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Manimaran V, Nivetha RP, Tamilanban T, Narayanan J, Vetriselvan S, Fuloria NK, Chinni SV, Sekar M, Fuloria S, Wong LS, Biswas A, Ramachawolran G, Selvaraj S. Nanogels as novel drug nanocarriers for CNS drug delivery. Front Mol Biosci 2023; 10:1232109. [PMID: 37621994 PMCID: PMC10446842 DOI: 10.3389/fmolb.2023.1232109] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/13/2023] [Indexed: 08/26/2023] Open
Abstract
Nanogels are highly recognized as adaptable drug delivery systems that significantly contribute to improving various therapies and diagnostic examinations for different human diseases. These three-dimensional, hydrophilic cross-linked polymers have the ability to absorb large amounts of water or biological fluids. Due to the growing demand for enhancing current therapies, nanogels have emerged as the next-generation drug delivery system. They effectively address the limitations of conventional drug therapy, such as poor stability, large particle size, and low drug loading efficiency. Nanogels find extensive use in the controlled delivery of therapeutic agents, reducing adverse drug effects and enabling lower therapeutic doses while maintaining enhanced efficacy and patient compliance. They are considered an innovative drug delivery system that highlights the shortcomings of traditional methods. This article covers several topics, including the involvement of nanogels in the nanomedicine sector, their advantages and limitations, ideal properties like biocompatibility, biodegradability, drug loading capacity, particle size, permeability, non-immunological response, and colloidal stability. Additionally, it provides information on nanogel classification, synthesis, drug release mechanisms, and various biological applications. The article also discusses barriers associated with brain targeting and the progress of nanogels as nanocarriers for delivering therapeutic agents to the central nervous system.
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Affiliation(s)
- V. Manimaran
- Department of Pharmaceutics, SRM College of Pharmacy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
| | - R. P. Nivetha
- Department of Pharmaceutics, SRM College of Pharmacy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
| | - T. Tamilanban
- Department of Pharmaceutics, SRM College of Pharmacy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
| | - J. Narayanan
- Department of Pharmaceutics, SRM College of Pharmacy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
| | - Subramaniyan Vetriselvan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Bandar Sunway, Selangor Darul Ehsan, Malaysia
- Center for Transdisciplinary Research, Department of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | | | - Suresh V. Chinni
- Department of Biochemistry, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Selangor, Malaysia
- Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - Mahendran Sekar
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor Darul Ehsan, Malaysia
| | | | - Ling Shing Wong
- Faculty of Health and Life Sciences, INTI International University, Nilai, Negeri Sembilan, Malaysia
| | - Anupam Biswas
- Faculty of Medicine, AIMST University, Kedah, Malaysia
| | - Gobinath Ramachawolran
- Department of Foundation, RCSI & UCD Malaysia Campus, Georgetown, Pulau Pinang, Malaysia
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Lakshmanan S, Manimaran V, Mohanraj L. Quality of Life in Non-Ventilated Tracheostomised Patients. Indian J Otolaryngol Head Neck Surg 2023; 75:282-286. [PMID: 37275065 PMCID: PMC10235252 DOI: 10.1007/s12070-022-03162-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction: Tracheostomy is a lifesaving procedure, often done at short notice to the patient and his kin. Living with a tracheostomy plays a significant role in the psychological and social aspect of the patient's life. Methods: In this study, fifty-two patients who underwent elective tracheostomy and did not depend on assisted ventilation were included. Three international standerized indices namely the Satisfaction with Life Scale, Karnofsky Performance Scale and Living with Tracheostomy Index Scale were used to assess the Quality of Life (QOL). Social, Psychological and Functional domains were assessed by means of questionnaire and specific scoring was allotted. Paired sample T-test was applied to find the level of significance across all domains. A p value of less than 0.05 was considered as the level of significance. Results: Most of the patients fell in the age group of 41-50 years. Domain wise analysis showed, high significant increase in quality of life at final administration of questionnaire with regard to all three domains. The indications of tracheostomy for all the patients in this study was long term mechanical ventilation. The effect of tracheostomy on swallowing and feeding was also noted. A significant amount of patients reported difficulty in communication and strained inter-personal communications. It was observed that patients who could perform their tracheostomy care independently had better self-image and quality of life. Conclusion: All tracheostomy patients had poor quality of life with compromise in Quality of Life across various domains. The functional, psychological and social aspects of quality of life improved over a period of time. Psychological assistance therefore should serve as a prerequisite to the comprehensive management of all patients undergoing tracheostomy. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03162-6.
