Ajeet Kumar Khilnani | Kskv Kachchh University (original) (raw)

Papers by Ajeet Kumar Khilnani

International Journal of Otorhinolaryngology and Head and Neck Surgery

mucoceles are the frontal and fronto-ethmoidal sinuses, although they can also be found in the ma... more mucoceles are the frontal and fronto-ethmoidal sinuses, although they can also be found in the maxillary and sphenoid sinuses. They cause slow, progressive expansion and dilatation of the sinuses, producing symptoms, such as headache, nasal obstruction, facial pain, decreased visual acuity, diplopia, displacement of the eyeball and facial edema. The diagnosis is based on the history, physical examination and radiological findings. Computed Tomography (CT) is the preferred imaging modality for mucoceles. Endoscopic endonasal ABSTRACT Background: Paranasal sinus mucoceles are quite rare and a comprehensive study regarding their incidence, presentations, management and complications is significantly lacking in our geographical area which led to our prospective study. Fronto-ethmoidal mucoceles are the most common expansile lesions of the paranasal sinuses. Methods: This is a prospective study of 25 cases of patients presenting with fronto-ethmoidal mucoceles in a tertiary care hospital in Ahmedabad. All patients were managed surgically through endoscopic approach. Results: The study comprised of 25 cases of fronto-ethmoidal mucoceles. The average age of the patients was 47.72 years with a range of 21-75 years. 16 patients (64%) were females. The most common involvement was of frontal sinus (16 cases, 64%). The most common presenting symptom was displacement of eyeball (68% cases). The most common presenting sign was proptosis, present in 68% cases. Endoscopic sinus surgery was the most commonly used modality of treatment of frontal mucocele and fronto-ethmoidal mucoceles (23 cases). In 2 cases combined approach surgery (endoscopic and external) was done. Conclusions: Mucoceles most commonly occur between 4 th to 7 th decades of life. In most cases no predisposing factor is identified. The diagnosis is based on the history, physical examination and radiological findings. CT is the preferred imaging modality for mucoceles. Endoscopic endonasal surgery is currently the most commonly used surgical approach.

International Journal of Otorhinolaryngology and Head and Neck Surgery

Secretory otitis media (SOM), also known as non suppurative otitis media, otitis media with effus... more Secretory otitis media (SOM), also known as non suppurative otitis media, otitis media with effusion and glue ear, is a common otological manifestation in children, that most of the time is left undiagnosed on account of unawareness and negligence in seeking early medical attention for trivial ailments. If untreated, it might end up in serious consequences in the form of poor speech and intellectual development and permanent anatomical disabilities within middle ear cleft. 1 Its causes are multifactorial and results from alteration of mucociliary system of middle ear resulting mainly from Eustachian tube dysfunction which maybe primary or ABSTRACT Background: Secretory Otitis Media (SOM) is a common otological condition in children presenting most commonly with hearing loss. If untreated for long time, it can affect the language development of child. Its causes are multifactorial and treatment depends on the etiology. Various treatment modalities (medical and surgical) are available and they are administered in isolation or in combination. The objectives of the study were the present study was conducted with the objectives of knowing the most common age group affected by SOM, the common etiological factors of SOM and the outcome of various modalities of treatment of SOM. Methods: This prospective study was conducted at a tertiary care teaching hospital of North Gujarat. IEC approval and consent from the patients were taken. 40 patients diagnosed with SOM were included in the study and their clinical and demographic details and treatment outcomes were studied. Results: Of the 40 patients, 65% were males. SOM was common in young children. Most of the cases (55%) were below 10 years of age. In 80% of cases SOM was bilateral. Deafness was the most common symptom (95%) with which patients presented with, followed by URTI and pain. All patients had impaired tympanic membrane mobility. Retraction of tympanic membrane was the next common otoscopic finding (85%). Initial management was medical and 18 patients required surgical intervention. Conclusions: SOM is a common ear disorder in children. Initial medical treatment has a definitive role and should be tried in all cases before surgical intervention is contemplated. A variety of surgical procedures are available which can be used depending on the indication. Complete recovery is expected to occur in most of the cases by a period of 3-6 months.

