Background: Skull base defects, accidental or planned during tumor resections, present significant reconstructive challenges. Effective repair prevents cerebrospinal fluid (CSF) leaks, meningitis, and pneumocephalus. Methods: This retrospective observational study analyzed 26 patients with anterior or lateral skull base defects treated between 2018 and 2024 at a tertiary care center in Western India. Both planned iatrogenic and accidental intraoperative defects were included. Patient demographics, surgical approach, defect characteristics, reconstruction techniques, and postoperative outcomes were recorded. All patients underwent multilayered repair with tailored perioperative management, including selective lumbar drainage. Results: Among 26 patients, 14 (53.8%) had anterior and 12 (46.2%) had lateral skull base defects. Intraoperative CSF leak occurred in 11 patients (42.3%). Defects were repaired using combinations of autologous tissue (fat, fascia lata, muscle), allogenic grafts (DuraGen), and vascularized flaps. Seven patients (26.9%) required lumbar drains. All reconstructions were successful with no secondary failures. However, two major complications were observed: one case of pneumocephalus and one of postoperative vision loss following ossifying fibroma excision. No postoperative meningitis or recurrent CSF leaks were noted. Conclusion Meticulous multilayered repair strategies and structured perioperative protocols provide excellent outcomes in skull base defect reconstruction. Differentiating between planned and accidental iatrogenic defects allows for better preoperative planning and individualized management. Despite a 100% repair success rate, rare but serious complications such as vision loss highlight the need for careful surgical technique near critical neurovascular structures.

Background and Objectives: This study aimed to evaluate whether preoperative oral prednisolone improves the intraoperative parameters and postoperative outcomes over a 3-month period in patients of sinonasal polyposis who undergo functional endoscopic sinus surgery. Methods: In a triple-blind, randomized controlled study, 43 patients diagnosed with sinonasal polyposis in the Department of ENT, AIIMS, Jodhpur, were enrolled. After obtaining institutional ethics clearance and registering the clinical trial, randomization was conducted to assign participants into experimental and control groups. Preoperatively, patients were assessed using the clinical severity score (Sino-nasal Outcome Test; SNOT-22), radiological severity score (Lund-Mackay score), and endoscopic severity scores (discharge-inflammation-polyp [DIP] score and Lund-Kennedy score). Intraoperative assessment was done using the Perioperative Sinus Endoscopy (POSE) score, the duration of surgery, intraoperative blood loss, and visual analog scale for visual field during surgery and for the ease of disease removal. Postoperatively, at 3 months all the preoperative parameters were reassessed, and, using independent t-test, comparison was made between the two groups. Results: Twenty-one patients were included in the experimental group (48%), and 22 in the control group (51%). Although the mean duration of surgery in the experimental group was shorter than in the control group, the difference was not statistically significant. Similarly, although the postoperative SNOT-22 score was lower in the experimental group compared to the control group, there was no statistically significant difference in outcomes between the two groups across any of the parameters assessed. Conclusion Although the role of oral steroids has been established in the treatment of sinonasal polyposis, our study did not find any significant difference between the group that received oral steroids prior to surgery and the group that received placebo.

Background and Objectives: This study aimed to evaluate whether preoperative oral prednisolone improves the intraoperative parameters and postoperative outcomes over a 3-month period in patients of sinonasal polyposis who undergo functional endoscopic sinus surgery. Methods: In a triple-blind, randomized controlled study, 43 patients diagnosed with sinonasal polyposis in the Department of ENT, AIIMS, Jodhpur, were enrolled. After obtaining institutional ethics clearance and registering the clinical trial, randomization was conducted to assign participants into experimental and control groups. Preoperatively, patients were assessed using the clinical severity score (Sino-nasal Outcome Test; SNOT-22), radiological severity score (Lund-Mackay score), and endoscopic severity scores (discharge-inflammation-polyp [DIP] score and Lund-Kennedy score). Intraoperative assessment was done using the Perioperative Sinus Endoscopy (POSE) score, the duration of surgery, intraoperative blood loss, and visual analog scale for visual field during surgery and for the ease of disease removal. Postoperatively, at 3 months all the preoperative parameters were reassessed, and, using independent t-test, comparison was made between the two groups. Results: Twenty-one patients were included in the experimental group (48%), and 22 in the control group (51%). Although the mean duration of surgery in the experimental group was shorter than in the control group, the difference was not statistically significant. Similarly, although the postoperative SNOT-22 score was lower in the experimental group compared to the control group, there was no statistically significant difference in outcomes between the two groups across any of the parameters assessed. Conclusion Although the role of oral steroids has been established in the treatment of sinonasal polyposis, our study did not find any significant difference between the group that received oral steroids prior to surgery and the group that received placebo.