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Affiliation(s)
- Somu Lakshmanan
- Department of Otorhinolaryngology and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Sri ramachandra institute of higher education and research, 600116 Porur, Chennai, India
| | - Vinoth Manimaran
- Department of Otorhinolaryngology and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Sri ramachandra institute of higher education and research, 600116 Porur, Chennai, India
| | - Lekhaa Mohanraj
- Department of Otorhinolaryngology and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Sri ramachandra institute of higher education and research, 600116 Porur, Chennai, India
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Manimaran V, Palanisamy T, Lakshmanan S, Jayagandhi S. 6 Months of Competency Based Medical Education for Undergraduate Medical Students- Challenges And Road Ahead. Indian J Otolaryngol Head Neck Surg 2023; 75:1263-1265. [PMID: 37275067 PMCID: PMC10235288 DOI: 10.1007/s12070-022-03358-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Competency based medical education (CBME) was introduced by National medical Commission (NMC) to improve the medical education to global standards. Lot of infrastructural and curricular reforms have been introduced. This article describes the 6 months experience, challenges and road ahead of CBME curriculum by otolaryngology faculties in a deemed to be university of South India. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03358-w.
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Affiliation(s)
- Vinoth Manimaran
- Department of Otolaryngology, Head and Neck surgery, Sri Ramachandra Institute of Higher Education and Research, 600116 Chennai, India
| | - Thirunavukarasu Palanisamy
- Department of Otolaryngology, Head and Neck surgery, Sri Ramachandra Institute of Higher Education and Research, 600116 Chennai, India
| | - Somu Lakshmanan
- Department of Otolaryngology, Head and Neck surgery, Sri Ramachandra Institute of Higher Education and Research, 600116 Chennai, India
| | - Sathishkumar Jayagandhi
- Department of Otolaryngology, Head and Neck surgery, Sri Ramachandra Institute of Higher Education and Research, 600116 Chennai, India
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Manimaran V, Babu DM, Lakshmanan S, Palanisamy T. Efficacy of Submucosal Diathermy of Inferior Turbinate in Patients with Chronic Rhinosinusitis Undergoing Functional Endoscopic Sinus Surgery. Indian J Otolaryngol Head Neck Surg 2023; 75:973-977. [PMID: 37206707 PMCID: PMC10188758 DOI: 10.1007/s12070-023-03491-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/13/2023] [Indexed: 02/12/2023] Open
Abstract
Aim To assess the efficacy of submucosal diathermy (SMD) in Chronic rhinosinusitis and inferior turbinate hypertrophy undergoing Functional Endoscopic Sinus Surgery. Materials and Methods We conducted a Randomized Prospective study in patients undergoing Functional Endoscopic Sinus surgery for Chronic Rhinosinusitis in a tertiary care centre in South India for a period of 2 years. Patients were divided into two groups, Group A underwent FESS and Group B underwent FESS with SMD. The outcome was evaluated using nasal endoscopy score (NES), modified SNOT score and Modified Lund Kennedy scores. Results A total of 80 patients were included in this study.40 patients were allotted in each group. Male: Female ratio was 48:32. The age distribution ranged from 19 to 44 years with a mean of 29.55 ± 6.90 yrs. Mean NES scores, Modified SNOT and Modified Lund -kennedy scores were estimated pre-operatively and during 1st, 2nd and 3rd month of post-operative periods. The mean pre-operative sores were comparable in both the groups except NES score, which was higher in group B. Both the groups showed significant improvement in post-operative period. Inter group comparison showed significant difference in all scores with group B having better results when compared to group A. Conclusion This study proves that FESS combined with SMD improves the postoperative clinical outcomes when compared with FESS without turbinate reduction. We conclude that SMD is a simple, mucosal preserving technique with almost no complications and can be safely done along with FESS to improve the outcomes .
