This document provides a synopsis for a study comparing the use of temporalis fascia with and without platelet rich fibrin (PRF) for myringoplasty. The study aims to evaluate the success rates and benefits of PRF in improving hearing outcomes when applied to the temporalis fascia graft. It is a prospective study that will recruit 100 patients with inactive chronic otitis media requiring myringoplasty, who will be divided into two groups: one receiving temporalis fascia alone and the other receiving PRF applied to the fascia graft. Patients will be followed for 12 weeks to assess graft healing and post-operative hearing.
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Medical College Hospital and Research Center, Thrissur, Kerala - 20TH PUBLICATION - IJADS
5th publication -Dr Rahul VC Tiwari - Department of ral and Maxillofacial Surgery, SIBAR Institute of Dental Sciences, Takkellapadu,Guntur, Andhra Pradesh - 522509.
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Medical College Hospital and Research Center, Thrissur, Kerala - 20TH PUBLICATION - IJADS
5th publication -Dr Rahul VC Tiwari - Department of ral and Maxillofacial Surgery, SIBAR Institute of Dental Sciences, Takkellapadu,Guntur, Andhra Pradesh - 522509.
L-PRF for increasing the width of keratinized mucosa around implants: A split...MD Abdul Haleem
Journal Club Presentation: L-PRF for increasing the width of keratinized mucosa around implants: A split-mouth, randomized, controlled pilot clinical trial.
Peri implantitis treatment with regenerative approachajayashreep
This study evaluates the clinical results and compare reentry hard tissue measurements following regenerative surgery after strict implant decontamination peri-implantitis cases.
This study is meant for determining the safety of
endoscopy followed by grommet insertion into the middle ear.
Traditionally, otoscopy, or the surgery using microscope has
been the preferred method of Myringology. But given the
limitations of using microscope, surgical interventions such as
postauricular access have turned popular for treating the
ailments of middle ear.
A sum total of 178 cases of otitis media with effusion who
had to undergo myringotomy along with or without
tympanostomy tube insertion i.e. grommet were studied. The
minimum age of the subject was 2.6 years while the maximum
age was 44 years. The patients consisted of both male and
female patients. 89 cases corresponded to that of right ear
while another 89 cases were indications of left ear.
The result derived from this study is clearly an indicative of
the fact that the comparatively novice practice of endoscopy in
grommet insertion is quite safe and also provides an edge in the
live demonstrations and group teaching methods. However, the
study also determines that although, this method is apparently
safer and efficient, there is no proof of patients have any gains
during post operative care and hearing efficiency when
compared to other traditional methods.
Background: Septoplasty is one of the commonest nasal surgeries
performed by otolaryngologist. Silicone is the most common
material used for nasal splints. Trans-septal suturing technique
has been described to approximate the mucosal flaps after septal
procedures to reduce the complication rate; however there are
few studies proving the efficacy.
Objective: This study is to elucidate the efficacy of trans-septal
suture method in preventing complications, discomfort and pain
in comparison with intranasal splinting using silicone plates after
septoplasty.
Patients and methods: This is a prospective study of 59 adult
patients underwent Septoplasty, between August 2013-January
2014 in Rizgary Teaching Hospital - Erbil city. Patients were
divided into 2 groups; trans-septal suture and silicone, 29 and 30
patients respectively. Visual analogue scale was used to evaluate
postoperative pain, bleeding, post-nasal drip, dysphagia and
sleep disturbance for three days. Epiphora and septal hematoma
are also evaluated. Septal perforation, crustation, and adhesion
were evaluated at 4th postoperative week.
Results: The severity of pain and post nasal drip were
significantly lower in trans-septal suture group than silicone
group (P< 0.05). The septal hematoma and septal perforation
were not seen in the study. No any significant difference found
concerning epiphora, crustation and adhesion.
Conclusion: we conclude that, suturing can be used safely in
septoplasty sp
The general indications for SARPE are skeletal maturity, transverse maxillary deficiency, excessive display of buccal corridors when smiling, and anterior crowding.