Journal of pharmacology & pharmacotherapeutics

International Journal of Otorhinolaryngology and Head and Neck Surgery

Secretory otitis media (SOM), also known as non suppurative otitis media, otitis media with effus... more Secretory otitis media (SOM), also known as non suppurative otitis media, otitis media with effusion and glue ear, is a common otological manifestation in children, that most of the time is left undiagnosed on account of unawareness and negligence in seeking early medical attention for trivial ailments. If untreated, it might end up in serious consequences in the form of poor speech and intellectual development and permanent anatomical disabilities within middle ear cleft. 1 Its causes are multifactorial and results from alteration of mucociliary system of middle ear resulting mainly from Eustachian tube dysfunction which maybe primary or ABSTRACT Background: Secretory Otitis Media (SOM) is a common otological condition in children presenting most commonly with hearing loss. If untreated for long time, it can affect the language development of child. Its causes are multifactorial and treatment depends on the etiology. Various treatment modalities (medical and surgical) are available and they are administered in isolation or in combination. The objectives of the study were the present study was conducted with the objectives of knowing the most common age group affected by SOM, the common etiological factors of SOM and the outcome of various modalities of treatment of SOM. Methods: This prospective study was conducted at a tertiary care teaching hospital of North Gujarat. IEC approval and consent from the patients were taken. 40 patients diagnosed with SOM were included in the study and their clinical and demographic details and treatment outcomes were studied. Results: Of the 40 patients, 65% were males. SOM was common in young children. Most of the cases (55%) were below 10 years of age. In 80% of cases SOM was bilateral. Deafness was the most common symptom (95%) with which patients presented with, followed by URTI and pain. All patients had impaired tympanic membrane mobility. Retraction of tympanic membrane was the next common otoscopic finding (85%). Initial management was medical and 18 patients required surgical intervention. Conclusions: SOM is a common ear disorder in children. Initial medical treatment has a definitive role and should be tried in all cases before surgical intervention is contemplated. A variety of surgical procedures are available which can be used depending on the indication. Complete recovery is expected to occur in most of the cases by a period of 3-6 months.

International Journal of Otorhinolaryngology and Head and Neck Surgery

mucoceles are the frontal and fronto-ethmoidal sinuses, although they can also be found in the ma... more mucoceles are the frontal and fronto-ethmoidal sinuses, although they can also be found in the maxillary and sphenoid sinuses. They cause slow, progressive expansion and dilatation of the sinuses, producing symptoms, such as headache, nasal obstruction, facial pain, decreased visual acuity, diplopia, displacement of the eyeball and facial edema. The diagnosis is based on the history, physical examination and radiological findings. Computed Tomography (CT) is the preferred imaging modality for mucoceles. Endoscopic endonasal ABSTRACT Background: Paranasal sinus mucoceles are quite rare and a comprehensive study regarding their incidence, presentations, management and complications is significantly lacking in our geographical area which led to our prospective study. Fronto-ethmoidal mucoceles are the most common expansile lesions of the paranasal sinuses. Methods: This is a prospective study of 25 cases of patients presenting with fronto-ethmoidal mucoceles in a tertiary care hospital in Ahmedabad. All patients were managed surgically through endoscopic approach. Results: The study comprised of 25 cases of fronto-ethmoidal mucoceles. The average age of the patients was 47.72 years with a range of 21-75 years. 16 patients (64%) were females. The most common involvement was of frontal sinus (16 cases, 64%). The most common presenting symptom was displacement of eyeball (68% cases). The most common presenting sign was proptosis, present in 68% cases. Endoscopic sinus surgery was the most commonly used modality of treatment of frontal mucocele and fronto-ethmoidal mucoceles (23 cases). In 2 cases combined approach surgery (endoscopic and external) was done. Conclusions: Mucoceles most commonly occur between 4 th to 7 th decades of life. In most cases no predisposing factor is identified. The diagnosis is based on the history, physical examination and radiological findings. CT is the preferred imaging modality for mucoceles. Endoscopic endonasal surgery is currently the most commonly used surgical approach.

International Journal of Otorhinolaryngology and Head and Neck Surgery

Background: High Resolution Computed Tomography (HRCT) has widely replaced conventional technique... more Background: High Resolution Computed Tomography (HRCT) has widely replaced conventional techniques (X-Ray Mastoid bone) for temporal bone imaging. The most significant use of computed tomography lies in evaluation of cases of Chronic Suppurative Otitis Media (CSOM). The objective of the study was to evaluate the usefulness of HRCT scanning of temporal bone in defining the extent and severity of disease in patients with CSOM, thereby altering the surgical plan and outcome. Methods: This prospective study was conducted at a tertiary care hospital in Ahmedabad. After obtaining approval from IEC (Institutional Ethical Committee), study was carried out on 50 patients diagnosed with CSOM of atticoantral type. Written informed consent of all patients was taken before enrollment in the study. HRCT scan findings were reviewed and correlated with per-operative findings. Results: Out of total 50 patients of CSOM, 26 (52%) were males. Majority of the patients (70%) were in the age group of 11 to 30 years. Left ear was involved in 40% of the patients. Majority of the patients (80%) presented with chief complaint of otorrhoea. In the present study, External Auditory Canal (EAC) was seen normal in majority of patients (82%) both radio logically and per operatively. HRCT scan was found to be very sensitive (96%) in diagnosing cholesteatoma. The sensitivity of HRCT for diagnosing disease in epitympanum, antrum and aditus was found to be 100%, 97% and 88% respectively. CT scans diagnosed erosion of malleus with 100% sensitivity and specificity and erosion of incus with 91% sensitivity and 100% specificity. Conclusions: HRCT was helpful in determining the anatomy of the middle ear and mastoid, and accurately predicted the extent of the disease process of CSOM.

