Publications by authors named "Hitesh Verma"

46 Publications

The Long-Term Effect of Vitamin D Supplementation on Quality of Life in Persistent (Perennial) Allergic Rhinitis Patients.

Indian J Otolaryngol Head Neck Surg 2022 Jun 21;74(2):212-216. Epub 2021 Oct 21.

Department of Otorhinolaryngology-Head & Neck, All India Institute of Medical Sciences, 4065, 4th floor, Teaching block, New Delhi, India.

Vitamin D is one of the thoroughly studied risk factors in the pathogenesis of allergic rhinitis (AR). Low serum level of vitamin D is well documented in the urban population of India. The supplementation policy of vitamin D is not uniform among practitioners. The study aims to assess the impact of vitamin D deficiency on AR & long-term quality of life in perennial AR patients with low vitamin D levels after its supplementation in the urban population. The policy for evaluation of serum level of vitamin D & its supplementation in deficit patients in AR is not uniform in our hospital. The data was extracted from the hospital records & the patients came to OPD in the year 2018-2019. Inclusion criteria were the clinical diagnosis (ARIA guideline) of the perennial form of AR where vitamin D assessment was performed before prescribing treatment & the patients received a complete course of vitamin D as per the recommendation followed in our Institute. The patients received oral antihistaminic & topical steroids based nasal spray and were clubbed together as a control group whereas, in the study group, the patients were pooled together who received vitamin D supplementation along with oral antihistaminic & topical steroids based nasal spray. Pre-treatment & post-treatment (at 8 weeks, 6 months, and 12 months) SNOT-22 scores were obtained from the records. The data were analyzed statistically using repeated measures ANOVA test. The study showed a significant decrease in the SNOT-22 score in both Groups in comparison to pre-treatment scores, but post-treatment group comparison was not found statistically significant at each point of comparison. The scores were found on the lower side in the study group at the initial two evaluation points whereas it was higher at the third point of evaluation. This study showed the additional therapeutic effect of vitamin D supplementation as an adjunct in the treatment of perennial AR patients but the effectiveness of the treatment does not last forever so maintenance therapy is required especially in areas following the Indian lifestyle.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12070-021-02938-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9256881PMC
June 2022

Structural impact of thioamide incorporation into a β-hairpin.

RSC Chem Biol 2022 May 5;3(5):582-591. Epub 2022 Apr 5.

Department of Chemistry, University of Pennsylvania 231 S. 34th Street Philadelphia 19104 USA

The thioamide is a naturally-occurring single atom substitution of the canonical amide bond. The exchange of oxygen to sulfur alters the amide's physical and chemical characteristics, thereby expanding its functionality. Incorporation of thioamides in prevalent secondary structures has demonstrated that they can either have stabilizing, destabilizing, or neutral effects. We performed a systematic investigation of the structural impact of thioamide incorporation in a β-hairpin scaffold with nuclear magnetic resonance (NMR). Thioamides as hydrogen bond donors did not increase the foldedness of the more stable "YKL" variant of this scaffold. In the less stable "HPT" variant of the scaffold, the thioamide could be stabilizing as a hydrogen bond donor and destabilizing as a hydrogen bond acceptor, but the extent of the perturbation depended upon the position of incorporation. To better understand these effects we performed structural modelling of the macrocyclic folded HPT variants. Finally, we compare the thioamide effects that we observe to previous studies of both side-chain and backbone perturbations to this β-hairpin scaffold to provide context for our observations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1039/d1cb00229eDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9092430PMC
May 2022

Phage Display Selected Cyclic Peptide Inhibitors of Kallikrein-Related Peptidases 5 and 7 and Their Delivery to the Skin.

J Med Chem 2022 Jul 2;65(14):9735-9749. Epub 2022 Jun 2.

Institute of Chemical Sciences and Engineering, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland.

Kallikrein-related peptidases 5 (KLK5) and 7 (KLK7) are serine proteases with homeostatic functions in the epidermis that play a critical role in Netherton syndrome (NS), a rare yet life-threatening genetic disorder that currently lacks specific treatment. Previous research suggests that controlling KLKs could lead to the development of NS therapies, but existing synthetic inhibitors have limitations. Herein, we used phage display to screen libraries comprising more than 100 billion different cyclic peptides and found selective, high-affinity inhibitors of KLK5 ( = 2.2 ± 0.1 nM) and KLK7 ( = 16 ± 4 nM). By eliminating protease-prone sites and conjugating the inhibitors to an albumin-binding peptide, we enhanced the inhibitor stability and prolonged the elimination half-life to around 5 h in mice. In tissue sections taken from mice, a fluorescently labeled peptide was detected in the epidermis, suggesting that the inhibitors can reach the KLKs upon systemic delivery and should be suited to control deregulated protease activity in NS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1021/acs.jmedchem.2c00306DOI Listing
July 2022

Batwing incision for a case of bilateral fungal zygomatic osteomyelitis.

BMJ Case Rep 2022 May 31;15(5). Epub 2022 May 31.