L-PRF for increasing the width of keratinized mucosa around implants: A split...MD Abdul Haleem
Journal Club Presentation: L-PRF for increasing the width of keratinized mucosa around implants: A split-mouth, randomized, controlled pilot clinical trial.
Peri implantitis treatment with regenerative approachajayashreep
This study evaluates the clinical results and compare reentry hard tissue measurements following regenerative surgery after strict implant decontamination peri-implantitis cases.
This study is meant for determining the safety of
endoscopy followed by grommet insertion into the middle ear.
Traditionally, otoscopy, or the surgery using microscope has
been the preferred method of Myringology. But given the
limitations of using microscope, surgical interventions such as
postauricular access have turned popular for treating the
ailments of middle ear.
A sum total of 178 cases of otitis media with effusion who
had to undergo myringotomy along with or without
tympanostomy tube insertion i.e. grommet were studied. The
minimum age of the subject was 2.6 years while the maximum
age was 44 years. The patients consisted of both male and
female patients. 89 cases corresponded to that of right ear
while another 89 cases were indications of left ear.
The result derived from this study is clearly an indicative of
the fact that the comparatively novice practice of endoscopy in
grommet insertion is quite safe and also provides an edge in the
live demonstrations and group teaching methods. However, the
study also determines that although, this method is apparently
safer and efficient, there is no proof of patients have any gains
during post operative care and hearing efficiency when
compared to other traditional methods.
Background: Septoplasty is one of the commonest nasal surgeries
performed by otolaryngologist. Silicone is the most common
material used for nasal splints. Trans-septal suturing technique
has been described to approximate the mucosal flaps after septal
procedures to reduce the complication rate; however there are
few studies proving the efficacy.
Objective: This study is to elucidate the efficacy of trans-septal
suture method in preventing complications, discomfort and pain
in comparison with intranasal splinting using silicone plates after
septoplasty.
Patients and methods: This is a prospective study of 59 adult
patients underwent Septoplasty, between August 2013-January
2014 in Rizgary Teaching Hospital - Erbil city. Patients were
divided into 2 groups; trans-septal suture and silicone, 29 and 30
patients respectively. Visual analogue scale was used to evaluate
postoperative pain, bleeding, post-nasal drip, dysphagia and
sleep disturbance for three days. Epiphora and septal hematoma
are also evaluated. Septal perforation, crustation, and adhesion
were evaluated at 4th postoperative week.
Results: The severity of pain and post nasal drip were
significantly lower in trans-septal suture group than silicone
group (P< 0.05). The septal hematoma and septal perforation
were not seen in the study. No any significant difference found
concerning epiphora, crustation and adhesion.
Conclusion: we conclude that, suturing can be used safely in
septoplasty sp
The general indications for SARPE are skeletal maturity, transverse maxillary deficiency, excessive display of buccal corridors when smiling, and anterior crowding.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
1. SYNOPSIS
DEPARTMENT OF OTORHINOLARYNGOLOGY CHIRAYU MEDICAL
COLLEGE AND HOSPITAL,BHOPAL, M.P.
“A Comparative Study Of Temporalis Fascia in Myringoplasty With Or Without
Platelat Rich Fibrin At A Tertiary Care Centre Of Central India”
GUIDE CO-GUIDE
DR. RAKESH MARAN DR. MAHESH C. PATIL
PROFESSOR DEPARTMENT PROFESSOR
OF OTORHINOLARYNGOLOGY DEPARTMENT OF PATHOLOGY
CHIRAYU MEDICAL COLLEGE AND HOSPITAL CHIRAYU MEDICAL COLLEGE
COLLEGE,BHOPAL(M.P.). AND HOSPITAL,BHOPAL(M.P.).
PRINCIPAL INVESTIGATOR
DR. PULKIT SHARMA
P.G RESIDENT 1st YEAR
CHIRAYU MEDICAL COLLEGE AND HOSPITAL
BHOPAL (M.P).
2. Introduction
• Chronic suppurative otitis media is defined as chronic mucoperiosteal inflammation of middle
ear cleft and mastoid cavity which presents with recurrent ear discharge or otorrhea through a
permanent tympanic membrane perforation for a period of more than 3 months[1].