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Affiliation(s)
- Vinoth Manimaran
- Department of Otolaryngology and Head and neck surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Divya Macherla Babu
- Department of Otolaryngology and Head and neck surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Somu Lakshmanan
- Department of Otolaryngology and Head and neck surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Thirunavukarasu Palanisamy
- Department of Otolaryngology and Head and neck surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Saravanam PK, Manimaran V. Role of Primary Aetiology of Intubation in Acquired Laryngotracheal Stenosis: An Institutional Audit and Review of Literature. Indian J Otolaryngol Head Neck Surg 2022; 74:2241-2246. [PMID: 36452704 PMCID: PMC9702272 DOI: 10.1007/s12070-020-02102-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022] Open
Abstract
Aetiology of acquired laryngotracheal stenosis (ALTS) is complex and heterogenous. The aim of this study is to discuss the role of primary aetiology of intubation in the development and outcomes of Post intubation Laryngo tracheal stenosis (PILTS). A retrospective review of patients diagnosed and managed as PILTS from May 2008 to January 2017 was conducted. Demography, primary aetiology of intubation, grade of stenosis, length of the stenotic segment, treatment and outcomes of these patients were recorded and analysed. Based on aetiology of intubation, patients were divided into Poisoning (I), Neurogenic (II) and Rest of aetiologies (III) group respectively. Group I had 28/52 patients (53.8%) followed by group II, 15/52(28.8%) and group III, 9/52(17.3%) respectively. Organophosphorus compound poisoning (OPP) (44.2%) was the commonest cause overall followed by Brain injury (23.1%) and Acute Respiratory Distress Syndrome (ARDS) (11.5%). Trachea (46.15%) was the commonest subsite involved in this study. 24/28(85.7%) of patients had advanced (either grade 3 or 4) subglottic stenosis. The average length of stenotic segment in the study was 18.5 ± 9.2 mm (7-34 mm). 39/52(74.9%) of patients underwent open surgical approaches like cricotracheal resection and anastomosis, Laryngotracheal reconstruction or Shian-Yan Lee technique. 48/52(92.3%) patients were decannulated successfully. There was no significant association between primary etiology of intubation and outcomes. We conclude that OPP and neurological disease patients are more susceptible to airway injury. The authors emphasize that clinicians should be aware of these facts and manage these susceptible patients accordingly.
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Affiliation(s)
- Prasanna Kumar Saravanam
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, India
| | - Vinoth Manimaran
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, India
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Lakshmanan S, Rajendran R, Jayagandhi S, Rajendran R, Palanisamy T, Manimaran V, Janani Marianne A. Expression of Marker PAK1 in Sinonasal Polyposis. Indian J Otolaryngol Head Neck Surg 2022; 74:1694-1700. [PMID: 36452523 PMCID: PMC9702192 DOI: 10.1007/s12070-021-02822-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022] Open
Abstract
Introduction Chronic rhinosinusitis with nasal polyposis involves mucosal lining of nose and paranasal sinuses. Numerous studies studied the mechanism leading to sinonasal polyposis. We attempted study the inflammatory mechanisms responsible for the recruitment and activation of leukocytes. Aim To study and compare the expression of the immunohistochemistry marker PAK1 in sinonasal polyposis and normal nasal mucosa. Material and Methods Prospective observational study done by comparing two groups of 30 each with Group A comprises Sinonasal polyposis and Group B comprises normal nasal mucosa. The specimens were subjected to PAK1 immunohistochemical staining. Results Immunihistrochemical staining showed higher intensity stain in sinonasal polyp when compared to normal nasal mucosa. Conclusion The upregulation of PAK1 in sinonasal polyposis when compared to normal nasal mucosa may indicate an increased cellular proliferation and turnover in the background of chronic inflammation.