ENT & head and neck surgery, All India Institute of Medical Sciences, New Delhi, India

Zygomatic osteomyelitis is a rare occurrence due to rich collateral blood supply of bone. A man in his 30s presented with complaints of pain over bilateral cheek and pus discharge below the eye on lateral aspect. He was a known case of COVID-19 associated mucormycosis postendoscopic debridement of sinuses 3 months back. Radiology revealed bilateral destruction of zygoma with discharging sinus. Microbiological analysis confirmed aseptate hyphae in pus, and a diagnosis of bilateral fungal zygomatic osteomyelitis made. Under general anaesthesia, sequestrectomy done using bilateral lateral rhinotomy with extended Dieffenbach's approach (batwing incision). Postsurgery 3000 mg of liposomal amphotericin was administered. There was no enophthalmos or restricted eye movements postoperatively. Follow-up MRI suggested minimal inflammatory enhancement in maxillary sinus. Patient was discharged on oral antifungals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2021-247387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9157357PMC
May 2022

Estimation of Serum Levels of Heavy Metals in Patients with Chronic Invasive Fungal Rhinosinusitis Before the COVID-19 Era: A Pilot Study.

Turk Arch Otorhinolaryngol 2022 Mar 12;60(1):29-35. Epub 2022 May 12.

Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India.

Objective: Various metals play role in the survival and pathogenesis of the invasive fungal disease. The objectives of this study were to compare the levels of heavy metals in patients with chronic invasive fungal rhinosinusitis (CIFR) and healthy controls, and to analyze their role in disease outcome.

Methods: Twenty-three patients (15 with invasive mucormycosis and 8 with invasive aspergillosis, Group 1), and 14 healthy controls (Group 2) were recruited. Blood samples were collected from each group into ion-free tubes and analyzed for serum levels of Nickel (Ni), Copper (Cu), Zinc (Zn), Gallium (Ga), Arsenic (As), Selenium (Se), Rubidium (Rb), Strontium (Sr), Cadmium (Cd), and Lead (Pb). The final outcome of the patients during their hospital stay was categorized clinico-radiologically as improved or worsened, or death.

Results: The levels of all metals were higher in Group 1 except for As and Pb. However, the differences in Cu (p=0.0026), Ga (p=0.002), Cd (p=0.0027), and Pb (p=0.0075) levels were significant. Higher levels of Zn (p=0.009), Se (p=0.020), and Rb (p=0.016) were seen in the invasive aspergillosis subgroup. Although Zn (p=0.035), As (p=0.022), and Sr (p=0.002) levels were higher in patients with improved outcome, subgroup analysis showed no differences.

Conclusion: The levels of some heavy metals in CIFR significantly differ from those of the general population and also vary with the type of the disease and its outcome. These levels may not have a direct effect on the outcome of the patient, but they do play a role in the pathogenesis of the invading fungus.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4274/tao.2022.2021-11-12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9103563PMC
March 2022

Objective Comparison of Benefits Derived From Contralateral Routing of Signal Hearing Aid and Bone Conduction Device in Noisy Surroundings in Patients With Single-Sided Deafness.

J Audiol Otol 2022 Apr 12. Epub 2022 Apr 12.

Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.

Background And Objectives: Single-sided deafness (SSD) leads to non-participation of the diseased ear in generating adequate auditory input, which results in poor speech discrimination in noisy surroundings. The present study objectively compared the audiological benefits rendered by contralateral routing of signal (CROS) hearing aid and bone conduction device (BCD) in patients with SSD >70 dB HL using the modified hearing in noise test (HINT).

Materials And Methods: Patients with SSD >70 dB HL in poor and clinically normal hearing in the better ear were enrolled. Patients aged <18 or >70 years, with a history of neurological insult or ear infection in the last 3 months, mental retardation, psychiatric or developmental disorders, and diabetes were excluded. Modified HINT was performed with the affected ear unaided, aided with CROS hearing aid, and with BCD, generating three groups. Noise signal was presented at a fixed intensity of 65 dB at the neutral position in the center and speech signal was presented to either ear sequentially. The test was repeated with the speech signal fixed at the neutral position and the noise signal presented to either ear.

Results: BCD led to a better signal-to-noise ratio (SNR) than CROS hearing aid in all situations except when noise was centralized and speech was presented to the affected ear.

Conclusions: A benefit was observed when auditory rehabilitation was used for the affected ear as demonstrated by better SNR scores. The results showed that BCD performed better than CROS hearing aid.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7874/jao.2021.00682DOI Listing
April 2022

Demographic Profile of p16 Immunopositive and HPV DNA PCR Positive Oral Squamous Cell Carcinoma in a Large Cohort of Indian Patients.

Asian Pac J Cancer Prev 2022 Feb 1;23(2):529-536. Epub 2022 Feb 1.

Lab Oncology Unit, DR. BRA IRCH, All India Institute of Medical Sciences, AIIMS- Delhi, New Delhi, India.

Background: The Indian subcontinent has the highest incidence of oral cavity squamous cell carcinoma in the world. The high incidence of tobacco chewing habit with or without smoking has been found to be the chief culprit. However in a minor subset of patients Human Papilloma Virus may play a role.

Materials And Methods: A total of 800 cases of Oral squamous cell carcinoma were included in the study. The patients were given a questionnaire comprising of questions about demographic details and habits. The biopsy samples were routinely processed for immunohistochemistry for p16 (E6H4 clone, CINtec histology, Roche diagnostics). Cases with 2+/3+ positive nuclear staining with more than 75% cells immunopositive were taken as p16 immunopositive as per the AJCC criteria and were further subjected to HPV DNA PCR for which DNA was extracted from the formalin fixed paraffin embedded tissue.

