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The aim of this study was to establish arytenoid asymmetry as a pre-operative predictive parameter for arytenoid adduction surgery in unilateral vocal fold paralysis and thereafter identify the most predictive parameter for arytenoid adduction among the established parameters.
A retrospective comparative study was undertaken. The ‘arytenoid asymmetry angle’ formed between skewed ‘glottic’ and ‘interarytenoid’ axes (traced along the plane of closure of the membranous and cartilaginous glottis, respectively) was quantified in pre-operative laryngoscopic images of 85 adults with unilateral vocal fold paralysis who underwent either type 1 thyroplasty (group 1) or type 1 thyroplasty with arytenoid adduction (group 2). The need for arytenoid adduction was determined intra-operatively based on subjective voice improvement and laryngoscopic results.
Arytenoid asymmetry (p < 0.0001), posterior phonatory gap (p = 0.001) and vertical level difference (p = 0.004) were significantly greater in group 2 (descending order of parameters). Arytenoid asymmetry angle showed a significant positive correlation with the latter two parameters.
Arytenoid asymmetry is the most predictive parameter for arytenoid adduction. An arytenoid asymmetry angle of more than or equal to 33.9⁰ is an indication for arytenoid adduction. This aids in pre-operative planning of arytenoid adduction.
Nipah virus (NiV) outbreak occurred in Kozhikode district, Kerala, India in 2018 with a case fatality rate of 91% (21/23). In 2019, a single case with full recovery occurred in Ernakulam district. We described the response and control measures by the Indian Council of Medical Research and Kerala State Government for the 2019 NiV outbreak. The establishment of Point of Care assays and monoclonal antibodies administration facility for early diagnosis, response and treatment, intensified contact tracing activities, bio-risk management and hospital infection control training of healthcare workers contributed to effective control and containment of NiV outbreak in Ernakulam.
Until recently, nodding syndrome (NS) was considered as a mysterious disease of unknown etiology. A link between onchocerciasis and epilepsy was suspected for a long time. However, onchocerciasis was not considered as the cause of NS because NS was believed to occur only in onchocerciasis-endemic regions in Uganda, South Sudan, and Tanzania. In October 2015, with funding from the European Research Council, the NSETHIO group launched a trans-disciplinary, multi-country research project to identify the cause of NS and to study the link between onchocerciasis and epilepsy.
We reviewed NSETHIO activities as well as all published papers, and compared project findings with results of previous research on NS.
Findings from the NSETHIO project showed that NS is only one of the clinical manifestations in the wide spectrum of onchocerciasis-associated epilepsy (OAE) that could be prevented by strengthening onchocerciasis elimination programs. NSETHIO demonstrated that OAE is an important neglected public health problem in onchocerciasis-endemic areas with no or a sub-optimally functioning onchocerciasis control strategies.
Today there is overwhelming evidence that NS together with the Nakalanga syndrome is clinical presentations of OAE, a condition that could be prevented by strengthening onchocerciasis elimination programs. While research needs to continue to elucidate the pathophysiological mechanisms causing NS, new strategies to accelerate onchocerciasis elimination coupled with community-based surveillance and treatment programs for epilepsy are urgently needed in areas of high Onchocerca volvulus transmission.
To compare nasal mucociliary clearance in adult non-smokers, cigarette smokers and bidi smokers using the methylene blue dye test.
The study sample consisted of 20 non-smokers, 20 cigarette smokers and 20 bidi smokers (age range, 20–40 years). A single drop of the methylene blue dye was placed at the anterior end of the inferior turbinate of the participants’ nasal cavity. The distance travelled by the methylene blue in 15 minutes inside the nasal cavity was measured. Nasal mucociliary clearance of the three groups was compared using the Kruskal Wallis test.
Nasal mucociliary clearance was significantly decreased in bidi smokers as compared to cigarette smokers and non-smokers (p < 0.05). Multivariate analysis revealed a significant association between nasal mucociliary clearance and bidi smoking, number of cigarettes or bidis smoked per day, and pack-years (all p < 0.05).
Nasal mucociliary clearance measurement is a simple and useful index for assessing the effect of smoking on the mucociliary activity of nasal mucosa.
Background: MRI criteria are used to support multiple sclerosis diagnosis and evolution. However, normal age-related lesions (ARLs) can be cofounded with MS white matter lesion (MSL). Methods: Two Multiparametric 7T MRI scans 4 motnhs apart from 5 relapsing MS (RMS) patients were analyzed and compared to 5 matched healthy controls (HC) aiming to differentiate MSLs from ARLs. Six-echo GRE, FLAIR and MPRAGE sequences were acquired. Results: Average size of ARLs was 51 mm3 and of MSLs was 69 mm3 (p=0.27). Both have the same general appearance on FLAIR and MPRAGE contrasts, but different contrast on the R2* and QS maps. Inter-visit variation on MPRAGE was significantly higher in MSLs. Inter-visit signal change in the other contrasts (QSM, R2* and FLAIR) was not significant. Conclusions: R2*, QS maps and inter-visit variation using MPRAGE allowed differentiating MSLs from ARLs in 5 RMS with mean long term disease duration. This could improve correct early diagnosis and accurate lesion load accumulation evolution.
To determine the prognostic value of laryngoscopy in predicting the recovery of unilateral vocal fold paralysis.
A prospective study was carried out of all patients with unilateral vocal fold paralysis without a progressive lesion or arytenoid dislocation.
