Effectiveness of endoscopic posterior nasal neurectomy for the treatment of intractable rhinitis INTRODUCTIONRhinitis is an inflammatory condition affecting the lining of the nose, characterized by nasal congestion, rhinorrhea, itching, sneezing and/or post-nasal discharge 1 . More than 20% of the population is affected by chronic rhinitis [2][3][4] . Depending on whether an allergic etiology is implicated, non-infectious rhinitis can be subdivided into allergic and non-allergic. With 600 million of world's population affected, allergic rhinitis is the most prevalent atopic disorder. The incidence of allergic rhinitis is on steady increase 5 . Various etiological factors have been postulated for chronic rhinitis -these include allergy, occupational exposures, hormonal changes, smoking, xylometazoline abuse, etc. The standard treatment strategy is medical (histamine antagonists, leukotriene receptor antagonists, intranasal corticosteroids, etc.) But many times, these therapies show limited effectiveness and cause substantial burden for treatment cost on the long term. In addition, the symptoms of intractable rhinitis can cause social embarrassment with a profound effect on patients' quality of life.Surgical management can be considered in such patients with intractable rhinitis. Various surgical techniques have been documented including Vidian neurectomy 6 , posterior nasal neurectomy, inferior turbinate reduction, with varying success rates [5][6][7][8] . In view of this, we are studying the effectiveness of posterior nasal neurectomy (PNN) in patients who have intractable rhinitis, refractory to maximum medical therapy. The outcome is assessed with patient's level of satisfac-ABSTRACT BACKGROUND. Chronic rhinitis is a clinical condition affecting more than 20% of the world population. The standard treat-

Introduction Approximately 20% of patients with tracheostomy are discharged from hospital with the tracheostomy  tube in situ. Proper long term care and management of such tracheostomy patients remains as a challenge to care givers. Fracture of metallic tracheostomy tube (TT) with aspiration of the fragment into tracheobronchial airway is a rare complication of  tracheostomy. Case Report Here we are presenting a case of a 42-year-old male patient, presented to the emergency department with complaint of mild respiratory distress following aspiration of fractured metallic TT and a novel method in removing the dislodged fragment. Discussion A detailed review of literature has been included to discuss different aspects of aspiration of fractured fragment of tracheostomy tube and best practice recommendations for proper tracheostomy care. Conclusion Educating the care-giver about care of the tracheostomized patient in general and care of the tracheostomy tube in particular, may help reduce accidental complications.

Introduction:The routine antenatal sonographic investigations of the umbilical cord are limited for assessment of number of umbilical vessels and doppler evaluation of umbilical blood flow. With the advancements of the sonographic techniques it is now possible to have more detailed evaluation of umbilical cord. There exist only few literatures on assessment of umbilical cord cross-sectional area during pregnancy to provide a baseline reference value.

Introduction:A presence or consequences of the plantar spur as a cause of plantar fasciitis are currently uncertain. But literature is deficient with conflicting findings regarding the relationship between the PS and PF. The study was undertaken to assess the incidence of types and sizes of the plantar spurs and to find the relationship between the plantar spur and plantar fasciitis. Material & Methods:We studied 30 patients with the complaints of plantar fasciitis having plantar spur were included. Length and size of the plantar spur were assessed radiologically using lateral view ankle X-rays. Pain and functional assessment were evaluated using VAS and AOFAS score before and after treatment. Results: Length of the plantar spur was classified as type 0/absent in 4 patients, 1/small in 4 patients, 2/medium in 12 patients and 3/large in 10 patients Plantar spur size was measure spurs as <5mm, 5-10mm, and >10mm. The highest incidence spurs size was 5-10mm and >10mm accounts for 36.67% each (n=11). Statistically, significant improvement was found in the mean VAS and AOFAS score in all the patients after treatment especially patient with a medium sized spur (grade 2).Cohen's Kappa statistic showed excellent intra and inter-observer agreement. Conclusions: These suggest that the presence or consequences of the plantar spur are not necessarily as a cause of plantar fasciitis. These results may enlighten the knowledge to understand the role of the plantar spur in a patient with plantar fasciitis.

Background: Coronary arteries are the branch of ascending aorta and it is the main arterial supply of the myocardium of the heart. Left coronary artery (LCA) usually arises from left posterior aortic sinus. The site of manifestation of myocardial infarction depends on the occlusion of an artery or its branches involved in atherosclerosis. To know the site of lesion and occlusion of the particular artery, detailed anatomy of its course, branches and variations to be studied in detail.Methods: Study was conducted on 55 heart specimens in Department of Anatomy at Sri Siddhartha Medical College (SSMC), Sri Siddhartha Academy of Higher Education (SSAHE). The left coronary artery was dissected carefully, and it was traced from its origin. Any variation in the course and branching pattern was recorded and photographed.Results: No variation was found in the origin of LCA. In the present study, the most frequent division pattern of the left coronary artery was observed as the bifurcation in 30 specimens (54.54%) followed by trifurcation in 23 specimens (41.82%). Tetrafurcation and pentafurcation of LCA were observed in one specimen each (1.82%).Conclusions: Our study tries to focus on branching pattern of LCA for the better knowledge of accurate diagnosis and therapeutic intervention in the management of coronary artery diseases.