Results: Out of 800 OSCC cases 139 (17.37%) showed p16 immunopositivity by AJCC criteria. Out of these, 104 (104/139, 74.8%) cases were positive by HPV DNA PCR for HPV-16/18. Following patient characteristics were associated with a higher proportion of p16 and HPV DNA positivity-urban residence, vegetarian diet, illiteracy, graduate or higher education. No correlation was noted with gender, tobacco smoking or chewing habits, religion, occupation or site of tumor. The p16 immunopositivity was higher in the younger age group with no tobacco habits.

Conclusion: A significant proportion of OSCC cases in India are associated with HPV infection. A higher percentage of p16 immunopositivity amongst younger patients with no tobacco habits points towards a distinct subset of patients in whom HPV may be the chief culprit and not just playing a supporting role.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.31557/APJCP.2022.23.2.529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9272603PMC
February 2022

Negative 68Ga-Prostate-Specific Membrane Antigen PET/CT Scan on a Recurrent Juvenile Nasopharyngeal Angiofibroma.

Clin Nucl Med 2022 Mar;47(3):e268-e270

Pathology, All India Institute of Medical Sciences, New Delhi, India.

Abstract: We present the case of a left-sided recurrent juvenile nasopharyngeal angiofibroma (JNA) in a 16-year-old boy who underwent endoscopic excision 2 years back. The preoperative contrast-enhanced MRI and histopathology were in favor of JNA. The follow-up 68Ga-prostate-specific membrane antigen (PSMA) PET/CT scan at 3-month interval revealed complete clearance of disease. Currently, the patient presented with recurrent bleeding and nasal endoscopic examination, and contrast-enhanced MRI revealed a presence of a recurrent tumor. The tumor did not show any uptake on 68Ga-PSMA PET/CT, and postoperative histopathology evaluation confirmed the presence of JNA. Although regarded as a criterion-standard imaging modality for assessment of recurrent or residual JNA, 68Ga-PSMA PET/CT is never 100% specific.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/RLU.0000000000003965DOI Listing
March 2022

Human papilloma virus in the etiopathogenesis of allergic nasal polyposis: A prospective study.

Am J Otolaryngol 2022 Jan-Feb;43(1):103273. Epub 2021 Oct 20.

Department of Otorhinolaryngology and Head-Neck Surgery, AIIMS, New Delhi, India. Electronic address:

Purpose: To evaluate and compare the prevalence of high-risk HPV and low-risk HPV types in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) and healthy controls.

Materials And Methods: A prospective cohort study was conducted in a tertiary care hospital on the patients of CRSwNP undergoing surgical management. All patients underwent preoperative endoscopic evaluation and radiological assessment using NCCT of the nose and paranasal sinuses. The severity of the disease was graded using the Lund-Mackay score on NCCT. All patients underwent endoscopic polypectomy and the sample of tissues was sent for HPV DNA detection using Hybrid Capture II® technique. The clinicopathological characteristics of HPV positive and negative patients were compared.

Results: Sixty cases and 20 controls were included in the study. All controls were negative for HPV DNA. 27 patients (45%) had the presence of HPV DNA, out of which 23 had only LR-HPV and 1 had only HR-HPV types. Three patients had both HR-HPV and LR-HPV subtypes. There was a significant difference between the cases and controls for the presence of HPV DNA (p < 0.001). However, the patients with HPV-positive DNA in the nasal specimen did not differ significantly from HPV-negative patients in age, gender, or severity of the disease.

Conclusions: Human papillomaviruses may play a significant role in the etiopathogenesis of CRSwNP, however, do not impact the degree of sinus involvement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjoto.2021.103273DOI Listing
February 2022

Management of Allergic Fungal Rhinosinusitis Associated with Vision Loss During COVID-19 Era.

Indian J Otolaryngol Head Neck Surg 2021 Oct 13:1-6. Epub 2021 Oct 13.

Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Room No.- 4057, ENT Office, 4th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029 India.

The ongoing COVID-19 pandemic has given rise to unique challenges related to healthcare management. The problems have arisen due to the direct effect of COVID 19 infection and treatment or as repercussions of administrative efforts being undertaken to check the rapid spread of the epidemic. The management of some of the diseases has been hampered with the implementation of the policies like lockdown and transportation difficulties. This paper presents a series of four patients (6 eyes with vision loss) of an otherwise benign entity, Allergic Fungal Rhinosinusitis (AFRS), causing visual deterioration, managed amid the pandemic. AFRS has been known to cause vision loss by pressure over the optic nerve or its blood supply; however, a timely surgical intervention in the form of functional endoscopic sinus surgery to remove the disease and decompress the optic nerve, results in favourable outcomes in most patients. A delay in diagnosis and treatment may result in irreparable damage with the resulting inability to salvage the vision. In our series, we observed that vision recovery could be achieved in 66.7% of the affected eyes (four out of six eyes), while a poor visual outcome was observed in two (33%). The poor visual outcome was observed for the eyes with a prolonged visual impairment (4-6 months) at the time of presentation. We would appeal to the physicians to be cognizant of the adverse outcomes associated with the delayed surgical intervention of AFRS in the current pandemic scenario.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12070-021-02914-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8513384PMC
October 2021

Revisiting rhino-orbito-cerebral acute invasive fungal sinusitis in the era of COVID-19: pictorial review.

Emerg Radiol 2021 Dec 31;28(6):1063-1072. Epub 2021 Aug 31.

Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.