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Affiliation(s)
- Somu Lakshmanan
- Department of ENT and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu India
| | | | - Sathishkumar Jayagandhi
- Department of ENT and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu India
| | | | - Thirunavukarasu Palanisamy
- Department of ENT and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu India
| | - Vinoth Manimaran
- Department of ENT and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu India
| | - A. Janani Marianne
- Department of ENT and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu India
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Lakshmanan S, Singh U, Zaffrullah NS, Manimaran V. Clinical Outcome Following Endoscopic Septoturbinal Surgeries for Rhinogenic Contact Point Headache: A Retrospective Analysis. Indian J Otolaryngol Head Neck Surg 2022; 74:780-784. [PMID: 36452515 PMCID: PMC9702146 DOI: 10.1007/s12070-020-01825-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/26/2020] [Indexed: 10/24/2022] Open
Abstract
To assess the clinical outcome of endoscopic septoturbinal surgeries in patients with rhinogenic contact point headache. Retrospective audit of medical records. Retrospective audit of medical records of patients having undergone endoscopic surgical management for contact point headache between a period of May 2017 to May 2018 were included in the study. Patients who underwent functional endoscopic sinus surgery were excluded from the study. Pre operative pain score were compared with post operative pain score at interval of 1 month for 3 months consequently and at 1 year interval using Visual Analog scale (VAS). The difference between preoperative (mean 6.82) and post operative VAS pain scores after 1 month (mean 3.36), 2 months (mean 4.50), 3 months (mean 5.48), 1 year (mean 5.01) was statistically significant (p < 0.001). Contact point headache is an important clinical entity that might be missed during evaluation and management of refractory headache. Surgical management under endoscopic guidance can help to ensure removal of mucosal contact point and aid in the treatment of refractory headache as noted in our study.
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Affiliation(s)
- Somu Lakshmanan
- Department of ENT, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Urvashi Singh
- Department of ENT, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Nufra Senopher Zaffrullah
- Department of ENT, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Vinoth Manimaran
- Department of ENT, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Manimaran V, Sivakumar PM, Narayanan J, Parthasarathi S, Prabhakar PK. Nanoemulsions: A Better Approach for Antidiabetic Drug Delivery. Curr Diabetes Rev 2021; 17:486-495. [PMID: 33297917 DOI: 10.2174/1573399817666201209095205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/06/2020] [Accepted: 10/27/2020] [Indexed: 11/22/2022]
Abstract
Conventional delivery of antidiabetic drugs faces many problems like poor absorption, low bioavailability, and drug degradation. Nanoemulsion is a unique drug technology, which is very suitable for the delivery of antidiabetic drugs. In recent years, the flaws of delivering anti-hypoglycaemic drugs have been overcome by choosing nanoemulsion drug technology. They are thermodynamically stable and also provide the therapeutic agent for a longer duration. Generally, nanoemulsions are made up of either oil-in-water or water-in-oil and the size of the droplets is from fifty to thousand nanometer. Surfactants are critical substances that are added in the manufacturing of nanoemulsions. Only the surfactants which are approved for human use can be utilized in the manufacturing of nanoemulsions. Generally, the preparation of emulsions includes mixing of the aqueous phase and organic phase and using surfactant with proper agitation. Nanoemulsions are used for antimicrobial drugs, and they are also used in the prophylaxis of cancer. Reduction in the droplet size may cause variation in the elastic and optical behaviour of nanoemulsions.
