Obstructive sleep apnea (OSA) is a multi-level airway disease, and the specific site of obstruction may influence associated conditions such as eustachian tube dysfunction (ETD) and gastroesophageal reflux disease (GERD). This study aimed to explore the relationship between OSA, ETD, acid reflux, and the anatomical site of obstruction. Methods: Participants were assessed using validated questionnaires for OSA, ETD, and reflux symptoms. The site of upper airway collapse was determined objectively using apneagraphy or sleep MRI. Acid reflux symptoms were evaluated using a standardized reflux symptom questionnaire, and 24-hour pH monitoring was done when indicated. ETD was assessed both subjectively and objectively through the Toynbee maneuver. Results: Sixty-three individuals completed the evaluation. The mean age was 40.4 years, and the mean BMI was 28.1 kg/m2. Retroglossal obstruction was observed in 76.1% (48/63), while 23.9% (15/63) had retropalatal obstruction. ETD was diagnosed in 53% of participants, and GERD in 38% by objective testing. A statistically significant association was found between retroglossal collapse and complete ETD (p=0.02). However, no significant link was noted between the obstruction site and laryngopharyngeal reflux or partial ETD. Additionally, salivary pepsin levels showed no correlation with reflux (p=0.412). Conclusions: OSA is frequently accompanied by ETD and GERD. Notably, retroglossal obstruction appears to be significantly associated with complete ETD, suggesting a potential site-specific impact. These findings underscore the importance of anatomical localization in understanding OSA-related comorbidities and warrant further investigation in larger multicenter studies.

We aimed to examine the outcomes of arthritic congenital dislocation of hip in adults after subtrochanteric shortening derotation osteotomy (SSDO) with cementless hip arthroplasty at a minimum follow-up period of five years. Bibliographic databases were searched and isolated studies were divided into three groups (1, 2, and 3) based on the femoral stem type (modular, monoblock, or mixed). We pooled 931 hips/737 patients from 20 studies. The mean difference in the Harris hip score (HHS) before and after the operation was 47.55 (95% confidence interval [CI] 43.16, 51.94). On subgroup analysis the mean differences of 46.59 (95% CI 41.67, 51.51), 48.24 (95% CI 41.37, 55.11), and 47.30 (95% CI 43.85, 50.75), respectively in HHS were noted in groups 1, 2, and 3. The incidence of uncontrolled proximal femur fractures was comparable at 7.9% and 4.2% in groups 1 and 2; however, it was 0% and 16.6% for controlled fractures. The incidences of nonunion, dislocation, nerve paralysis, heterotopic ossification and revision due to any cause were 0.3%, 6.5%, 1.7%, 2.1%, and 7.9% for group 1 and 1.9%, 4.3%, 1.6%, 5.6%, and 7.4% for group 2. Similar improvements in functional outcome for both monoblock and modular stems can be expected. An increased incidence of controlled proximal femur fractures was observed with use of modular stems. The nonunion at the SSDO site was sporadic.

We aimed to examine the outcomes of arthritic congenital dislocation of hip in adults after subtrochanteric shortening derotation osteotomy (SSDO) with cementless hip arthroplasty at a minimum follow-up period of five years. Bibliographic databases were searched and isolated studies were divided into three groups (1, 2, and 3) based on the femoral stem type (modular, monoblock, or mixed). We pooled 931 hips/737 patients from 20 studies. The mean difference in the Harris hip score (HHS) before and after the operation was 47.55 (95% confidence interval [CI] 43.16, 51.94). On subgroup analysis the mean differences of 46.59 (95% CI 41.67, 51.51), 48.24 (95% CI 41.37, 55.11), and 47.30 (95% CI 43.85, 50.75), respectively in HHS were noted in groups 1, 2, and 3. The incidence of uncontrolled proximal femur fractures was comparable at 7.9% and 4.2% in groups 1 and 2; however, it was 0% and 16.6% for controlled fractures. The incidences of nonunion, dislocation, nerve paralysis, heterotopic ossification and revision due to any cause were 0.3%, 6.5%, 1.7%, 2.1%, and 7.9% for group 1 and 1.9%, 4.3%, 1.6%, 5.6%, and 7.4% for group 2. Similar improvements in functional outcome for both monoblock and modular stems can be expected. An increased incidence of controlled proximal femur fractures was observed with use of modular stems. The nonunion at the SSDO site was sporadic.