COVID-19 patients have been found to have an increased incidence of superadded fungal infections because of multiple factors such as impaired cell-mediated immunity, immunosuppressive therapy, and coexistent diabetes mellitus. Recently, there has been a significant rise in the COVID-19-associated mucormycosis and aspergillosis cases involving the sinonasal cavity and the lungs. Rhino-orbito-cerebral acute invasive fungal rhinosinusitis (AIFR) is a potentially life-threatening, invasive fungal infection. Early diagnosis followed by prompt medical management and surgical intervention is crucial for patient survival. The role of cross-sectional imaging (CT/MRI) is not only to suggest a diagnosis of invasive fungal sinusitis but also to delineate the complete extent of disease. Mapping the extent of orbital and intracranial disease has prognostic as well as management implications, as involvement of these sites marks a worse prognosis. A stepwise approach to evaluation of imaging of AIFR along with a pictorial depiction of the key imaging findings is presented.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10140-021-01980-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8406018PMC
December 2021

Development, optimization and characterization of chewable tablet containing synergistic combination of magnesium orotate dihydrate with cholecalciferol and menaquinone-7 for management of hyperglycemia and its pharmacokinetic study.

Magnes Res 2021 05;34(2):43-63

IKG Punjab Technical University, Kapurthala, India, Amar Shaheed Baba Ajit Singh Jujhar Singh Memorial College of Pharmacy, Bela, Ropar, Punjab, India, Institute of Pharmaceutical Sciences, IET Bhaddal Technical Campus, Ropar, Punjab, India.

The objective of the present research is to develop and optimize a chewable tablet containing synergistic combination of magnesium orotate dihydrate (MOD), cholecalciferol (CHOL) and menaquinone-7 (MK-7) as per product development guidelines of ICH Q8 (R2). The effects of critical variables on quality attributes of chewable tablets were evaluated using 30 runs based design of experiment (DoE) after risk assessment. Optimized formulation was found to be the one that was prepared with moderate granulation time of 7.23 min and contained 14 mg/tablet binder, 31 mg/tablet disintegrant and 11.377 mg/tablet lubricant. Prepared tablets were evaluated for prescribed pharmacopoeial and regulatory quality checks. Optimized formulation was found to have very low disintegration time of 6.06 min and 87.39% dissolution of MOD within 15 min in acidic media (0.1 N HCl), which ensure that the developed formulation behaves as a solution following oral administration. Stability studies under accelerated conditions revealed that the developed formulation can retain its quality characteristics throughout its shelf life. Pharmacokinetics study of chewable tablets in male Wistar rats shows that the time to reach maximum plasma or serum concentration (T) was 3 h for MOD and 6 h for both CHOL and MK-7. Maximum plasma or serum concentration (C) of MOD, CHOL and MK-7 was found to be 7.233 ± 1.159, 8.182 ± 0.783 and 8.331 ± 0.863 μg/mL [mean ± standard deviation (SD)], respectively. The area under the curve (AUC -) for MOD, CHOL and MK-7 was 80.692 ± 11.197, 124.325 ± 17.101 and 126.568 ± 12.064 μg.mL.h (mean ± SD), respectively. Comparison of pharmacokinetic data of chewable tablets with a mixture of pure drugs proves that the developed formulation can efficiently deliver all the three nutrients in blood and is capable to elicit desired pharmacological response.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1684/mrh.2021.0487DOI Listing
May 2021

Giant cell tumor of thyroid cartilage: A diagnostic dilemma on aspiration cytology.

Diagn Cytopathol 2021 Nov 31;49(11):E423-E427. Epub 2021 Jul 31.

Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.

Giant cell tumor of the larynx is an uncommon entity with only 44 cases reported in the literature. These tumors occur most commonly in the epiphysis of the long bones of female patients in third decade. Here in we report a case of 23 years old male patient who presented with an anterior neck swelling since past 4 months. Ultrasound and computed tomography of neck revealed a heterogenously enhancing lesion involving posteroinferior half of right thyroid cartilage with extension into the extra laryngeal strap muscle and intralaryngeal right true vocal cord and false vocal cord. The findings were suggestive of a neoplastic cartilagenous lesion. A fine needle aspiration of the right anterior neck mass was performed which showed many mononuclear cells along with multinucleated osteoclast type giant cells. No thyroid follicular cells or inflammatory cells were seen. A diagnosis of giant cell tumor of the thyroid cartilage was rendered on cytology. A biopsy was subsequently performed for the patient which confirmed the same. Hence, although giant cell tumor of the larynx is a rare entity, with very few cases reported in the literature, these tumors should be included in the differential diagnosis of giant cell lesions of the neck and aspiration cytology can offer an accurate and quick diagnosis in such cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/dc.24845DOI Listing
November 2021

In reference to Predictive Nomogram for the Necessity of Tracheotomy During Oral and Oropharyngeal Cancer Surgery.

Laryngoscope 2021 10 3;131(10):E2660. Epub 2021 Jul 3.

Department of Oto-Rhino-Laryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/lary.29722DOI Listing
October 2021

A Pilot Study Comparing Teletherapy with the Conventional Face-to-Face Therapy for Speech-Language Disorders.

Indian J Otolaryngol Head Neck Surg 2021 Sep 28;73(3):366-370. Epub 2021 May 28.

Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India.