• The diagnosis of chronic otitis media implies that there is permanent abnormality of pars
tensa or flaccida which results from previous acute otitis media or negative middle ear
pressure or otitis media with effusion.
• Chronic Suppurative Otitis Media (CSOM) is an inflammatory process in the middle-ear
space that results in permanent changes in the tympanic membrane that may lead to
atelectasis, perforation, tympanosclerosis, retraction pocket, or cholesteastoma.
• The most common bacteria isolate of chronic otitis media is Pseudomonas[2].
3. • It is a widespread disease of the developing countries, like India. Globally, the prevalence of chronic
suppurative otitis media is 65-330 million people, and 39-200 million (60%) suffer from clinically
significant hearing impairment [3].
• Tympanic perforations result from multiple causes, including infection and trauma, and its regeneration
is a process complex that includes epithelial proliferation, cell migration, fibroblast proliferation and
angiogenesis ending in remodeling tissue. When these do not heal after three months, can cause
complications serious, such as recurrent otitis media or even hearing loss, so there is the need for surgery
and the use of grafts to repair them. Myringoplasty is a surgical procedure performed only on the
tympanic membrane, without ossicular reconstruction[4].
• whereas, Tympanoplasty involves eradication of middle ear disease and reconstruction of hearing
mechanism including Tympanic membrane and ossicles[5].
• One of the most frequent procedures performed on the middle ear is tympanoplasty. In the surgical repair
of perforations of tympanic membrane several variables come into play such as size of perforation,
overhang, eustachian tube function, state of the mucosa, wound healing, degree of pneumatization
etc.[6].
4. • Wullstein and Zollner created the fundamental principles of tympanoplasty. Ear surgery has been
focused on restoring function and creating a stabilised, problem-free ear [7].
• Various graft materials are available for closing the tympanic membrane perforation. Most
commonly used grafting material is temporalis fascia graft. Other materials that can be used are
vein, areolar tissue over temporalis fascia, tragal perichondrium, periosteum over mastoid process,
meatal skin from bony external auditory meatus, split skin, fat, cartilage, xenografts like bovine
pericardium and treated acellular dermal homograft‘s etc. can be used [8].
• Platelet-rich fibrin is a second-generation platelet concentrate, which is rich in platelets, cytokines,
growth factors, and leukocytes that are trapped and released over a period. It serves as a resorbable
membrane that offers both mechanical and inflammatory protection to the tympanic membrane [9].
• As for platelet-rich fibrin, it has many advantages, such as safety be an autologous material, greater
deposition of growth factors and platelets in a specific area and short preparation time, in addition
to offering inflammatory protection and mechanics to grafts and accelerate proliferation cell, as
well as preparation and easy obtaining with easy handling during the procedure surgical.
• Autologous platelet-rich plasma is easy to prepare and handle, and no associated side effects
have been reported [10].
5. • RESEARCH QUESTIONS
What are the benefits and success rate of Platelet Rich Fibrin (PRF) applied in Temporalis
Fascia as a graft material in Myringoplasty.
• AIM
To compare the efficiency of autologous platelet rich fibrin with Temporalis Fascia as a graft material in
closure of tympanic membrane perforation during Myringoplasty.
• OBJECTIVES
1.To evaluate the success rate of the Platelet Rich Fibrin (PRF) and Temporalis Fascia as a graft material in
Myringoplasty.
2.To assess the benefits of Platelet Rich Fibrin (PRF) applied in Temporalis Fascia graft in terms of
improvement in hearing after Myringoplasty.
6. METHODOLOGY:-
• 100 Patients attending Chirayu medical College having history of ear discharge will be evaluated.
• Detailed history will be taken from the patients and the information will be obtained including socio-
demographic characteristics,symptoms, duration of symptoms,recurrent Sino-nasal symptoms (if any) and the
information will be entered in the master chart.
• These patients will undergo ENT examination, and if found to be having Inactive Chronic Suppurative Otitia
Media (CSOM), which will be confirmed by Otoscopic examination, Tuning Fork tests, X-ray mastoid and Pure
Tone Audiometry( PTA), will be included in the study after obtaining informed consent.
