Objective To compare the impact of decongestive effect of xylometazoline and adrenaline in controlling active idiopathic anterior epistaxis on adult patients prior to use silver nitrate for cauterization. Study design Prospective case study. Methods The study used a prospective review of 150 consecutive adult patients diagnosed as anterior epistaxis (from August 2010 to January 2011). The study group was analyzed in three groups based on method of intervention used for management of anterior epistaxis. The conventional method of pinching nose and use of xylometazoline (0.5%) or adrenaline (1:10,000) soaked cotton packs for control of active arterial spurt followed in each case with silver nitrate cauterization. Results A total of 150 patients reviewed who were medically fit and subjected to study design in three groups. Fifty adult patients in each group with similar presentation. In first group, 32 patients out of 50 (64%) had successful control of bleeding with silver nitrate cauterization only after pinching nose (for 10 minutes). In second group, it was seen that 43 patients out of 50 (86%) in one group had successful control of bleeding following use of 0.5% xylometazoline-soaked cotton packs (for 10 minutes). prior to silver nitrate cauterization. In another group, 45 patients out of 50 (90%) had successful control of bleeding following use of 1:10,000 adrenaline-soaked cotton packs (for 10 minutes) prior to silver nitrate cauterization. Conclusions 1. Almost all patients with idiopathic anterior epistaxis can be managed more effectively and successfully by the use of vasoconstrictive agents followed by silver nitrate cauterization and risks of anterior nasal packing can be avoided. 2. The success rate of silver nitrate cauterization can be increased significantly with use of vasoconstrictive agents (xylometazoline and adrenaline) for control of actively bleeding arterial spurts prior to cauterization. 3. With the use of adrenaline not suitable in high-risk group patients, like coronary artery disease, cerebrovascular diseases, myocarditis, drugs like beta blockers, tricyclic antidepressants; xylometazoline can safely replace adrenaline in these cases.
Objective: To compare the outcomes of various medical treatment modalities for laryngopharyngeal reflux (LPR).Study design: Prospective study design. Materials and methods:One-hundred and fifty patients were divided into three groups (A, B, C) based on the mode of intervention used for the control of LPR. Each study group enrolled 50 patients using random tables. • Group A: These patients were put on a twice daily dosage of esomeprazole (20 mg bd) and domeperidone (10 mg bd) for 4 months • Group B: These patients were put on bd dosage of esomeprazole (20 mg) and domeperidone (10 mg) and also received counseling for dietary and lifestyle changes. The duration of treatment was for 4 months. • Group C: These patients received, in addition to above, 10 mg of amitriptyline (tricyclic antidepressant) bid, again for 4 months. Results:The success achieved in controlling LPR was defined as greater than 50% improvement in baseline symptoms. The success achieved in group A was 46%, in group B was 54% and in group C was 40%. The relative change in reflux symptom index (RSI) over any given period of time was significantly higher than the relative change in reflux finding score (RFS). The relative change in RSI over first month was 30.99%, which is significantly higher than the relative change of RFS (6.39%) over the same period.The mean RSI scores during 4 months of treatment fell from 20.67 to 8.9 (p < 0.01) in group A, from 23.3 to 8.6 (p < 0.01) and from 21.3 to 10.8 (p < 0.05) in group C.The mean RFS during 4 months fell from 15 to 6.5 (p < 0.05) in group A, from 16 to 6.4 (p < 0.05) and from 15 to 6.4 (p < 0.05) in group C. Conclusion• All the three interventions had a statistically significant impact on the signs and symptoms of LPR. • However, higher success rates were achieved in group Bwhere patients were put on a bid dosage esomeprazole and domeperidone nad counseled for lifestyle and dietary changes. Paradoxically, success rates achieved in group C was lower than other groups, possibly because of the anticholinergic effects of amitriptyline causing dry mouth and dry throat. • The symptomatic improvement was seen much earlier than the improvement in laryngoscopic findings. This was evidenced by the fact that relative change in RSI was much higher than the relative change of RFS over a given period of time. • If diagnosed with enough surety and certainty, patients of LPR do not need any antidepressant medications as these medications may not have any role in the treatment of same and may, however, worsen the condition owing to their anticholinergic side effects.
for a period of 22 months w.e.f January 2011 to October 2012. In this study, we evaluated the association between thyroid autoimmunity and Meniere's disease. 35 Meniere's disease patients were enrolled in this study and two groups as controls: group A, 20 subjects suffering from acute unilateral peripheral vestibulopathy of non-Meniere origin; and group B, 30 healthy volunteers. All subjects were submitted to assessment of cochlear-vestibular function and analysis of standard thyroid function test, anti-TSH receptor antibody (TR-Ab), anti-thyroperoxidase antibody (TPO-Ab) and anti-thyroglobulin antibody (Tg-Ab). Results:The prevalence of autoimmune thyroiditis in Meniere's disease patients was higher (P <0•01) when compared to control groups. Conclusion:Our data demonstrate a significant association between Meniere's disease and thyroid autoimmunity, which suggest that an autoimmune factor may be involved in the aetiopathogenesis of this disease.
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