Abstract: Speech-language therapists along with affected individuals face various challenges for accomplishing the rehabilitation services. In the current COVID19 pandemic scenario, telerehabilitation has emerged as a substitute to the traditional face-to-face therapy, and is the only option possible in some cases. To subjectively assess the feasibility & acceptability of telerehabilitation provided by speech-language pathologist to patients of speech and language disorders. This qualitative study includes 20 patients suffering from disorders of fluency, voice, swallowing and neurogenic disorders. The participants included were undergoing face-to-face therapy at our institute. After the completion of face-to-face session series, telerehabilitation services were provided through a video calling app. The outcomes of teletherapy were assessed subjectively using a structured questionnaire on 11 parameters using a Likert scale. Of the included 20 patients, after completion of teletherapy, four patients chose the physical interaction as the preferred mode of therapy while 16 chose teletherapy as the preferred mode. Except three clients who rated their overall satisfaction as '3', others rated as '4' or '5'.The therapists were satisfied with the outcomes in 17 cases, and were pleased with the overall progress of all the clients (rated 4 or 5). Telerehabilitation is a reliable method to deliver speech and language services at community level, on long-term basis, as is proven by the high satisfaction scores among the clients as well as the service providers.

Clinical Trial Registration: The trial has been registered in Clinical Trials Registry of India (CTRI) vide number CTRI/2018/04/ 012,922 (http://ctri.nic.in/Clinicaltrials/login.php) on 02/04/2018.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12070-021-02647-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160551PMC
September 2021

Tracheo-bronchial recurrent respiratory papillomatosis: role of powered instruments in overcoming surgical challenges.

Acta Otorhinolaryngol Ital 2021 Apr;41(2):146-150

Department of Otorhinolaryngology, AIIMS, New Delhi, India.

Objective: Respiratory papillomatosis involving the trachea is a challenging problem. In this paper, we present our experience in the management of 13 cases of tracheal papillomatosis and the difficulties encountered in the procedure. The surgical technique and results are discussed.

Methods: A modified transoral trans-stomal approach was employed for the removal of papillomas by using microdebrider. All patients were operated on under general anaesthesia with intermittent removal of intubation tube and apnoea. All patients required repeated surgeries. Tracheostomy removal was considered after adequate surgery and recurrence-free interval. The follow-up period was 12-24 months.

Results: The total number of surgeries per patient ranged from 3-35 (mean 10). Decannulation could be successfully achieved in 9 patients. There were no procedure-related complications.

Conclusions: Transoral trans-stomal microdebrider assisted excision of tracheal papilloma showed excellent results without procedure-related complications. It can be used as a routine procedure for tracheal papillomas. The prognosis of tracheal involvement is fair and most patients can be decannulated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.14639/0392-100X-N0822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142726PMC
April 2021

The serum and tissue expression of vascular endothelial growth factor-in recurrent respiratory papillomatosis.

Int J Pediatr Otorhinolaryngol 2021 Jul 5;146:110737. Epub 2021 May 5.

Department of Otolaryngology, Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.

Objective: Recurrent respiratory papillomatosis (RRP) is known for its recurrent relapse despite various surgical and non-surgical treatments. Vascular Endothelial growth factor (VEGF) receptor expression on tissue is reported to be raised in RRP, and anti-VEGF targeted treatment is being explored to decrease recurrences. This study aims to identify the patients most suitable for systemic anti-VEGF therapy.

Methods: The study design was a prospective cohort evaluation. The study group included all consecutive cases of RP treated surgically from November 2016-June 2019. Tissue receptor expression and serum levels of VEGF were assessed by immunohistochemistry and ELISA assay. Control samples for normal levels obtained by serum samples of healthy individuals and tissue samples obtained from healthy non-inflamed peripheral tissue of laryngectomy specimens. The tissue expression and serum levels of VEGF were compared with various disease-related factors of RP.

Results: 32 cases of RRPs were included in the study with a median age of 20.85 years (range: 3-60 years). The glottis was involved in all patients and tracheobronchial involvement was seen among 6 patients (18.75%). The systemic and tissue expression of VEGF-A was significantly higher among cases than controls (p= <0.001). The serum level of VEGF-A was significantly higher among cases with higher Derkay's score (>20) (p = 0.02) and tissue expression of VEGF-A was significantly higher in tracheobronchial RRP (p = 0.04).

Conclusion: Patients of RP with tracheobronchial involvement and high Derkay's score with strong tissue receptor expression & high serum level of VEGF can be identified as the patients wherein anti-VEGF monoclonal antibody treatment is more likely to be effective and merits further investigation to prove this.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijporl.2021.110737DOI Listing
July 2021

Pterygoid Base Pneumatization Simulating Residual Disease-A Pitfall of Structural Imaging in Juvenile Nasal Angiofibroma.

Clin Nucl Med 2021 Oct;46(10):e496-e497

Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.

Abstract: As prostate-specific membrane antigen (PSMA) expression is universal in juvenile nasopharyngeal angiofibroma, it is commonly used for specifically differentiating recurrences from surgical site reparative tissues. Postoperative contrast-enhanced MRI revealed a residual disease in the left pterygoid base, but there was no PET/CT uptake with 68Ga-labeled PSMA at the same site. In retrospect, in comparison with preoperative PET/CT, it was found that the pterygoid base pneumatization was showing enhancement in contrast-enhanced MRI and not in functional PSMA. Postoperative 68Ga-PSMA PET/CT is a useful clinical tool in ambivalent diagnostic conditions avoiding morbidities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/RLU.0000000000003612DOI Listing
October 2021

An evaluation of serum Otolin-1 & Vitamin-D in benign paroxysmal positional vertigo.

J Vestib Res 2021 ;31(6):433-440

Associate Professor, Department of Otorhinolaryngology-Head & Neck Surgery, AIIMS, New Delhi, India.