• Prospective study over 80 patients, divided into 2 group according to graft material used.
PREPARATION PLATELET RICH FIBRIN (PRF)
• 10 ml blood will withdrawn from patient just before the surgery. The sample will centrifuged at 3000 rpm for 25
min which formed platelet-rich fibrin in the middle of the tube. Platelet rich fibrin obtained. The blob of Platelet
rich fibrin will placed between two glass slides and gently pressed for about three minutes.
OPERATIVE TECHNIQUE
• The underlay technique involves placement of the Temporalis Fascia graft medial to the entire tympanic
membrane, with elevation of a flap of ear canal skin together with the drumhead being most commonly
used for access, stabilizing the graft under the fibrous annulus. Platelet Rich fibrin will be placed on
graft. Ear canal was packed with abgel soaked in antibiotic drop.
7. FOLLOW UP
• Patient will follow up at 4-week, 6 week, and 12 weeks and post-op Pure Tone Audiometry
(PTA) will be done at 12 week and graft condition will be assessed.
STUDY DESIGN
• Hospital based prospective study.
STUDY DURATION
• 18 Months (MARCH 2023 - SEPTEMBER 2024)
STUDY SETTING
• Study will be conducted in OTORHINOLARYNGOLOGY(ENT) Department, Chirayu
Medical College & Hospital Bhopal (M.P.) India , after approval by Research and Ethics
Committee over a period of 18 months.
8. INCLUSION CRITERIA
• Patient who is ready to give informed written consent for surgery.
• Patient 18 year and above with Small Central Perforation (SCP) of tympanic membrane will included in this study.
• Patient with inactive Mucosal Chronic Suppurative Otitis Media (CSOM).
• Patient with mild conductive hearing loss
EXCLUSION CRITERIA
• Patient who does not ready to give informed written consent for surgery.
• Patient below 18 year will excluded in this study.
• Patient with active Mucosal and UNSAFE Chronic Suppurative Otitis Media (CSOM).
• Patient with mixed hearing loss and Sensorineural Hearing Loss(SNHL).
• Revision myringoplasty
STUDY POPULATION
• GROUPA: Myringoplasty with Temporalis fascia as a graft(50 Patient)
• GROUP B: Myringoplasty with Platelet Rich Fibrin applied in Temporalis Fascia as a graft(50 Patient)
SAMPLE SIZE
• A sample size of 100 patients (i.e., 50 in each group).
DATA ANALYSIS
• Data will be analyzed using appropriate statistical test of significance and appropriate statistical software like SPSS
(Statistical Package for Social Science) software as per requirement.
9. ETHICAL CONSIDERATION
• Approval will be taken from Institutional Research and Ethics Committee.
• Identity of the patient will be kept confidential.
• Written Informed consent will be taken from Parents/Guardian.
INFORMED CONSENT FORM IN HINDI AND ENGLISH
• Enclosed.
FINANCIAL IMPLICATION
• There is NO financial implication.
• Study will be part of treatment.
CONFLICT OF INTEREST
• There are NO conflicts of interest.
10. REFERENCES:-
1.Nair NP, Alexander A, Abhishekh B, Hegde JS, Ganesan S, Saxena SK. Safety and efficacy of autologous
platelet-rich fibrin on graft uptake in myringoplasty: a randomized controlled trial. International archives of
otorhinolaryngology. 2019 Jan;23(01):077-82.
2.Jahn AF. Chronic otitis media: diagnosis and treatment. The Medical clinics of North America. 1991 Nov
1;75(6):1277-91.
3. Monasta L, Ronfani L, Marchetti F, et al; Burden of disease caused by otitis media: systematic review and
global estimates. PLoS One. 20127(4): -36226. Epub 2012 Apr 30.
4. Sarkar, S., 2013 Dec. A review on the history of tympanoplasty. Indian J. Otolaryngol. Head Neck Surg. 65
(Suppl. 3). 455-460.
5. A. Akyigit et al. Endoscopic tympanoplasty, Journal of Otology 12 (2017) 62-6.
6. Glasscock and Shambaugh. "Tympanoplasty", In Glasscock and Shambaugh, Surgery of the Ear 5th edition,
chapter, 2003; 16:350-370.