Obstructive sleep apnea (OSA) is a multi-level airway disease, and the specific site of obstruction may influence associated conditions such as eustachian tube dysfunction (ETD) and gastroesophageal reflux disease (GERD). This study aimed to explore the relationship between OSA, ETD, acid reflux, and the anatomical site of obstruction. Methods: Participants were assessed using validated questionnaires for OSA, ETD, and reflux symptoms. The site of upper airway collapse was determined objectively using apneagraphy or sleep MRI. Acid reflux symptoms were evaluated using a standardized reflux symptom questionnaire, and 24-hour pH monitoring was done when indicated. ETD was assessed both subjectively and objectively through the Toynbee maneuver. Results: Sixty-three individuals completed the evaluation. The mean age was 40.4 years, and the mean BMI was 28.1 kg/m2. Retroglossal obstruction was observed in 76.1% (48/63), while 23.9% (15/63) had retropalatal obstruction. ETD was diagnosed in 53% of participants, and GERD in 38% by objective testing. A statistically significant association was found between retroglossal collapse and complete ETD (p=0.02). However, no significant link was noted between the obstruction site and laryngopharyngeal reflux or partial ETD. Additionally, salivary pepsin levels showed no correlation with reflux (p=0.412). Conclusions: OSA is frequently accompanied by ETD and GERD. Notably, retroglossal obstruction appears to be significantly associated with complete ETD, suggesting a potential site-specific impact. These findings underscore the importance of anatomical localization in understanding OSA-related comorbidities and warrant further investigation in larger multicenter studies.

We aimed to examine the outcomes of arthritic congenital dislocation of hip in adults after subtrochanteric shortening derotation osteotomy (SSDO) with cementless hip arthroplasty at a minimum follow-up period of five years. Bibliographic databases were searched and isolated studies were divided into three groups (1, 2, and 3) based on the femoral stem type (modular, monoblock, or mixed). We pooled 931 hips/737 patients from 20 studies. The mean difference in the Harris hip score (HHS) before and after the operation was 47.55 (95% confidence interval [CI] 43.16, 51.94). On subgroup analysis the mean differences of 46.59 (95% CI 41.67, 51.51), 48.24 (95% CI 41.37, 55.11), and 47.30 (95% CI 43.85, 50.75), respectively in HHS were noted in groups 1, 2, and 3. The incidence of uncontrolled proximal femur fractures was comparable at 7.9% and 4.2% in groups 1 and 2; however, it was 0% and 16.6% for controlled fractures. The incidences of nonunion, dislocation, nerve paralysis, heterotopic ossification and revision due to any cause were 0.3%, 6.5%, 1.7%, 2.1%, and 7.9% for group 1 and 1.9%, 4.3%, 1.6%, 5.6%, and 7.4% for group 2. Similar improvements in functional outcome for both monoblock and modular stems can be expected. An increased incidence of controlled proximal femur fractures was observed with use of modular stems. The nonunion at the SSDO site was sporadic.