Background and Objectives: This study aimed to evaluate whether preoperative oral prednisolone improves the intraoperative parameters and postoperative outcomes over a 3-month period in patients of sinonasal polyposis who undergo functional endoscopic sinus surgery. Methods: In a triple-blind, randomized controlled study, 43 patients diagnosed with sinonasal polyposis in the Department of ENT, AIIMS, Jodhpur, were enrolled. After obtaining institutional ethics clearance and registering the clinical trial, randomization was conducted to assign participants into experimental and control groups. Preoperatively, patients were assessed using the clinical severity score (Sino-nasal Outcome Test; SNOT-22), radiological severity score (Lund-Mackay score), and endoscopic severity scores (discharge-inflammation-polyp [DIP] score and Lund-Kennedy score). Intraoperative assessment was done using the Perioperative Sinus Endoscopy (POSE) score, the duration of surgery, intraoperative blood loss, and visual analog scale for visual field during surgery and for the ease of disease removal. Postoperatively, at 3 months all the preoperative parameters were reassessed, and, using independent t-test, comparison was made between the two groups. Results: Twenty-one patients were included in the experimental group (48%), and 22 in the control group (51%). Although the mean duration of surgery in the experimental group was shorter than in the control group, the difference was not statistically significant. Similarly, although the postoperative SNOT-22 score was lower in the experimental group compared to the control group, there was no statistically significant difference in outcomes between the two groups across any of the parameters assessed. Conclusion Although the role of oral steroids has been established in the treatment of sinonasal polyposis, our study did not find any significant difference between the group that received oral steroids prior to surgery and the group that received placebo.

Background/Aims: Gastric varices (GV) are present in 25% of cirrhotic patients with high rates of rebleeding and mortality. Data on endoscopic ultrasound (EUS)-guided treatment in severe liver disease (model for end stage liver disease sodium [MELD-Na] >18 and Child-Turcotte-Pugh [CTP] C with GV) are scarce. Thus, we performed a retrospective comparison of endoscopic glue injection with EUS-guided therapy in cirrhotic patients with large GV. Methods: A retrospective study was performed in the tertiary hospitals of India. A total of 80 patients were recruited. The inclusion criteria were gastroesophageal varices type 2, isolated gastric varices type 1, bleeding within 6 weeks, size of GV >10 mm, and a MELD-Na >18. Treatment outcomes and complications of endoscopic glue injection and EUS-guided GV therapy were compared. Results: In this study, the patients’ age, sex, liver disease severity (CTP, MELD-Na) and clinical parameters were comparable. The median number of procedures, injected glue volume, complications, and GV obturation were better in the EUS group, respectively. On subgroup analysis of the EUS method (e.g., direct gastric fundus vs. paragastric collateral [PGC] coil placement), PGC coil placement showed decreased coil requirement, less injected glue volume, decreased luminal coil extrusion, and increased successful GV obturation. Conclusions EUS-guided treatment is more efficient and safer, and requires a smaller number of treatment sessions, as compared to endoscopic treatment in severe liver disease patients with large GV. Furthermore, PGC coil placement increases the complete obliteration of GV.

Background and Objectives: Cochlear implantation in late implanted prelinguals necessitates a complex decision-making process for clinicians and patients due to the uncertainty of achieving adequate benefit in auditory and speech perception. This study longitudinally evaluated clinical and social outcomes of prelingually deaf children with implantation in their late childhood. Subjects and Methods: A total of 113 (49 females and 64 males) participants, with an age range of 5-15 years, were assessed for the pre-implant parameters such as hearing loss etiology, aided responses, anatomical aspects, and psychological evaluation. The Category of Auditory Performance, Speech Awareness Threshold, Speech Reception Threshold, and Speech Discrimination Score were administered to assess the patient’s auditory skills. Further, the Speech Intelligibility Rating scale was administered to evaluate the patient’s speech intelligibility at 3, 6, 9, 12, 18, and 24 months post-surgery. Subjectively perceived benefits were evaluated using the satisfaction rating scale and a questionnaire. Results: The statistical results showed a significant impact of cochlear implantation in all domains. Positive impact and improvement post-implantation were noted in all the spheres, including auditory, linguistic, social, and educational. Conclusions The study highlighted that the outcomes of a cochlear implant at a later age might not parallel with the implantation at a younger age. However, this still provides measurable benefits even after a longer period of auditory deprivation.