International Journal of Otorhinolaryngology and Head and Neck Surgery

International Journal of Otorhinolaryngology and Head and Neck Surgery

Traditionally this surgery was performed with the microscope. However, microscope functions on st... more Traditionally this surgery was performed with the microscope. However, microscope functions on straight line of sight principle and visualization of middle ear completely and removal of pathology, especially that of ABSTRACT Background: Tympanoplasty is an ever evolving surgery with myriad of approaches and tools. Use of endoscope is relatively new and there are few studies evaluating the use of endoscope via microscope because of a big learning curve in using one hand endoscopic technique despite it being minimally invasive. Methods: This is a prospective study conducted from June 2016 to May 2017 with a sample size of 44 patients. The study included patients of Chronic Otitis Media (COM) of mucosal inactive type without any co-morbidities in which only Type-1 tympanoplasty was done. The patients were divided into endoscopic or microscopic group using simple random sampling and after taking written and informed consent. The patient's details regarding audiometric, otoendoscopic and nasal endoscopic evaluation were recorded. Intra operative findings, duration of surgery and postoperative pain scoring were recorded. The patients were followed up for 3 months and subjected to post-operative audiometry and patient satisfaction questionnaire. The groups were evaluated for graft take up and closure of air bone gap, post-operative complications and patient satisfaction. The results were analysed using descriptive statistics (mean and percentage) and CHISQ test. Results: Graft was taken up in 21 patients (95%) in microscopic as opposed to 20 in endoscopic group (90%). Mean VAS scoring for pain was 2.5 in microscopic group on first post-operative day and 1.5 for the endoscopic group. The mean improvement in air bone gap post-surgery was 23.68 dB (SD=4.94) for microscopic group and 16.13 dB (SD=6.49) for endoscopic group. Conclusions: Endoscopic tympanoplasty as a technique has a long learning curve. The results indicate that endoscopic technique is as efficacious as and less invasive than microscope surgery for doing tympanoplasty.

Indian Journal of Pharmacology, 2016

Indian Journal of Pharmacology, 2016

National Journal of Physiology Pharmacy and Pharmacology, 2014

Indian Journal of Psychiatry, 2016

National Journal of Medical Research, 2013

Indian Journal of Pharmacology, 2015

The study aims to understand the process and factors influencing the implementation of structured... more The study aims to understand the process and factors influencing the implementation of structured oral examination (SOE) for undergraduate medical students; in comparison with conventional oral examination (COE) in pharmacology. In a randomized, parallel group study, 123 students of pharmacology were divided into two groups, SOE (n = 63) and COE (n = 60). Students of each group were subdivided into two, and four examiners took viva voce individually. Three sets of questionnaires from autonomic nervous system were prepared, each having 15 items with increasing difficulty levels and were validated by subject experts and pretested. Ten minutes were allotted for each student for each viva. Feedback of students and faculty about the novel method was obtained. SOE yielded significantly lower marks as compared to COE. There were significant inter-examiner variations in marks awarded in SOE and COE. Other factors influencing implementation were difficulty in structuring viva, rigid time limits, lack of flexibility in knowledge content, monotony, and fatigue. The students perceived this format not different from COE but felt that it required in-depth preparation of topic. Faculty opined that SOE led to less drift from main topic and provided uniform coverage of topics in given time. Conducting SOE is a resource-intensive exercise. Despite structuring, inter-examiner variability was not completely eliminated. The students' performance was depended on factors related to examiners such as teaching experience, vernacular language used, and lack of training. Orientation and training of examiners in assessment strategies is necessary. Standardization of questionnaire is necessary before the implementation of SOE for summative assessment.