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Affiliation(s)
- V Manimaran
- Department of Pharmaceutics, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, Chennai, Tamilnadu-603203, India
| | | | - J Narayanan
- Department of Pharmacology, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, Chennai, Tamilnadu-603203, India
| | | | - Pranav Kumar Prabhakar
- Department of Allied Medical Sciences, Lovely Professional University, Phagwara Punjab-144411, India
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Manimaran V, Lakshmanan S, Prateep A, Baburajan R. Outcomes of Middle Turbinate Flap in the Reconstruction of Non-tumorous Ventral Skull Base Defects - an Institutional Review. Turk Arch Otorhinolaryngol 2020; 58:214-219. [PMID: 33554195 DOI: 10.5152/tao.2020.5743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/12/2020] [Indexed: 11/22/2022] Open
Abstract
Objective Middle turbinate (MT) flap, based on the branches of sphenopalatine artery is one of the commonest mucosal flaps used in endoscopic skull base surgery. The objective of this study is to analyze the outcomes of the MT flap in the reconstruction of non-tumorous ventral skull base defects. Methods A retrospective review of patients was done from 2010-19. Patients who underwent reconstruction for non-tumorous ventral skull base defects using middle turbinate (MT) flap were included in the study. The parameters assessed include patient demography, primary etiology, site of the defect, size of the defect, graft materials used, outcomes and postoperative complications. Results A total of 13 patients who met the study criteria were included. Three (23.07%) of the patients had meningo-encephalocele, while the remaining 10 (76.93%) had CSF fistula. Isolated foveal defect (53.8%) was the most common site involved, followed by isolated cribriform, combined cribriform-foveal and combined foveal-planar defects. Graft materials used were fascia lata, fat and septal cartilage. MT flap was successfully harvested in 11 (84.6%) patients, with successful outcome in 10/11 patients. Hypoplastic MT was present in two patients, who subsequently required Hadad flap for defect closure. No major complications were reported in the postoperative period. Conclusion The MT flap is effective in the reconstruction of selective skull base defects. Appropriate surgical technique and expertise are required for successful harvest. Further studies are required to analyze its outcomes in various skull base defects.
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Affiliation(s)
- Vinoth Manimaran
- Department of Otorhinolaryngology and Head & Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Tamil Nadu, Chennai, India
| | - Somu Lakshmanan
- Department of Otorhinolaryngology and Head & Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Tamil Nadu, Chennai, India
| | - Aishwarya Prateep
- Department of Otorhinolaryngology and Head & Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Tamil Nadu, Chennai, India
| | - Ramya Baburajan
- Department of Otorhinolaryngology and Head & Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Tamil Nadu, Chennai, India
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Umamaheswaran P, Mohanty S, Manimaran V, Jayagandhi S, Jeyabalakrishnan SP. A comparative study of sequential vs. simultaneous type I tympanoplasty in patients with bilateral chronic otitis media - Mucosal type. J Otol 2020; 15:59-61. [PMID: 32440267 PMCID: PMC7231987 DOI: 10.1016/j.joto.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/24/2019] [Accepted: 12/27/2019] [Indexed: 11/25/2022] Open
Abstract
Background Patients with bilateral chronic otitis media – mucosal type have been conventionally treated with sequential tympanoplasty. Bilateral simultaneous tympanoplasty is usually not preferred because of the theoretical risk of iatrogenic sensorineural hearing loss. With the advent of modern surgical instruments and surgical techniques, the risk is expected to be lower. This study compares the clinical outcomes in type I tympanoplasty performed simultaneously and sequentially. Materials & methods This randomized prospective study was carried out in a tertiary care hospital between August 2015 and July 2017. A total of 30 patients were divided into two groups of 15 each. This study analyzed the graft uptake, pure tone audiogram findings pre- and post-operatively, duration of surgery and number of hospital visit for each patient and the outcomes were compared between both the groups. Result Patients undergoing bilateral simultaneous tympanoplasty had significantly lesser mean duration of surgery and number of hospital visits than the patients undergoing sequential tympanoplasty. Graft uptake and postoperative wound infections were similar in both the groups. Postoperative hearing improvement was significantly better in the bilateral simultaneous tympanoplasty group. However, further studies are needed to authenticate this observation. None of the patients had a postoperative deterioration of hearing or sensorineural hearing loss. Conclusion Bilateral simultaneous tympanoplasty is not only feasible but also better than sequential tympanoplasty, especially in terms of operating time, follow-up and overall financial implications on the patient.