Background: Serum otolin-1 is an inner ear protein exclusively expressed in otoconia and cells of vestibule and cochlea. Serum otolin-1 is found to be quantifiable in patients with BPPV. Low Vitamin-D is associated with pathogenesis of BPPV. Since otoconia degeneration contributes to BPPV, lack of Vitamin-D may impact otoconia structure and integrity.

Objective: We aimed at studying the s.otolin-1 as biomarker and significance of vit-D in BPPV.

Material And Method: 23 patients in test and control groups respectively were chosen within the age of 20 to 65 years. All the patients were diagnosed using Dix Hallpike menouver and head roll test, patients were treated with appropriate Canal Reposition Menouver (CRM).

Results: Serum Otolin-1 levels among the test ranged from 366 to 882 pg/mL with mean of 585.17 pg/mL whereas in control group ranged from 223 to 462 pg/mL with mean of 335.26 pg/mL. Mean Vitamin-D levels among the test group was 22.67 ng/mL (Range = 6.3-68.4) and that of control 15.43 pg/mL (Range = 5.4-27.7) respectively. The relationship between the serum Otolin-1 and Vitamin-D was not statistically significant.

Conclusion: Otolin-1 levels is increased in BPPV patients and is sensitive in BPPV, specificity needs to be validated. Role of vitamin-D with respect to inner ear proteins needs further investigation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/VES-201601DOI Listing
November 2021

Evaluation of synergistic combination comprising magnesium orotate, menaquinone-7, and cholecalciferol for management of type 2 diabetes and dyslipidemia.

Magnes Res 2020 Nov;33(4):88-105

IKG Punjab Technical University, KapurthalaIndia, Amar Shaheed Baba Ajit Singh Jujhar Singh Memorial College of Pharmacy, Bela, Ropar, PunjabIndia.

Epidemiological outburst of type 2 diabetes is of great global concern. T2D starts with Insulin Resistance (IR) which arises largely due to environmental factors and to a lesser extent due to genetic factor. IR gradually develops into T2D and encompasses a wide array of conditions including Impaired Glucose Tolerance (IGT), hyperinsulinemia, Impaired Fasting Glucose (IFG), and Impaired Insulin Release (IIR). Initiation of IR increases the risk of Cardiovascular Diseases (CVD). Therefore, early diagnosis and management of IR and its related outcomes (hyperinsulinemia, hyperglycemia, and dyslipidemia) should be the prime focus of intervention therapies. Present research aimed to evaluate the synergistic combination of Magnesium orotate (MOD), Menaquinone- 7 (MK-7), and Cholecalciferol (CHOL) for the management of these therapeutic targets in the Streptozotocin-Nicotinamide-induced T2D Wistar rat model. Synergistic combination was found to be superior over its individual components in management of hyperglycemia, impaired insulin secretion, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and dyslipidemia (p < 0.01 or p < 0.05). Its effect was found to be equivalent or better than reference drugs (p < 0.01 or p < 0.05). Histopathological analysis depicted that combination treatment was able to regenerate and preserve pancreatic β-cell mass in diabetic rats. In conclusion, combination studied in present research can be evaluated further under clinical settings for management of IR and its related outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1684/mrh.2020.0472DOI Listing
November 2020

Sinonasal IgG4-related disease: a rare and emerging entity broadening the differential diagnosis in the sinonasal universe.

Eur Arch Otorhinolaryngol 2021 Aug 4;278(8):2883-2890. Epub 2021 Jan 4.

Department of Radiology, All India Institute of Medical Sciences, New Delhi, 110029, India.

Background: IgG4-related disease (IgG4-RD) is a multi-organ immune-mediated disorder characterized by fibroinflammatory mass-forming lesions, mimicking malignancy or infection. While well-documented in salivary glands, orbit and thyroid in the head and neck, sinonasal IgG4-RD is rare.

Methods: Cases of sinonasal IgG4-RD were retrieved, and clinicopathological features reviewed.

Results: Seven cases of sinonasal IgG4-RD were identified over a 2-year period, including three males and four females, with an age range of 13-48 years (median: 32 years). Patients presented with cheek swelling, pain and visual disturbances. Serum IgG4 levels were mildly elevated. Storiform fibrosis, obliterative phlebitis and plasma cell infiltration were seen in varying proportions. Destruction of bone and subepithelial mucoserous glands was present. ALK-1 negativity distinguished from inflammatory myofibroblastic tumor.

Conclusion: Sinonasal IgG4-RD expands the growing spectrum of IgG4-RD. A high degree of suspicion is required to include IgG4-RD in differential diagnosis of sinonasal masses, and perform detailed histological and immunohistochemical workup for accurate diagnosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00405-020-06564-wDOI Listing
August 2021

Erection of pinna.

BMJ Case Rep 2020 Dec 22;13(12). Epub 2020 Dec 22.

Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2020-239745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757462PMC
December 2020

Respiratory papillomatosis - An unusual cause of hoarseness!

Indian J Med Res 2020 11;152(Suppl 1):S103-S104

Department of Otorhinolaryngology & Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi 110 029, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ijmr.IJMR_2169_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8257117PMC
November 2020

Plasma ablation-assisted endoscopic excision versus traditional technique of endoscopic excision of juvenile nasopharyngeal angiofibroma.

Int J Pediatr Otorhinolaryngol 2020 Dec 29;139:110410. Epub 2020 Sep 29.

Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India. Electronic address:

Background: Juvenile nasopharyngeal angiofibroma is the vascular and locally aggressive tumor of the posterior nares and nasopharynx. Endoscopic excision is the preferred surgical modality in early Radkowski stages. The prime challenge is intraoperative bleeding. Literature is in favor of the use of plasma ablation to overcome surgical challenges.

Objective: To evaluate the effectiveness of plasma ablation technique in the surgical management of juvenile nasopharyngeal angiofibroma.

Materials And Methods: The current study recruited 36 patients of clinico-radiologically diagnosed cases of primary JNA of stage I and II (Modified Radkowski). In prospective arm, 18 consecutive patients were recruited, who underwent plasma ablation assisted endoscopic excision. In retrospective arm, 18 consecutive patients who underwent excision by traditional endoscopic instruments in the past two years, were recruited. Both the groups were compared for baseline characteristics, intraoperative blood loss, duration of surgery, length of hospital stay, and recurrence rates.

Results: The use of plasma ablation decreased overall blood loss by 338 ml (mean difference) which was not statistically significant (p = 0.26). On subgroup analysis, the use of plasma ablation significantly decreased mean blood loss (648 ml, p = 0.046) and duration of surgery (83 min, p < 0.001) in patients who underwent embolization. No statistically significant difference was noted between two groups in length of hospital stay (p = 0.36) and recurrence rates (p = 0.64).

Conclusion: Plasma ablation is an effective technique available to decrease blood loss and duration of surgery during endoscopic excision of post embolized stage I and II patients of JNA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijporl.2020.110410DOI Listing
December 2020

Study of morphologic variability of incudostapedial angle and its relation with temporal bone pneumatization.

J Otol 2020 Jun 24;15(2):50-53. Epub 2019 Sep 24.

Department of Otorhinolaryngology, Command Hospital, Kolkata, 700027, India.

Introduction: Optimal sound transmission across the ossicular chain is dependent on the appropriate alignment of the middle ear ossicles. Incudostapedial joint (ISJ) is conventionally considered to be at right angle.

Objective: We intended to study the ISJ anatomy and the impact of temporal bone pneumatization on the same.

Methods: In a cadaveric study comprising of 47 human temporal bones, canal wall down mastoidectomy was carried out under microscopic guidance keeping the ossicular chain intact. The morphology of ISJ was recorded and analysed with respect to the pneumatization status of the temporal bone. The data analysis was performed using statistical software Stata version 12.0.

Results: The mean ISJ angle for the 47 bones was 90.5 (SD-15; range:54-122). The mean angle in well pneumatized bones was 93.7 (SD-16.5; Range:54°-122) and in sclerotic mastoids was 88.7 (SD-14; Range:68°-118). The difference in the ISJ angle in these two conditions was not statistically significant (0.27). The mean angle was found to be significantly more obtuse in the cases with partially eroded ISJ (111.4 {SD-8.8; range:100.3-121.9};  = 0.0001) and in the cases with an 'adherent/tilted morphology' of the stapes suprastructure with the promontory (mean-95.8{SD-13.8; range:70.7- 120.4); - <0.00001).

Conclusion: The ISJ angle shows considerable variations. This variability needs to be taken into account when undertaking middle ear reconstructive procedures, specifically the ones involving the stapes footplate. The mastoid pneumatization does not appear to have an impact on the ISJ angle.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.joto.2019.09.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231975PMC
June 2020

Grading of the Position of the Mastoid Tegmen in Human Temporal Bones - A Surgeon's Perspective.

J Int Adv Otol 2020 Apr;16(1):63-66

Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.

Objectives: To establish a new surgically relevant classification system of the anatomic variations of the temporal bone tegmen plate as well as to perform a comparative analysis, with respect to the pneumatization patterns in the cadaveric temporal bones.

Materials And Methods: Microdissection of the human cadaveric temporal bones was performed after obtaining ethical approval from the Institutional Ethical Committee (F.8-522/A-522/2017/RS). The pneumatization pattern of the temporal bones was noted as "under-pneumatized" or "well-pneumatized." The tegmen mastoid (TM) was classified into two grades as per the position of the tegmen plate and the visibility of the superior semicircular canal (SSCC) and the aditus. The latter two structures were well visualized in Grade A and poorly visualized in Grade B. The data were analyzed using Stata 14.0 (Stata Corp, 4905, Lakway drive, College Station, Texas, USA).

Results: Ninety-three temporal bones were dissected under microscope. Fifty-eight bones were well-pneumatized and 35 were under-pneumatized. The tegmen plates were classified as Grade-A in 49 bones (well-pneumatized -37 and under-pneumatized -12), and as Grade-B in 44 bones (well-pneumatized-21, poorly-pneumatized-23). Grade-A classification was significantly more common in well-pneumatized temporal bones, while Grade-B was more common in under-pneumatized bones (p=0.0057).

Conclusion: We propose a surgically relevant classification for TM positioning. A well-pneumatized temporal bone is associated with a significantly higher position of the tegmen plate (Grade-A TM).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5152/iao.2020.7748DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7224437PMC
April 2020

Primary Spheno-Petro-Clival Tuberculosis.

Indian J Otolaryngol Head Neck Surg 2019 Nov 20;71(Suppl 3):1796-1799. Epub 2017 Jul 20.

Department of Otorhinolaryngology, Head & Neck Surgery, All India Institute of Medical Sciences, 4065, ENT Office, 4th Floor, Teaching Block, New Delhi, India.