Indian Dermatology Online Journal, 2014

Lipoid proteinosis is a very rare autosomal recessive disorder characterized by deposition of hya... more Lipoid proteinosis is a very rare autosomal recessive disorder characterized by deposition of hyaline material in the skin and the upper aerodigestive tract. Hoarseness of voice occurs very early in life and airway obstruction may occur. Characteristic skin lesions include multiple brown atrophic scars over face and distal extremities, beaded papules over the margins of the eyelids and verrucous nodules over the friction bearing areas (elbows, knees). The overall prognosis is good. There is no definitive treatment.

Pharmaceutical Biology, 2013

Guggulipid is a neutral fraction of ethyl acetate extract of gum resin of the tree Commiphora muk... more Guggulipid is a neutral fraction of ethyl acetate extract of gum resin of the tree Commiphora mukul Engl. (Burseraceae) and used in Ayurvedic medicine for treatment of neurological disorders. The present study was undertaken to assess the antiallodynic and antihyperalgesic activities of guggulipid in rats. The screening study included the CCI and L5-L6 SNL models of neuropathic pain. Guggulipid (100 and 50 mg/kg) or saline was administered intraperitoneally in a blinded, randomized manner from postoperative day (POD) 7 to 13. Paw withdrawal duration (PWD) to spontaneous pain, chemical allodynia and mechanical hyperalgesia and paw withdrawal latency (PWL) to mechanical allodynia and thermal hyperalgesia were tested before surgery, before and after guggulipid or saline administration (from POD7 to 13) and after the withdrawal of treatment (from POD14 to 20). The activity profiles of the different doses of guggulipid were found to vary with time. In CCI rats, guggulipid (100 and 50 mg/kg) significantly (p < 0.05) reduced the spontaneous pain, mechanical allodynia and mechanical and thermal hyperalgesia responses and the LD50 of guggulipid was 1600 mg/kg. In SNL rats, both doses of guggulipid were found to be ineffective in reversing the spontaneous pain but showing antiallodynic and antihyperalgesic activity. The results demonstrated that guggulipid produce antinociception in the peripheral nerve injury (CCI and SNL) models of neuropathic pain. The underlying mechanisms are expected to be modulating microglial activation occurring due to peripheral nerve injury.

Indian Journal of Pharmacology, 2011

A large number of G-protein-coupled receptors (GPCRs) show varying degrees of basal or constituti... more A large number of G-protein-coupled receptors (GPCRs) show varying degrees of basal or constitutive activity. This constitutive activity is usually minimal in natural receptors but is markedly observed in wild type and mutated (naturally or induced) receptors. According to conventional two-state drug receptor interaction model, binding of a ligand may initiate activity (agonist with varying degrees of positive intrinsic activity) or prevent the effect of an agonist (antagonist with zero intrinsic activity). Inverse agonists bind with the constitutively active receptors, stabilize them, and thus reduce the activity (negative intrinsic activity). Receptors of many classes (α-and β-adrenergic, histaminergic, GABAergic, serotoninergic, opiate, and angiotensin receptors) have shown basal activity in suitable in vitro models. Several drugs that have been conventionally classified as antagonists (β-blockers, antihistaminics) have shown inverse agonist effects on corresponding constitutively active receptors. Nearly all H(1) and H(2) antihistaminics (antagonists) have been shown to be inverse agonists. Among the β-blockers, carvedilol and bucindolol demonstrate low level of inverse agonism as compared to propranolol and nadolol. Several antipsychotic drugs (D(2) receptors antagonist), antihypertensive (AT(1) receptor antagonists), antiserotoninergic drugs and opioid antagonists have significant inverse agonistic activity that contributes partly or wholly to their therapeutic value. Inverse agonism may also help explain the underlying mechanism of beneficial effects of carvedilol in congestive failure, naloxone-induced withdrawal syndrome in opioid dependence, clozapine in psychosis, and candesartan in cardiac hypertrophy. Understanding inverse agonisms has paved a way for newer drug development. It is now possible to develop agents, which have only desired therapeutic value and are devoid of unwanted adverse effect. Pimavanserin (ACP-103), a highly selective 5-HT(2A) inverse agonist, attenuates psychosis in patients with Parkinson's disease with psychosis and is devoid of extrapyramidal side effects. This dissociation is also evident from the development of anxioselective benzodiazepines devoid of habit-forming potential. Hemopressin is a peptide ligand that acts as an antagonist as well as inverse agonist. This agent acts as an antinociceptive agent in different in vivo models of pain. Treatment of obesity by drugs having inverse agonist activity at CB(1/2) receptors is also underway. An exciting development is evaluation of β-blockers in chronic bronchial asthma-a condition akin to congestive heart failure where β-blockade has become the standard mode of therapy. Synthesis and evaluation of selective agents is underway. Therefore, inverse agonism is an important aspect of drug-receptor interaction and has immense untapped therapeutic potential.