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Affiliation(s)
- Preethi Umamaheswaran
- Department of ENT, Head & Neck Surgery, Panimalar Medical College Hospital & Research Institute, Chennai, Tamil Nadu, India
| | - Sanjeev Mohanty
- Department of ENT, Head & Neck Surgery, MGM Healthcare, Chennai, Tamil Nadu, India
- Corresponding author.
| | - Vinoth Manimaran
- Department of ENT, Head & Neck Surgery, Sri Ramachandra Institute of Higher Education & Research, Chennai, Tamil Nadu, India
| | - Sathishkumar Jayagandhi
- Department of ENT, Head & Neck Surgery, Sri Ramachandra Institute of Higher Education & Research, Chennai, Tamil Nadu, India
| | - Shiva Priya Jeyabalakrishnan
- Department of ENT, Head & Neck Surgery, Karpagam Faculty of Medical Sciences & Research, Coimbatore, Tamil Nadu, India
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Manimaran V, Mohanty S, Lakshmanan S. A retrospective comparison of intratympanic dexamethasone with gentamicin in meniere's disease – A single-institutional study. Indian J Otol 2020. [DOI: 10.4103/indianjotol.indianjotol_73_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Manimaran V, Mohanty S, Jayagandhi SK, Umamaheshwaran P, Jeyabalakrishnan S. A Retrospective Analysis of Peroperative Risk Factors Associated with Posttonsillectomy Reactionary Hemorrhage in a Teaching Hospital. Int Arch Otorhinolaryngol 2019; 23:e403-e407. [PMID: 31649759 PMCID: PMC6805177 DOI: 10.1055/s-0039-1696702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/03/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction
Tonsillectomy is one of the most common otolaryngology procedures performed worldwide. It is also one of the first procedures learnt by residents during their training period. Although tonsillectomy is viewed relatively as a low-risk procedure, it can be potentially harmful because of the chance of posttonsillectomy hemorrhage.
Objective
The objective of the present study is to analyze the effects of peroperative factors and experience of the surgeon on the incidence and pattern of posttonsillectomy reactionary hemorrhage.
Methods
A retrospective review of medical charts was performed from 2014 to 2017 in a tertiary care hospital. A total of 1,284 patients who underwent tonsillectomy and adenoidectomy were included in the study. The parameters assessed were experience of the surgeon, operating time, intraoperative blood loss, difference in mean arterial pressure (MAP) and pulse rate.
Results
A total of 23 (1.79%) out of the 1,284 patients had reactionary hemorrhage. Out of those 23, 16 (69.5%) patients had been operated on by trainees, while 7 (30.5%) had been operated on by consultants (
p
= 0.033, odds ratio [OR] = 0.04). Operating time, intraoperative blood loss, difference in MAP and pulse rate were significantly higher in the reactionary hemorrhage group, and showed a positive association with risk of hemorrhage (
p
< 0.05; OR >1). Re-exploration to control the bleeding was required in 10 (76.9%) out of the 23 cases.
Conclusion
The experience of the surgeon experience and peroperative factors have an association with posttonsillectomy hemorrhage. Close surveillance and monitoring of the aforementioned peroperative factors will help in the identification of patients at risk of hemorrhage.
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Affiliation(s)
- Vinoth Manimaran
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Sanjeev Mohanty
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Satish Kumar Jayagandhi
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Preethi Umamaheshwaran
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Shivapriya Jeyabalakrishnan
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
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Saravanam PK, Manimaran V, Ramadhan M, Prakash GK. Laryngopyocele in a case of bilateral mixed laryngocele: an impending airway emergency. BMJ Case Rep 2019; 12:12/8/e229450. [PMID: 31473632 DOI: 10.1136/bcr-2019-229450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Laryngopyocele is a rare complication involving the laryngocele which can present with acute airway compromise. A 31-year-old man presented with acute onset respiratory distress and dysphagia. He had swelling on either side of upper aspect of the neck with tenderness on left side. Videolaryngoscopy using 70° rigid Hopkins rod telescope showed a swelling in the left pyriform sinus pushing the ipsilateral vocal cord. However, glottic space was adequate. Contract-enhanced CT scan of the neck confirmed left-sided mixed laryngopyocele with contralateral mixed laryngocele. Patient underwent excision of both the lesions in a single stage by transcervical approach. Laryngopyocele in a case of bilateral mixed laryngocele presenting as an impending airway emergency has not been reported in literature. The diagnostic and therapeutic challenges are discussed here along with review of literature.