Background/Aims: Existing therapeutic options for complicated Crohn’s disease (CD) like biologics and surgery are limited by inadequate long-term efficacy, cost, and adverse effects. Tissue hypoxia is important in CD pathogenesis and may be ameliorated with hyperbaric oxygen therapy (HBOT). We assessed the efficacy and tolerability of HBOT in small bowel stricturing CD. Methods: This pilot study included patients of small bowel stricturing CD (from April 2019 to January 2020) who underwent HBOT. These patients were refractory to conventional medical treatment or had multiple strictures not amenable to resection. Each session of HBOT was given for 60 minutes with a pressure of 1.5–2.5 atm. Clinical, biochemical responses and Short Inflammatory Bowel Disease (SIBD) questionnaire were evaluated at 2 and 6 months, and radiological response was evaluated at 6 months. Results: Fourteen patients (mean age, 42.9±15.7 years; male, 50%) were subjected to 168 HBOT sessions. Thirteen patients (92.7%) had strictures and 1 patient had enterocutaneous fistula in addition. Median number of HBOT sessions was 11 (range, 3–20) which were administered over a median of 4 weeks. Most patients tolerated it well except 1 who had hemotympanum. At 2 and 6 months of follow-up, 64.2% of patients had a clinical response, 50% and 64.2% of patients had clinical remission respectively. Steroid-free clinical remission was seen in 8 (57%) of patients with radiological improvement in 50%. There was a significant improvement in SIBD scores at 2-month follow-up (59.4 vs. 44.5, P=0.03). Conclusions HBOT can be a safe and effective therapeutic option in patients with stricturing small bowel CD refractory to conventional medical treatment.

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.

BACKGROUND/AIMS: The aim of this study was to study the efficacy and safety of zolpidem for sleep disturbances in patients with cirrhosis. METHODS: Fifty-two Child-Turcotte-Pugh (CTP) class A or B cirrhotics with Pittsburgh Sleep Quality Index >5 were randomized to either zolpidem 5 mg daily (n=26) or placebo (n=26) for 4 weeks. RESULTS: The therapy of 4 weeks was completed by 23 patients receiving zolpidem (3 stopped treatment due to excessive daytime drowsiness) and 24 receiving placebo (2 refused to continue the study). In the zolpidem group, after 4 weeks of therapy, there was significant increase in total sleep time (TST) and sleep efficiency compared to baseline and improvement in polysomnographic parameters of sleep initiation and maintenance (i.e., decrease in sleep latency time, decrease in wake time, and decreases in number of arousals and periodic limbs movements per hour of sleep), without any significant change in sleep architecture. CONCLUSIONS: Four weeks of 5 mg daily zolpidem in CTP class A or B cirrhosis patients with insomnia led to significant increases in TST and sleep efficiency and improvement in polysomnographic parameters of sleep initiation and maintenance without any significant change in sleep architecture.
Arousal ; Cytidine Triphosphate ; Extremities ; Fibrosis ; Humans ; Sleep Initiation and Maintenance Disorders

PURPOSE: Celiac disease is a common non-communicable disease with varied presentations. Purpose of this study was to find the duodeno-endoscopic features in celiac disease and to compare duodeno-endoscopic and histological findings between typical and atypical celiac disease in children. METHODS: Hospital based observational study was conducted at Sir Padampat Mother and Child Health Institute, Jaipur from June 2015 to May 2016. Patients were selected and divided in two groups- typical and atypical celiac disease based upon the presenting symptoms. Upper gastrointestinal endoscopy and duodenal biopsy was performed for serology positive patients. Results were analysed using appropriate statistical test of significance. RESULTS: Out of 101 enrolled patients, 47.5% were male. Age ranged from 1 to 18 years. Study showed that 54.5% were typical and 45.5% were atypical. Patients presenting with atypical symptoms were predominantly of older age group. On endoscopy, scalloping, mosaic pattern, reduced fold height and absent fold height; and in histology, advanced Marsh stage were significantly higher in the typical group. CONCLUSION: Awareness of atypical presentations as well as duodeno-endoscopic features may have considerable practical importance for the diagnosis of celiac disease in children. Scalloping, mosaic pattern, reduced fold height and nodularity are main endoscopic markers of celiac disease in children. Endoscopic markers of duodenal mucosa may be important in early diagnosis of celiac disease, in children subjected to endoscopy for atypical presentations or indication other than suspected celiac disease.
Biopsy ; Celiac Disease* ; Child Health ; Child* ; Diagnosis ; Early Diagnosis ; Endoscopy ; Endoscopy, Gastrointestinal ; Humans ; Male ; Mothers ; Mucous Membrane ; Observational Study ; Pectinidae ; Wetlands