The increase awareness and advent of anti-tuberculosis therapy led to decline in tuberculosis. Now a resurgence of tuberculosis is with immunosuppression and with resistant strains. The detection rate of extrapulmonary is increased with the advent of newer modalities of detection, imaging, and better testing. This case series documents our experience with seven cases of primary spheno-petro-clival lesion and details of the clinical and radiological presentations of these patients. Intraoperative obtained tissue was send for histopathological and microbiological evaluation. The most common symptoms were headache and nasal discharge. The final diagnosis of spheno-petro-clival tuberculosis was confirmed in all cases with histopathology and by culture post-operatively. Skull base tuberculosis is relative rare entity in past because of late occurrence of specific symptom, incomplete radiological evaluation and it may present as neck swelling by travelling through various neck spaces. (1) Tubercular infection should be considered as differential in skull base lesion as pickup rate is increasing with advancement in technology. (2) Two of our cases had retropharyngeal abscess have focus in skull base bone. The skull base, hence, may be one of foci in undetermined sites of tuberculous infections and should be searched for.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12070-017-1159-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6848799PMC
November 2019

Development and evaluation of novel bio-safe filter paper-based kits for sputum microscopy and transport to directly detect Mycobacterium tuberculosis and associated drug resistance.

PLoS One 2019 13;14(8):e0220967. Epub 2019 Aug 13.

Center for Bio-design and Diagnostics, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, India.

India has the highest burden of Tuberculosis (TB) and multidrug-resistant TB (MDR-TB) worldwide. Innovative technology is the need of the hour to identify these cases that remain either undiagnosed or inadequately diagnosed due to the unavailability of appropriate tools at primary healthcare settings. We developed and evaluated 3 kits, namely 'TB Detect' (containing BioFM-Filter device), 'TB Concentration and Transport' (containing Trans-Filter device) and 'TB DNA Extraction' kits. These kits enable bio-safe equipment-free concentration of sputum on filters and improved fluorescence microscopy at primary healthcare centres, ambient temperature transport of dried inactivated sputum filters to central laboratories and molecular detection of drug resistance by PCR and DNA sequencing (Mol-DST). In a 2-site evaluation (n = 1190 sputum specimens) on presumptive TB patients, BioFM-Filter smear exhibited a significant increase in positivity of 7% and 4% over ZN smear and LED-FM smear (p<0.05), respectively and an increment in smear grade status (1+ or 2+ to 3+) of 16% over ZN smear and 20% over LED-FM smear. The sensitivity of Mol-DST in presumptive MDR-TB and XDR-TB cases (n = 148) was 90% for Rifampicin (95% confidence interval [CI], 78-96%), 84% for Isoniazid (95% CI, 72-92%), 83% for Fluoroquinolones (95% CI, 66-93%) and 75% for Aminoglycosides (95% CI, 35-97%), using phenotypic DST as the reference standard. Test specificity was 88-93% and concordance was ~89-92% (κ value 0.8-0.9). The patient-friendly kits described here address several of the existing challenges and are designed to provide 'Universal Access' to rapid TB diagnosis, including drug-resistant disease. Their utility was demonstrated by application to sputum at 2 sites in India. Our findings pave the way for larger studies in different point-of-care settings, including high-density urban areas and remote geographical locations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220967PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6692035PMC
March 2020

Study of Sigmoid Sinus Variations in the Temporal Bone by Micro Dissection and its Classification - A Cadaveric Study.

Int Arch Otorhinolaryngol 2019 Jul 28;23(3):e311-e316. Epub 2019 May 28.

Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India.

 Sigmoid sinus (SS) variations have been classified variously in the literature. These classifications suffer from some form of shortcoming from a clinical point of view for their application.  We propose a clinically relevant classification of the SS in relation to the posterior semicircular canal (PSCC) and to the exposure of the presigmoid dural plate. The positioning of the SS was analyzed with reference to the volume of the mastoid and to the level of mastoid pneumatization.  A total of 94 formalin-preserved human cadaveric temporal bones were microdissected to carry out a complete mastoidectomy. The SS, the presigmoid dural plate, and the PSCC were exposed, and the position of the former was analyzed in relation to the latter two in order to classify the position of the SS into three grades.  Grade I had the best exposure of the presigmoid dura and of the PSCC, while grade III had the poorest exposure of the presigmoid dura and of the PSCC. Grade I SS was associated with good pneumatization and higher mastoid volumes compared with grades II and III.  The SS exhibits considerable anatomic variability. A favorable positioning of the SS is associated with a large mastoid volume and pneumatization. A careful preoperative study of the imaging may help in understanding the positioning of the SS and the safety of various transmastoid approaches.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0039-1688455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6660287PMC
July 2019

A Review of Surgical Nuances and Outcomes of the Reverse Stapedotomy.

J Int Adv Otol 2019 Apr;15(1):151-155

Department of Otorhinolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.

The stapes surgery has evolved through different eras of technical and technological development. The current standard of care is creating a stapedotomy with piston placement, and both these aspects have multiple variations and show well-established technological advances. The conventional technique has been fairly standardized,and it offers gratifying results to both the surgeon and the patient. To overcome certain procedural risks and potential complications, the reversal of steps technique was developed and streamlined by Ugo Fisch in the early 1980s. Since its beginning, the technique has been adopted by various centers, and surgical outcomes have been demonstrated to be at par with the conventional technique, with a reduced risk of complications. The aim of the present review is to detail the various surgical nuances and outcomes of this particular technique in a comprehensive narrative manner.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5152/iao.2019.6800DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483427PMC
April 2019
-->