International Journal of Otorhinolaryngology and Head and Neck Surgery

mucoceles are the frontal and fronto-ethmoidal sinuses, although they can also be found in the ma... more mucoceles are the frontal and fronto-ethmoidal sinuses, although they can also be found in the maxillary and sphenoid sinuses. They cause slow, progressive expansion and dilatation of the sinuses, producing symptoms, such as headache, nasal obstruction, facial pain, decreased visual acuity, diplopia, displacement of the eyeball and facial edema. The diagnosis is based on the history, physical examination and radiological findings. Computed Tomography (CT) is the preferred imaging modality for mucoceles. Endoscopic endonasal ABSTRACT Background: Paranasal sinus mucoceles are quite rare and a comprehensive study regarding their incidence, presentations, management and complications is significantly lacking in our geographical area which led to our prospective study. Fronto-ethmoidal mucoceles are the most common expansile lesions of the paranasal sinuses. Methods: This is a prospective study of 25 cases of patients presenting with fronto-ethmoidal mucoceles in a tertiary care hospital in Ahmedabad. All patients were managed surgically through endoscopic approach. Results: The study comprised of 25 cases of fronto-ethmoidal mucoceles. The average age of the patients was 47.72 years with a range of 21-75 years. 16 patients (64%) were females. The most common involvement was of frontal sinus (16 cases, 64%). The most common presenting symptom was displacement of eyeball (68% cases). The most common presenting sign was proptosis, present in 68% cases. Endoscopic sinus surgery was the most commonly used modality of treatment of frontal mucocele and fronto-ethmoidal mucoceles (23 cases). In 2 cases combined approach surgery (endoscopic and external) was done. Conclusions: Mucoceles most commonly occur between 4 th to 7 th decades of life. In most cases no predisposing factor is identified. The diagnosis is based on the history, physical examination and radiological findings. CT is the preferred imaging modality for mucoceles. Endoscopic endonasal surgery is currently the most commonly used surgical approach.

International Journal of Otorhinolaryngology and Head and Neck Surgery

Secretory otitis media (SOM), also known as non suppurative otitis media, otitis media with effus... more Secretory otitis media (SOM), also known as non suppurative otitis media, otitis media with effusion and glue ear, is a common otological manifestation in children, that most of the time is left undiagnosed on account of unawareness and negligence in seeking early medical attention for trivial ailments. If untreated, it might end up in serious consequences in the form of poor speech and intellectual development and permanent anatomical disabilities within middle ear cleft. 1 Its causes are multifactorial and results from alteration of mucociliary system of middle ear resulting mainly from Eustachian tube dysfunction which maybe primary or ABSTRACT Background: Secretory Otitis Media (SOM) is a common otological condition in children presenting most commonly with hearing loss. If untreated for long time, it can affect the language development of child. Its causes are multifactorial and treatment depends on the etiology. Various treatment modalities (medical and surgical) are available and they are administered in isolation or in combination. The objectives of the study were the present study was conducted with the objectives of knowing the most common age group affected by SOM, the common etiological factors of SOM and the outcome of various modalities of treatment of SOM. Methods: This prospective study was conducted at a tertiary care teaching hospital of North Gujarat. IEC approval and consent from the patients were taken. 40 patients diagnosed with SOM were included in the study and their clinical and demographic details and treatment outcomes were studied. Results: Of the 40 patients, 65% were males. SOM was common in young children. Most of the cases (55%) were below 10 years of age. In 80% of cases SOM was bilateral. Deafness was the most common symptom (95%) with which patients presented with, followed by URTI and pain. All patients had impaired tympanic membrane mobility. Retraction of tympanic membrane was the next common otoscopic finding (85%). Initial management was medical and 18 patients required surgical intervention. Conclusions: SOM is a common ear disorder in children. Initial medical treatment has a definitive role and should be tried in all cases before surgical intervention is contemplated. A variety of surgical procedures are available which can be used depending on the indication. Complete recovery is expected to occur in most of the cases by a period of 3-6 months.