7. Sismanis A (2003) Tympanoplasty Glasscock-Shambaugh surgery of the ear", Chap 24. BC Decker Inc,
Hamilton.
11. 8. Kumar N, Chilke D, Puttewar MP. Clinical profile of tubotympanic CSOM and its management with special
reference to site and size of tympanic membrane perforation, Eustachian tube functions and three flap tympanoplasty.
Indian J Otolaryngology Head Neck Surg. 2012; 64(1):5- 12.
9. Nair NP, Alexander A, Abhishekh B, Hegde JS, Ganesan S, Saxena SK. Safety and Efficacy of Autologous Platelet-
rich Fibrin on Graft Uptake in Myringoplasty: A Randomized Controlled Trial. Int Arch Otorhinolaryngol.
2019;23(1):77-82.
10.El-Anwar MW, Elnashar I, Foad YA. Platelet-rich plasma myringoplasty: A new office procedure for the
repair of small tympanic membrane perforations. Ear Nose Throat J. 2017;96(8):312-326.
12. PARTICIPANT INFORMATION SHEET:-
TITLE OF THE STUDY “A Comparative Study Of Temporalis Fascia In Myringoplasty With Or Without Platelat
Rich Fibrin At A Tertiary Care Centre Of Central India”
PATIENT’S NAME-
INTRODUCTION TO RESEARCH STUDY-
PURPOSE OF THE STUDY:
WHO CAN TAKE PART:
WHO WILL BE CONDUCTING THE STUDY:
MY ROLE/RESPONSIBILITY IN THE STUDY:
PARTICIPATION IS VOLUNTARY:
TOTAL STUDY DURATION:
RISKS AND DISCOMFORTS OF THE STUDY:
BENEFITS OF THE STUDY:
PARTICIPATION OF THE STUDY KEPT CONFIDENTIAL:
Name of the Principal investigator :- DR. PULKIT SHARMA
Sign-
Date –
Designation – PG RESIDENT FIRST YEAR
Department of :- OTORHINOLARYNGOLOGY
Chirayu Medical College ad Hospital,
Bhopal, (M.P.)
13. Informed consent document (ICD) in English and the local language(s).
Consent Form
Participant identification number for this trial:Title of project, “A Comparative Study Of Temporalis
Fascia In Myringoplasty With Or Without Platelat Rich Fibrin At A Tertiary Care Centre Of Central
India”
Name of Principal Investigator .Dr. _____________Tel. No(s). ____
The contents of the information sheet dated ……………….. that was provided
have been read carefully by me / explained in detail to me, in a language that I comprehend, and I have
fully understood the contents. I confirm that I have had the opportunity to ask questions.
The nature and purpose of the study and its potential risks / benefits and expected duration of the study,
and other relevant details of the study have been explained to me in detail. I understand that my
participation is voluntary and that I am free to withdraw at any time, without giving any reason, without
my medical care or legal right being affected.
I understand that the information collected about me from my participation in this research and sections
of any of my medical notes may be looked at by responsible individuals from Chirayu Medical College
and Hospital Bhopal,(M.P.). I give permission for these individuals to have access to my records.
I agree to take part in the above study.
--------------------------------------------- Date:
(Signatures / Left Thumb Impression) Place:
Name of the Participant: ____________
Son / Daughter of ____________
Complete postal address: _____________
This is to certify that the above consent has been obtained in my presence.
Witness
------------------------------
Signature
Name:
Address:
Date: Date:
Signature of the Principal Investigator
Place:
14. सहमति पत्र
अध्ययन क्रम ांक ..................