Among the 66 candidates, 15 recovered. Patients with interarytenoid paralysis (p < 0.001) or posterolateral tilt of the arytenoid (p = 0.028) had less chance of recovery. Among 51 patients who did not recover, 25.49 per cent regained phonatory function by compensatory movement of the normal side; the rest required an intervention. Intervention requirement was significantly less for those patients who had isolated glottic level compensation. The paralysed vocal fold was at the same level in 32.35 per cent of patients, higher in 38.23 per cent and lower in 29.42 per cent. In those in whom vocal folds were in the abducted position (46.67 per cent), the affected vocal fold was at a lower position on phonation. Inter-observer reliability assessment revealed excellent to good agreement for all criteria.
Interarytenoid paralysis and posterolateral tilt of the arytenoid were predictors of poor recovery.
Debates about secularism in post-independence India have often revolved around the visions of two of the country's founding fathers—M. K. Gandhi and Jawaharlal Nehru. A sharp distinction is drawn between them by those who argue that the Gandhian model (or, what in common parlance and state discourses is called communal harmony) stems from Indian cultural and religious values, and lies beyond the realm of the state. The Nehruvian model, however, is a state project through and through. This article transcends this dichotomy to show that the association of Nehru and Gandhi with these models does not necessarily mean that secularism and communal harmony faithfully reflect their ideas and, despite the differences in their aims and methods, both models are united in the discourses and practices of the state as strategies of ‘governmentality’. After redefining the core of communal harmony as reciprocity (rather than tolerance), I show how it is performed, how it supplements the state's efforts to keep the peace in a religiously plural society by the force of law, and shores up the state's legitimacy deficit. However, the state's simultaneous involvement in Nehruvian and Gandhian projects is not an innocuous fact because it undermines the state's constitutional and secular obligations to non-discriminatory citizenship in the Indian nation. The argument is that the state's endorsement of dargah-centred Islamic piety as an exemplary site of communal harmony and particular ideas of the Indian nation legitimized by communal harmony ‘problematizes’ the national belonging of certain kinds of pious Muslims.
To study the effect of explosive field emission cathodes on high power microwave generation, experiments were conducted on a reflex triode virtual cathode oscillator. Experimental results with cathodes made of graphite, stainless steel nails, and carbon fiber (needle type) are presented. The experiments have been performed at the 1 kJ Marx generator (200 kV, 300 ns, and 9 kA). The experimentally obtained electron beam diode perveance has been compared with the one-dimensional Child-Langmuir law. The cathode plasma expansion velocity has been calculated from the perveance data. It was found that the carbon fiber cathode has the lowest cathode plasma expansion velocity of 1.7 cm/μs. The radiated high power microwave has maximum field strength and pulse duration for the graphite cathode. It was found that the reflex triode virtual cathode oscillator radiates a single microwave frequency with the multiple needle cathodes for a shorter (<200 ns full width at half maximum) voltage pulse duration.
Recent Genome-Wide Association Studies (GWAS) have identified four low-penetrance ovarian cancer susceptibility loci. We hypothesized that further moderate- or low-penetrance variants exist among the subset of single-nucleotide polymorphisms (SNPs) not well tagged by the genotyping arrays used in the previous studies, which would account for some of the remaining risk. We therefore conducted a time- and cost-effective stage 1 GWAS on 342 invasive serous cases and 643 controls genotyped on pooled DNA using the high-density Illumina 1M-Duo array. We followed up 20 of the most significantly associated SNPs, which are not well tagged by the lower density arrays used by the published GWAS, and genotyping them on individual DNA. Most of the top 20 SNPs were clearly validated by individually genotyping the samples used in the pools. However, none of the 20 SNPs replicated when tested for association in a much larger stage 2 set of 4,651 cases and 6,966 controls from the Ovarian Cancer Association Consortium. Given that most of the top 20 SNPs from pooling were validated in the same samples by individual genotyping, the lack of replication is likely to be due to the relatively small sample size in our stage 1 GWAS rather than due to problems with the pooling approach. We conclude that there are unlikely to be any moderate or large effects on ovarian cancer risk untagged by less dense arrays. However, our study lacked power to make clear statements on the existence of hitherto untagged small-effect variants.
The primary objective in intraoperative neurophysiologic monitoring is to identify and prevent the development of new neurologic deficits or worsening of a preexisting neurologic injury to a patient who is undergoing surgery. This chapter presents a case study of a 24-year-old right-handed female diagnosed with neurofibromatosis type I at age 3 years, presented with progressive right upper extremity weakness, new onset left upper extremity weakness and difficulty walking. The agents used for anesthesia were fentanyl, sevoflurane, nitrous oxide, and remifentanil. The chapter provides an overview of the anesthetic agents such as inhalational agents, intravenous anesthetic agents and neuromuscular blocking agents and their effects on neurophysiologic monitoring. Almost all of the anesthetic agents can cause depression of the evoked potentials if given at sufficiently high doses and therefore a suitable combination of anesthetic agents should be chosen in discussion with the surgeon, anesthetist, and the monitoring team.
Recently, we reported the discovery of new high-aspect ratio titania nanotubes. These nanotubes were synthesized by means of anodization in an oxalic acid electrolyte containing chlorine ions and were found to have significant carbon content. In this article, the synthesis of similar titania nanotubes in oxalic, formic, trichloroacetic, gluconic, hydrochloric, and sulfuric acid is reported. Differences in carbon content and morphology are analyzed, which in turn provides information on the chemistry of the formation of these nanotubes. Our results suggest that the carbon content in the nanotubes can be controlled by the use of an appropriate organic acid.