockwise SVV ( P  = 0.024 and P  = 0.031 for age group 20-40 years, and > 40 years respectively) between the control group and the SNHL group. Correlational analysis also shows a moderate correlation between the bone conduction threshold and the various SVV parameters. Statistical difference of SVV parameters between the two groups suggests a possible early involvement of the otolith organ in SNHL. As such the utility of SVV as an early marker for otolith dysfunction needs to be further explored. It may be worthwhile to follow up the patients of SNHL longitudinally and assess the otolith function with SVV at periodic intervals to identify any progression., Competing Interests: Conflict of InterestThe authors do not have any conflict of interest to declare., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

The primary objective of this study was to use artificial neural network (ANN) to predict the post operative hypocalcemia and severity of hypocalcemia following total thyroidectomy. The secondary objective was to determine the weightage for the factors predicting the hypocalcemia with the ANN. A single center, retrospective case series included treatment-naive patients undergoing total thyroidectomy for benign or malignant thyroid nodules from January 2020 to December 2022. Artificial neural network (ANN) - Multilayer Perceptron (MLP) used to predict post-operative hypocalcemia in ANN. Multivariate analysis was used construct validity. The data of 196 total thyroidectomy cases was used for training and testing. The mean incorrect prediction during training and testing was 3.18% (± σ = 0.65%) and 3.66% (± σ = 1.88%) for hypocalcemia. The cumulative Root-Mean-Square-Error (RMSE) for MLP model was 0.29 (± σ = 0.02) and 0.32 (± σ = 0.04) for training and testing, respectively. Area under ROC was 0.98 for predicting hypocalcemia 0.942 for predicting the severity of hypocalcemia. Multivariate analysis showed lower levels of post operative parathormone levels to be predictor of hypocalcemia ( p  < 0.01). The maximum weightage given to iPTH (100%) > Need for sternotomy (28.55%). Our MLP NN model predicted the post-operative hypocalcemia in 96.8% of training samples and 96.3% of testing samples, and severity in 92.8% of testing sample in 10 generations. however, it must be used with caution and always in conjunction with the expertise of the surgical team. Level of Evidence - 3b., Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04608-9., Competing Interests: Conflict of InterestNone., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Purpose: Obstructive sleep apnea (OSA) is a common clinical problem that is associated with adverse cardiovascular outcomes attributed to the oxidative stress due to sympathetic overstimulation. Treatment approaches targeting oxidative stress have been tried by multiple investigators. This systematic review and meta-analysis evaluated the efficacy and safety of such approaches., Methods: Pubmed and Embase databases were searched for human studies evaluating the utility of antioxidant therapies in patients with OSA., Results: A total of six studies (five randomized trials and one case-control study) were included, including 160 patients with OSA using N-acetyl cysteine, vitamin C, carbocysteine, superoxide dismutase, vitamin E, allopurinol, and their combinations. There was a significant improvement in flow-mediated dilatation (FMD) following antioxidants, with the pooled effect being 2.16 % (95% CI 1.65-2.67) using the random-effects model (I2 = 0% and p<0.001). It was also associated with a significant reduction in malondialdehyde levels and an increase in reduced glutathione (GSH) levels. There was also a significant improvement in the Epworth sleepiness scale, oxygen desaturation index, and minimum oxygen saturation during sleep without any significant adverse effects., Conclusion: Antioxidant therapy in patients with OSA is associated with improved endothelial function, reduced oxidative stress, and improved sleep parameters. These results call for future multicentre studies with longer follow-ups to assess the utility of antioxidant therapy in patients with OSA., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)