Journal of pharmacology & pharmacotherapeutics

International Journal of Otorhinolaryngology and Head and Neck Surgery

Secretory otitis media (SOM), also known as non suppurative otitis media, otitis media with effus... more Secretory otitis media (SOM), also known as non suppurative otitis media, otitis media with effusion and glue ear, is a common otological manifestation in children, that most of the time is left undiagnosed on account of unawareness and negligence in seeking early medical attention for trivial ailments. If untreated, it might end up in serious consequences in the form of poor speech and intellectual development and permanent anatomical disabilities within middle ear cleft. 1 Its causes are multifactorial and results from alteration of mucociliary system of middle ear resulting mainly from Eustachian tube dysfunction which maybe primary or ABSTRACT Background: Secretory Otitis Media (SOM) is a common otological condition in children presenting most commonly with hearing loss. If untreated for long time, it can affect the language development of child. Its causes are multifactorial and treatment depends on the etiology. Various treatment modalities (medical and surgical) are available and they are administered in isolation or in combination. The objectives of the study were the present study was conducted with the objectives of knowing the most common age group affected by SOM, the common etiological factors of SOM and the outcome of various modalities of treatment of SOM. Methods: This prospective study was conducted at a tertiary care teaching hospital of North Gujarat. IEC approval and consent from the patients were taken. 40 patients diagnosed with SOM were included in the study and their clinical and demographic details and treatment outcomes were studied. Results: Of the 40 patients, 65% were males. SOM was common in young children. Most of the cases (55%) were below 10 years of age. In 80% of cases SOM was bilateral. Deafness was the most common symptom (95%) with which patients presented with, followed by URTI and pain. All patients had impaired tympanic membrane mobility. Retraction of tympanic membrane was the next common otoscopic finding (85%). Initial management was medical and 18 patients required surgical intervention. Conclusions: SOM is a common ear disorder in children. Initial medical treatment has a definitive role and should be tried in all cases before surgical intervention is contemplated. A variety of surgical procedures are available which can be used depending on the indication. Complete recovery is expected to occur in most of the cases by a period of 3-6 months.

International Journal of Otorhinolaryngology and Head and Neck Surgery

mucoceles are the frontal and fronto-ethmoidal sinuses, although they can also be found in the ma... more mucoceles are the frontal and fronto-ethmoidal sinuses, although they can also be found in the maxillary and sphenoid sinuses. They cause slow, progressive expansion and dilatation of the sinuses, producing symptoms, such as headache, nasal obstruction, facial pain, decreased visual acuity, diplopia, displacement of the eyeball and facial edema. The diagnosis is based on the history, physical examination and radiological findings. Computed Tomography (CT) is the preferred imaging modality for mucoceles. Endoscopic endonasal ABSTRACT Background: Paranasal sinus mucoceles are quite rare and a comprehensive study regarding their incidence, presentations, management and complications is significantly lacking in our geographical area which led to our prospective study. Fronto-ethmoidal mucoceles are the most common expansile lesions of the paranasal sinuses. Methods: This is a prospective study of 25 cases of patients presenting with fronto-ethmoidal mucoceles in a tertiary care hospital in Ahmedabad. All patients were managed surgically through endoscopic approach. Results: The study comprised of 25 cases of fronto-ethmoidal mucoceles. The average age of the patients was 47.72 years with a range of 21-75 years. 16 patients (64%) were females. The most common involvement was of frontal sinus (16 cases, 64%). The most common presenting symptom was displacement of eyeball (68% cases). The most common presenting sign was proptosis, present in 68% cases. Endoscopic sinus surgery was the most commonly used modality of treatment of frontal mucocele and fronto-ethmoidal mucoceles (23 cases). In 2 cases combined approach surgery (endoscopic and external) was done. Conclusions: Mucoceles most commonly occur between 4 th to 7 th decades of life. In most cases no predisposing factor is identified. The diagnosis is based on the history, physical examination and radiological findings. CT is the preferred imaging modality for mucoceles. Endoscopic endonasal surgery is currently the most commonly used surgical approach.

International Journal of Otorhinolaryngology and Head and Neck Surgery

Background: High Resolution Computed Tomography (HRCT) has widely replaced conventional technique... more Background: High Resolution Computed Tomography (HRCT) has widely replaced conventional techniques (X-Ray Mastoid bone) for temporal bone imaging. The most significant use of computed tomography lies in evaluation of cases of Chronic Suppurative Otitis Media (CSOM). The objective of the study was to evaluate the usefulness of HRCT scanning of temporal bone in defining the extent and severity of disease in patients with CSOM, thereby altering the surgical plan and outcome. Methods: This prospective study was conducted at a tertiary care hospital in Ahmedabad. After obtaining approval from IEC (Institutional Ethical Committee), study was carried out on 50 patients diagnosed with CSOM of atticoantral type. Written informed consent of all patients was taken before enrollment in the study. HRCT scan findings were reviewed and correlated with per-operative findings. Results: Out of total 50 patients of CSOM, 26 (52%) were males. Majority of the patients (70%) were in the age group of 11 to 30 years. Left ear was involved in 40% of the patients. Majority of the patients (80%) presented with chief complaint of otorrhoea. In the present study, External Auditory Canal (EAC) was seen normal in majority of patients (82%) both radio logically and per operatively. HRCT scan was found to be very sensitive (96%) in diagnosing cholesteatoma. The sensitivity of HRCT for diagnosing disease in epitympanum, antrum and aditus was found to be 100%, 97% and 88% respectively. CT scans diagnosed erosion of malleus with 100% sensitivity and specificity and erosion of incus with 91% sensitivity and 100% specificity. Conclusions: HRCT was helpful in determining the anatomy of the middle ear and mastoid, and accurately predicted the extent of the disease process of CSOM.