अध्ययन विषय: , “A Comparative Study Of Temporalis Fascia In Myringoplasty With Or Without Platelat Rich Fibrin At A Tertiary Care Centre Of
Central India”
उपययुक्त शोध क
े अध्ययन क
े विए प्रविभ गी पहच न क्रम ांक ............... को शोधक यु क
े ब िि् इस्तेम ि कर ज िेग l इस शोध की प्रमयख अन्वेषक DR.PULKIT SHARMA
है वजनक मोब ईि नां 9427672929 है l
मैं यह घोवषि करि /िी हां की;
1.यह की मैंने उपरोक्त शोधक यु ब िि् ज नक री पत्र विन ांक ............. को पढ़ एिां समझ विय है / वजसक मयझे सम्पूर्ु वििरर् मेरी भ ष में बि एिां समझ विय गय है और
मयझे हर सि ि को पूछने क पय ुप्त समय विय गय और मेरी सांियवि की l
2.यह की मयझे उपययुक्त शोधक यु से जयड़े हुए सांभ विि जोखखम/ फ यिे और सांभ विि िक़्त जो इस शोधक यु में िग सकि है िह मयझे सवििरर् समझ विय गय है l
3.मैं यह भी जनि /िी हां की मेरी इस शोध मैं प्रविभ वगि पूर्ु रूप से स्वेखिक है एिां मैं वकसी भी समय वबन कोई क रर् विए अथि बि ए इस शोधक यु से अपनी
प्रविभ वगि वनरस्त कर सकि / िी हां एिां उससे मेरे उपच र पर वकसी िरह क कोई प्रभ ि नहीांपड़ेग एिां न ही वकसी िरह से वचवकत्स एिां उपच र से जयड़े मेरे मौविक
अवधक रोां क उल्लांघन होग l
4.यह की मेरे द्व र िी गई ज नक री क इस्तम ि उपययुक्त शोधक यु क
े ब िि् होग और इससे जयडी समस्त ज नक री को विम्मेि र व्यखक्त द्व र , जो वचर यय मेवडकि कॉिेज एिां
हॉखिटि , भोप ि (म.प्र.), क
े द्व र िेख ज सकि और मैं इसकी अनयमवि िेि / िी हां l
5.यह की मैंने उपययुक्त शोधक यु हेिय अपनी प्रविभ वगि क
े विए स्वेि से अपनी सहमवि प्रि न करि / िी हां l
............................................... ि रीख
(िस्तखि/ ब एँ अांगूठे क वनश न) स्थ न
प्रविभ गी क पूर न म :..............................
जन्मविवथ एिां उम्र :..../......./......
पि :....................
यह प्रम वर्ि वकय ज ि है की उपययुक्त सहमवि मेरी उपखस्थवि मैं िी गयी है l
-------------------------------
(गि ह क
े िस्तखि)
गि ह क न म : .............................
पि : ...................................
विन ांक : ................................
.............................................
(प्रमयख अन्वेषक क
े िस्तखि) विन ांक स्थ न
16. 1.LAST EAR DISCHARGE …………………………………….
2. PAIN IN EAR: YES/NO
3. DECREASED HEARING YES/NO
4. RECURRENT URTI YES/NO
5. TONSILLITIS ……….
6. ITCHING: YES/NO
7. FEVER: YES/NO
8. TINNITUS: YES/NO
9. GIDDINESS: YES/NO
10.HEADACHE YES/NO
11.FACIAL WEAKNESS: YES/NO
12.ALLERGIC HISTORY: YES/NO
PAST HISTORY:
HISTORY OF SIMILAR COMPLAINS, SURGERY……………………
FAMILY HISTORY:………………………………………………………...
HISTORY OF SIMILAR COMPLAINS ………………………………….
PERSONAL HISTORY: APPETITE …………………..DIET……………
17. SLEEP …………………………….BLADDER/BOWEL ………….
ADDICTION ………………………………….
HYPERTENSION, DIABETES, TB, ASTHMA, BLOODTRANSFUSION…………….
MENSTRUAL H/O ……………………………
IMMUNIZATION H/O ………………………..