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Affiliation(s)
- Prasanna Kumar Saravanam
- Otorhinolaryngology and Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
| | - Vinoth Manimaran
- Otorhinolaryngology and Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
| | - Mohamed Ramadhan
- Otorhinolaryngology and Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
| | - Gowthame Kanagasabai Prakash
- Otorhinolaryngology and Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
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Lakshmanan S, Manimaran V, Valliappan V, Arumugam V. An unusual presentation of chronic sclerosing sialadenitis of submandibular gland (Kuttner's tumour). BMJ Case Rep 2019; 12:12/8/e231189. [PMID: 31466959 DOI: 10.1136/bcr-2019-231189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Kuttner's tumour, also known as chronic sclerosing sialadenitis, is a localised form of IgG4 disease which presents as asymptomatic submandibular gland swelling. The diagnosis is usually based on histopathology and immunohistochemistry. A 33-year-old woman presented with acute-onset pain and swelling in the right submandibular region. Clinical examination showed an enlarged submandibular gland, and CT showed a calculus in the Wharton's duct. After treating the acute phase with antibiotics, the patient underwent submandibular gland excision and calculus removal. Histopathology of the specimen showed areas of periductal sclerosis, acinar atrophy and intense lymphoplasmacytic infiltrates with occasional eosinophils. The IgG4 to IgG plasma cell ratio was >40%, suggestive of an IgG4-related disease. The authors have chosen to report this case because of the unusual presentation of IgG4 disease as acute sialadenitis.
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Affiliation(s)
- Somu Lakshmanan
- Otorhinolaryngology and Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
| | - Vinoth Manimaran
- Otorhinolaryngology and Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
| | - Valliammai Valliappan
- Otorhinolaryngology and Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
| | - Vasugi Arumugam
- Pathology, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
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Jayagandhi S, Cheruvu SC, Manimaran V, Mohanty S. Deep Neck Space Infection: Study of 52 Cases. Indian J Otolaryngol Head Neck Surg 2019; 71:923-926. [PMID: 31742095 DOI: 10.1007/s12070-019-01592-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022] Open
Abstract
Deep neck spaces are still common in developing countries like India, even though its less prevalent in developed nations. It can lead to serious complications like jugular vein thrombosis and dissemination of infection if not diagnosed early and intervened. This is a retrospective chart review of 52 patients from 2014 to 2017 in a tertiary care hospital. Only patients with infection deeper to the superficial fascia of neck were included. Submandibular space infection was the most common and precipitating factor being dental infection. Most common comorbid condition was diabetes mellitus. Klebsiella pneumoniae was the most common isolated organism and few patients had mixed culture with anaerobes. Injectable cephalosporin with metronidazole was the most effective antibiotic combination against such infections. Low threshold for early surgical intervention reduce hospital stay and enable quick recovery of patients. Usage of over the counter antibiotics masks the conditions and complicate diagnosis and treatment of this condition.