Obstructive sleep apnea (OSA) is a multi-level airway disease, and the specific site of obstruction may influence associated conditions such as eustachian tube dysfunction (ETD) and gastroesophageal reflux disease (GERD). This study aimed to explore the relationship between OSA, ETD, acid reflux, and the anatomical site of obstruction. Methods: Participants were assessed using validated questionnaires for OSA, ETD, and reflux symptoms. The site of upper airway collapse was determined objectively using apneagraphy or sleep MRI. Acid reflux symptoms were evaluated using a standardized reflux symptom questionnaire, and 24-hour pH monitoring was done when indicated. ETD was assessed both subjectively and objectively through the Toynbee maneuver. Results: Sixty-three individuals completed the evaluation. The mean age was 40.4 years, and the mean BMI was 28.1 kg/m2. Retroglossal obstruction was observed in 76.1% (48/63), while 23.9% (15/63) had retropalatal obstruction. ETD was diagnosed in 53% of participants, and GERD in 38% by objective testing. A statistically significant association was found between retroglossal collapse and complete ETD (p=0.02). However, no significant link was noted between the obstruction site and laryngopharyngeal reflux or partial ETD. Additionally, salivary pepsin levels showed no correlation with reflux (p=0.412). Conclusions: OSA is frequently accompanied by ETD and GERD. Notably, retroglossal obstruction appears to be significantly associated with complete ETD, suggesting a potential site-specific impact. These findings underscore the importance of anatomical localization in understanding OSA-related comorbidities and warrant further investigation in larger multicenter studies.

Recurrent anterior shoulder dislocation (RASD) in cases of seizure disorders (SDs) total 50%–80% of all SD-associated shoulder instabilities. Based on the extent of bone loss, treatment options include bony and soft-tissue reconstructions, arthroplasty, and arthrodesis. The primary objective of this paper was to review the treatment options for RASD in SDs. Methods: Several bibliographic databases were searched for RASD treatment options in SD patients. The demographic outcome measures, the failure rate (defined as the relative risk of recurrence of dislocation postoperation), and the postoperative seizure recurrence rate were recorded. Results: We pooled 171 cases (187 shoulders) from 11 studies. Of these, one, five, two, two, and one reports studied Bankart’s operation with remplissage (27 cases/29 shoulders), the Latarjet procedure (106/118), bone block operation (21/23), arthroplasty (11/11), and arthrodesis (6/6), respectively, in treating SD-associated RASD. The relative risk of failure between SD and non-SD patients was 3.76 (1.3610.38) after the Latarjet operation. The failure rates were 17% and 13% for Bankart’s operation with remplissage and the Latarjet procedure in SD patients, respectively, but 0% each for bone block operation, arthroplasty, and arthrodesis. The total rate of seizure recurrence after operation was 33% of the pooled cases. Conclusions: SD recurrence in the postoperative period, the size of the bone block, and the muscular attachments to a small coracoid autograft are the determinants of failure among various reconstructive operations in SD-associated RASD. Level of evidence: III.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has adversely impacted medical education worldwide. However, its impact on the postgraduate medical thesis and dissertation work is still not evaluated. Through this study, we planned to find out the problems brought by the pandemic and likely alternatives and possible solutions to thrust the academic competence of postgraduate students. Methods: After obtaining institutional ethics committee approval, we sent a 13-item questionnaire to postgraduate medical students in India via various social media online platforms. Data on the impact of the COVID-19 pandemic on thesis work and alternatives/solutions to improve the research competence were collected on a Likert scale and analyzed. Results: We received a total of 398 responses out of which 377 entries were included for final analysis. The majority of participants (88%) reportedly had an adverse impact on the thesis work and out of 25% of the participants who recently submitted their around 45% had to do so without achieving the estimated sample size. The 6-month departmental review for thesis progress was seen in merely 28% of participants. Possible alternatives suggested were the maintenance of log books, task-based assessment of research methodology, departmental audits, and systematic reviews. Solutions suggested for improving the research competence of students were a compulsory research methodology curriculum, a biostatistics department in each institution, permission to conduct thesis work beyond submission time, exclusive time for research work, and financial incentives. Conclusion Modification in the research aspect of the current postgraduate medical education is the need of the hour and the pandemic has enlightened us regarding the current weaknesses.

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 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.