EAR EXAMINATION:-
TUNING FORK TEST:-
Rinne Test (256Hz)
Rinne Test (512Hz)
Rinne Test (1024Hz)
Weber Test
Absolute Bone Conduction
18. Haemoglobin
Platelet Count
RIGHT EAR LEFTEAR
PURE TONE
AUDIOMETRY
FREQUENCYAVERAGE
AB GAP
NOSE:
ORAL CAVITY:
INVESTIGATIONS: -
•PATHOLOGY:
•AUDIOLOGY:
19. X - RAY MASTOID
RIGHT EAR LEFT EAR
OSSICULAR MOBILITY
EUSTACHIAN TUBE ORIFICE
MIDDLE EAR MUCOSA
PROMONTORY
ROUND WINDOW REFLEX
•RADIOLOGY:
INTRA OP FINDINGS:-
FOLLOW UP: -
4 WEEKS
6 WEEKS
12 WEEKS
21. TOPIC OF THESIS
“A Comparative Study Of Temporalis Fascia In Myringoplasty With Or Without Platelat Rich
Fibrin At A Tertiary Care Centre Of Central India”
22. Details Name Designation Department Mobile no. E-mail ID Signature
Principal
Investigator
DR.PULKIT
SHARMA
P.G.
RESIDENT 1ST
YEAR
ENT 9427672929 spulkitsharma@gmail.com
Co-
Investigator/
Guide
DR.RAKESH
MARAN
PROFESSOR ENT 8120142375 drrakeshmaran@gmail.com
Co-Guide DR.MAHESH
C PATIL
PROFESSOR PATHOLOGY 9618613452 maheash12july@gmail.com
CHIRAYU MEDICAL COLLEGE AND HOSPITAL, BHOPAL, (M.P.)
Research Committee
DECLARATION BY THE INVESTIGATOR
I/We the undersigned solemnly declare that the project Submitted “A Comparative Study Of Temporalis Fascia In
Myringoplasty With Or Without Platelat Rich Fibrin At A Tertiary Care Centre Of Central India”
is based on my/ our own work to be carried out during the course of our study.
I /We assert the statements made and conclusions drawn are an outcome of my/our research work. I further certify that
1. The work contained in the report is original
•The work has not been submitted for publication
•We will be following the protocol provided for the project
•Whenever we will use materials (data, theoretical analysis, and text) from other sources, we give due credit to them in the
text of the report and giving their details in the references.
•We will acknowledge the help provided by others (as & when needed) we agree to the sequence of authorship as mentioned
bellow
23. SECTION E: DECLARATION AND CHECKLIST
11. DECLARATION (Please tick as applicable)
I/We certify that the information provided in this application is complete and
correct.
I/We confirm that all investigators have approved the submitted version of
proposal/related documents.
I/We confirm that this study will be conducted in accordance with the latest
ICMR National Ethical Guidelines for Biomedical and Health Research
involving Human Participants and other applicable regulations and guidelines
including responsible.
I/We confirm that this study will be conducted in accordance with the Drugs
and CosmeticsAct 1940 and its Rules 1945 as amended from time to time, GCP
guidelinesand other applicable regulations and guidelines.
I/We will comply with all policies and guidelines of the institute and
affiliated/collaborating institutions where this study will be conducted.
24. I/We will ensure that personnel performing this study are qualified,
appropriatelytrained and will adhere to the provisions of the EC approved
protocol.
I/We declare that the expenditure in case of injury related to the study will be
takencare of.
If applicable, I/We confirm that an undertaking of what will be done with the
leftoversamples is provided, if applicable.
I/We confirm that we shall submit any protocol amendments, adverse events
report, significant deviations from protocols, progress reports (if required) and
a final reportand also participate in any audit of the study if needed.
I/We confirm that we will maintain accurate and complete records of all
aspects ofthe study.
I/We will protect the privacy of participants and assure safety and
confidentiality ofstudy data and biological samples.
25. I/We hereby declare that I/any of the investigators, researchers and/or close
relative(s), have no conflict of interest (Financial/Non-Financial) with the
sponsor(s)and outcome of study.
I/We have the following conflict of interest (PI/Co-PI):
I/We declare/confirm that all necessary government approvals will be obtained
as perrequirements wherever applicable.
Name of PI: DR.PULKIT SHARMA Signature: Date-
NAME OF CO-GUIDE:DR.MAHESH C.PATIL Signature: Date-
Name of Guide: DR.RAKESH MARAN Signature: Date-
Name of HOD: DR.ANIL KUMAR JAIN Signature: Date-