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Affiliation(s)
- Sathishkumar Jayagandhi
- Department of ENT Head and Neck Surgery, Sri Ramachandra Medical College and Hospital, Porur, Chennai, 600116 India
| | - Saranya Chithra Cheruvu
- Department of ENT Head and Neck Surgery, Sri Ramachandra Medical College and Hospital, Porur, Chennai, 600116 India
| | - Vinoth Manimaran
- Department of ENT Head and Neck Surgery, Sri Ramachandra Medical College and Hospital, Porur, Chennai, 600116 India
| | - Sanjeev Mohanty
- Department of ENT Head and Neck Surgery, Sri Ramachandra Medical College and Hospital, Porur, Chennai, 600116 India
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Abstract
Clear cell variant is a rare histological type of myoepithelioma seen in parotid and soft palate. This article describes clear cell variant of myoepithelioma in the tongue base, which has not been reported in the literature so far. A 34-year-old man presented with dysphagia and foreign body sensation of throat. Video laryngostroboscopy using a 70° rigid telescope showed a smooth globular mass in the oropharynx arising from the tongue base. Based on clinical and radiological findings, the lesion was considered as benign. Fine needle aspiration cytology was not attempted fearing risk of bleeding, aspiration and airway compromise. Hence, an excisional biopsy followed by definitive histopathological examination without frozen section was planned. The patient underwent coblator-assisted excision and subsequently sent for histopathological analysis. There were cuboidal cell nests with abundant clear cytoplasm which stained positive for p63 by immunohistochemistry. This helped in establishing the diagnosis of clear cell myoepithelioma.
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Affiliation(s)
- Prasanna Kumar Saravanam
- ENT, Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
| | - Vinoth Manimaran
- ENT, Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
| | - Rashmika Rajendran
- ENT, Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
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Mohanty S, Manimaran V, Umamaheswaran P, Jeyabalakrishnan S, Chelladurai S. Endoscopic cartilage versus temporalis fascia grafting for anterior quadrant tympanic perforations — A prospective study in a tertiary care hospital. Auris Nasus Larynx 2018; 45:936-942. [DOI: 10.1016/j.anl.2018.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/22/2017] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
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Saravanam PK, Manimaran V. Flexible Laryngoscopy in Management of Congenital Stridor. Indian J Otolaryngol Head Neck Surg 2017; 69:509-513. [PMID: 29238683 DOI: 10.1007/s12070-017-1217-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022] Open
Abstract
The incidence of congenital stridor is on rise due to improved neonate and infant survival rate. The gold standard investigation for evaluation of stridor is rigid laryngotracheobronchoscopy, but this is invasive and requires general anesthesia. Flexible fibreoptic laryngoscopy, a relatively simple and less invasive procedure can be done under topical anaesthesia for evaluation of stridor. In this study, we have presented our experience of flexible laryngoscopy in children with congenital stridor, their results and management. Laryngomalacia was the commonest cause of stridor accounting for 80% of cases. 15% (6) patients required tracheostomy for relieving airway obstruction and 22.5% (9) patients required a definitive surgical procedure for correcting the cause. Flexible laryngoscopy is safe and gives a comprehensive analysis of airway including its dynamic functions. We also recommend flexible laryngoscopy as a frontline investigation for evaluation of stridor.
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Affiliation(s)
- Prasanna Kumar Saravanam
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, India
| | - Vinoth Manimaran
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, India
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Abstract
A 44-year-old man presented with swelling in the left parotid region. The swelling was firm and Fine Needle Aspiration Cytology report proved pleomorphic adenoma. In the CT scan, the tumour was confined to the superficial lobe of parotid. So, left superficial parotidectomy was planned. Modified Wilson Blair's incision was used. On course of identifying the facial nerve, a large calibre vein was identified running vertically through the parotid substance. Assuming it as retromandibular vein, further dissection was carried out more meticulously. Marginal mandibularbranch of facial nerve was identified near the angle of mandible and retrograde dissection showed the cervicofacial division running medial to retromandibular vein with the main facial nerve trunk lying unusually medial and posterior to it. Adding to it, the temporofacial division was found 'forked' between the branches of retromandibular vein. These variations in head and neck venous channels are not that rare as we believe. All these variations have an embryological basis. Therefore, knowledge and understanding of this complex anatomy will help us preventing devastating complications like bleeding and facial nerve injury in such cases.
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Affiliation(s)
- Prasanna Kumar Saravanam
- Department of ENT, Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
| | - Vinoth Manimaran
- Department of ENT, Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
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