International Journal of Otorhinolaryngology and Head and Neck Surgery

International Journal of Otorhinolaryngology and Head and Neck Surgery

Traditionally this surgery was performed with the microscope. However, microscope functions on st... more Traditionally this surgery was performed with the microscope. However, microscope functions on straight line of sight principle and visualization of middle ear completely and removal of pathology, especially that of ABSTRACT Background: Tympanoplasty is an ever evolving surgery with myriad of approaches and tools. Use of endoscope is relatively new and there are few studies evaluating the use of endoscope via microscope because of a big learning curve in using one hand endoscopic technique despite it being minimally invasive. Methods: This is a prospective study conducted from June 2016 to May 2017 with a sample size of 44 patients. The study included patients of Chronic Otitis Media (COM) of mucosal inactive type without any co-morbidities in which only Type-1 tympanoplasty was done. The patients were divided into endoscopic or microscopic group using simple random sampling and after taking written and informed consent. The patient's details regarding audiometric, otoendoscopic and nasal endoscopic evaluation were recorded. Intra operative findings, duration of surgery and postoperative pain scoring were recorded. The patients were followed up for 3 months and subjected to post-operative audiometry and patient satisfaction questionnaire. The groups were evaluated for graft take up and closure of air bone gap, post-operative complications and patient satisfaction. The results were analysed using descriptive statistics (mean and percentage) and CHISQ test. Results: Graft was taken up in 21 patients (95%) in microscopic as opposed to 20 in endoscopic group (90%). Mean VAS scoring for pain was 2.5 in microscopic group on first post-operative day and 1.5 for the endoscopic group. The mean improvement in air bone gap post-surgery was 23.68 dB (SD=4.94) for microscopic group and 16.13 dB (SD=6.49) for endoscopic group. Conclusions: Endoscopic tympanoplasty as a technique has a long learning curve. The results indicate that endoscopic technique is as efficacious as and less invasive than microscope surgery for doing tympanoplasty.

Indian Journal of Pharmacology, 2016

Indian Journal of Pharmacology, 2016

National Journal of Physiology Pharmacy and Pharmacology, 2014

Indian Journal of Psychiatry, 2016

National Journal of Medical Research, 2013

Indian Journal of Pharmacology, 2015

The study aims to understand the process and factors influencing the implementation of structured... more The study aims to understand the process and factors influencing the implementation of structured oral examination (SOE) for undergraduate medical students; in comparison with conventional oral examination (COE) in pharmacology. In a randomized, parallel group study, 123 students of pharmacology were divided into two groups, SOE (n = 63) and COE (n = 60). Students of each group were subdivided into two, and four examiners took viva voce individually. Three sets of questionnaires from autonomic nervous system were prepared, each having 15 items with increasing difficulty levels and were validated by subject experts and pretested. Ten minutes were allotted for each student for each viva. Feedback of students and faculty about the novel method was obtained. SOE yielded significantly lower marks as compared to COE. There were significant inter-examiner variations in marks awarded in SOE and COE. Other factors influencing implementation were difficulty in structuring viva, rigid time limits, lack of flexibility in knowledge content, monotony, and fatigue. The students perceived this format not different from COE but felt that it required in-depth preparation of topic. Faculty opined that SOE led to less drift from main topic and provided uniform coverage of topics in given time. Conducting SOE is a resource-intensive exercise. Despite structuring, inter-examiner variability was not completely eliminated. The students' performance was depended on factors related to examiners such as teaching experience, vernacular language used, and lack of training. Orientation and training of examiners in assessment strategies is necessary. Standardization of questionnaire is necessary before the implementation of SOE for summative assessment.

Indian Dermatology Online Journal, 2014

Lipoid proteinosis is a very rare autosomal recessive disorder characterized by deposition of hya... more Lipoid proteinosis is a very rare autosomal recessive disorder characterized by deposition of hyaline material in the skin and the upper aerodigestive tract. Hoarseness of voice occurs very early in life and airway obstruction may occur. Characteristic skin lesions include multiple brown atrophic scars over face and distal extremities, beaded papules over the margins of the eyelids and verrucous nodules over the friction bearing areas (elbows, knees). The overall prognosis is good. There is no definitive treatment.

Pharmaceutical Biology, 2013

Guggulipid is a neutral fraction of ethyl acetate extract of gum resin of the tree Commiphora muk... more Guggulipid is a neutral fraction of ethyl acetate extract of gum resin of the tree Commiphora mukul Engl. (Burseraceae) and used in Ayurvedic medicine for treatment of neurological disorders. The present study was undertaken to assess the antiallodynic and antihyperalgesic activities of guggulipid in rats. The screening study included the CCI and L5-L6 SNL models of neuropathic pain. Guggulipid (100 and 50 mg/kg) or saline was administered intraperitoneally in a blinded, randomized manner from postoperative day (POD) 7 to 13. Paw withdrawal duration (PWD) to spontaneous pain, chemical allodynia and mechanical hyperalgesia and paw withdrawal latency (PWL) to mechanical allodynia and thermal hyperalgesia were tested before surgery, before and after guggulipid or saline administration (from POD7 to 13) and after the withdrawal of treatment (from POD14 to 20). The activity profiles of the different doses of guggulipid were found to vary with time. In CCI rats, guggulipid (100 and 50 mg/kg) significantly (p < 0.05) reduced the spontaneous pain, mechanical allodynia and mechanical and thermal hyperalgesia responses and the LD50 of guggulipid was 1600 mg/kg. In SNL rats, both doses of guggulipid were found to be ineffective in reversing the spontaneous pain but showing antiallodynic and antihyperalgesic activity. The results demonstrated that guggulipid produce antinociception in the peripheral nerve injury (CCI and SNL) models of neuropathic pain. The underlying mechanisms are expected to be modulating microglial activation occurring due to peripheral nerve injury.

Indian Journal of Pharmacology, 2011

A large number of G-protein-coupled receptors (GPCRs) show varying degrees of basal or constituti... more A large number of G-protein-coupled receptors (GPCRs) show varying degrees of basal or constitutive activity. This constitutive activity is usually minimal in natural receptors but is markedly observed in wild type and mutated (naturally or induced) receptors. According to conventional two-state drug receptor interaction model, binding of a ligand may initiate activity (agonist with varying degrees of positive intrinsic activity) or prevent the effect of an agonist (antagonist with zero intrinsic activity). Inverse agonists bind with the constitutively active receptors, stabilize them, and thus reduce the activity (negative intrinsic activity). Receptors of many classes (α-and β-adrenergic, histaminergic, GABAergic, serotoninergic, opiate, and angiotensin receptors) have shown basal activity in suitable in vitro models. Several drugs that have been conventionally classified as antagonists (β-blockers, antihistaminics) have shown inverse agonist effects on corresponding constitutively active receptors. Nearly all H(1) and H(2) antihistaminics (antagonists) have been shown to be inverse agonists. Among the β-blockers, carvedilol and bucindolol demonstrate low level of inverse agonism as compared to propranolol and nadolol. Several antipsychotic drugs (D(2) receptors antagonist), antihypertensive (AT(1) receptor antagonists), antiserotoninergic drugs and opioid antagonists have significant inverse agonistic activity that contributes partly or wholly to their therapeutic value. Inverse agonism may also help explain the underlying mechanism of beneficial effects of carvedilol in congestive failure, naloxone-induced withdrawal syndrome in opioid dependence, clozapine in psychosis, and candesartan in cardiac hypertrophy. Understanding inverse agonisms has paved a way for newer drug development. It is now possible to develop agents, which have only desired therapeutic value and are devoid of unwanted adverse effect. Pimavanserin (ACP-103), a highly selective 5-HT(2A) inverse agonist, attenuates psychosis in patients with Parkinson's disease with psychosis and is devoid of extrapyramidal side effects. This dissociation is also evident from the development of anxioselective benzodiazepines devoid of habit-forming potential. Hemopressin is a peptide ligand that acts as an antagonist as well as inverse agonist. This agent acts as an antinociceptive agent in different in vivo models of pain. Treatment of obesity by drugs having inverse agonist activity at CB(1/2) receptors is also underway. An exciting development is evaluation of β-blockers in chronic bronchial asthma-a condition akin to congestive heart failure where β-blockade has become the standard mode of therapy. Synthesis and evaluation of selective agents is underway. Therefore, inverse agonism is an important aspect of drug-receptor interaction and has immense untapped therapeutic potential.