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Maxillofacial defects can result from congenital disabilities, cancer surgery, trauma, infection, or disease. Facial deformities can affect how a person looks, feels about themselves, and interacts with others. It can significantly impair phonetics, mastication, and deglutition and cause facial deformation. Maxillectomy due to mucormycosis is one such maxillofacial defect and it becomes essential to rehabilitate these cases with modified techniques based on the extension of intraoral defect, the severity, the degree of resection, the type of mucormycosis, the stability of lesions over time, the presence ofcontiguous disease, the accessibility of dental and prosthetic resources, and patient expectations. The prosthetic reconstruction with a maxillofacial prosthesis can restore function and appearance, comfort, and quality of life. The prosthesis should be simple to handle, easy to maintain, biocompatible, light in weight, and convenient for future adjustments. The maxillofacial surgeon, oncologist, and reconstructive dentist should work together to develop a treatment plan based on these considerations. Thiscase report provides the current treatment options for these patients and rehabilitation of the defect. It also discusses the issues that need to be addressed during the planning of prosthetic treatment and highlights some challenges the clinicians face in providing prosthetic treatment for mucormycosis patients.

Introduction: Intertrochanteric hip fractures are common with increasing age.Unstable intertrochanteric fractures are now commonly fixed using PFN, however it cannot engage greater trochanter on its own. Gluteus Medius and gluteus minimus (main abductors) attach to greater trochanter, hence abductor weakness is a likely consequence especially in comminuted fractures. In this study we measured the incidence of post-operative abductor weakness and result of targeted physiotherapy on it. Materials and Methods: 135 patients with unstable intertrochanteric fractures underwent proximal femoral nailing at our hospital. The patients included in this study were more than 18 years of age with unstable fractures classified according to Modified Evans classification type 3, 4 and 5 with the duration of trauma less than 3 weeks. The functional assessment was made using Modified McKay criteria through analysis of abductor muscle strength. All patients underwent a pre-determined physiotherapy as per protocol. Result: Immediate post-operative muscle power was Grade 1-(09 pt.), Grade 2 (39 pt.), Grade 3 (43 pt.) and Grade 4 (43 pt.). Most of the patient improved their muscle power grade at 12 weeks with only 09 patients with grade 2 and 23 patients with grade 3 power. At final months follow up only 08 patients had grade 3 power and only 6 patients had grade 4 power while the rest had muscle power grade 5.In our study excellent score was seen in 87 patients (83%), good in 12 patients (12%) and poor only 7 patients (5%) at 6 months, as per Modified Mckay criteria.Conclusion: Abductor weakness and Trendelenburg gait are surprisingly common in patients treated with PFN and this complaint is often overlooked. Correct surgical method and targeted physiotherapy can help alleviate this problem.

Assessment of soil moisture availability and timely declaration of drought are keys for exemplary relief assistance in water stressed regions. Percent available soil moisture (PASM) is one among several drought declaration indices, needs evaluation with respect to individual crop and cropping system, as the amount of water requirement varies with respect to crop and its growth stage. Analysis of yield variability due to PASM was carried out by employing correlation and linear regression analyses based on long term observations in experiments conducted at different dry farming locations of the peninsular India. The range of available soil moisture in order to obtain at least 50 per cent of optimum yield in cereals (maize: 26 and finger millet: 52.9 PASM), pulses (pigeonpea: 37.2 PASM), oilseeds (soybean: 26.8 to 30.5, groundnut: 53.8 to 61.7 PASM) and commercial crops (cotton: 26.3 PASM) was 26 to 61 per cent. Establishment of these regression models helped in timely drought declaration / precise identification of drought hit areas and assuring feasible relief assistance. The outcomes of the study may be used for amending the existing drought norms (0–50; severe, 50–75; mild and 75–100; no drought) for provision of proportionate compensations to the farmers.

Background: Previous studies suggest there is a need to improve the delivery of bad and challenging news in obstetric ultrasound settings. However, no research has explored the experiences of trainee sonographers when learning how to deliver challenging news. Understanding this could identify gaps in current provision and inform future training interventions. Aims: To explore the experiences of trainee sonographers when learning how to deliver challenging news. Methods: Semi-structured interviews were conducted with trainee sonographers (n = 7) from four training centres to explore their experiences and preferences for news delivery training. Results: Learning how to deliver difficult news was a journey where trainees developed their confidence over time. Most learning occurred in clinical settings, but classroom teaching complemented this. Trainees appreciated the opportunity to observe clinical practice and to hear from patient representatives. However, quality of teaching varied between centres and trainees reported uncertainty regarding the specific language and behaviours they should use. They described building their own personal protocol for news delivery through the course of their training. Discussion: An ultrasound-specific news delivery protocol which details the words and behaviours sonographers can employ could help reduce uncertainty in trainees. Trainees may also benefit from receiving structured feedback on their news delivery performance.

Introduction: Forearm fractures are one of the most common orthopaedic injuries in paediatric age group. Normal function is often achieved with closed reduction and casting. Loss of fracture reduction is the most commonly reported complication of forearm fractures. An important modifiable risk factor for fracture redisplacement is the quality of casting, which can be measured objectively by the use of casting indices. An attempt is made to validate the role of cast index in middle third fractures of both bones of forearm in children. Materials and methods: Patients in the age group of 2 to 12 years with fracture of both bones of forearm involving the middle third treated by closed manipulation and cast application were included in the study. An above elbow cast was applied in the emergency room after closed reduction in all patients. Cast Index, defined as ratio of inner diameter of the cast in lateral view to that in anteroposterior view was measured at the fracture site in all the radiographs.The mean Cast Index in nondisplaced and displaced groups were calculated and compared. Results: Thirty children with middle third fractures of radius and ulna were included in the study. At 1 and 2 week follow-up, all but 5 cases maintained acceptable reduction. The mean cast index in 25 cases which maintained reduction was 0.75 whereas that in the group with significant displacement was 0.84. Conclusion: Majority of paediatric forearm fractures are amenable to conservative treatment. Quality of casting as expressed by indices such as cast index is one of the indicators of satisfactory outcome following middle third forearm fractures when used as a measure of risk of redisplacement.

Background: Diabetes mellitus require lifelong intervention and Kerala has high prevalence. New expensive agents require comparison with existing regimens for cost-effectiveness. Methods: Socio-demographic, anthropometric, FPG and HbA1C (baseline and post treatment) of 150 patients (73 men; 77 women) were obtained from records using standard case report forms in our retrospective study. ANOVA and paired t test were used for between groups and within group comparison. Results: Metformin was maximum utilized (DDD/1000/day-252.39). All treatment regimens produced significant reduction in FPG (except metformin monotherapy) and HbA1C (except metformin sulfonylurea α-glucosidase inhibitor DPP-4 inhibitor combination). When compared to metformin sulfonylurea pioglitazone combination (best therapy), other regimens were less cost effective in reducing FPG and metformin sulfonylurea α-glucosidase inhibitor DPP-4 inhibitor was more effective and expensive in reducing HbA1C. Conclusions: High prescription rates of metformin were due to its action on insulin resistance and weight. Addition of pioglitazone was cost effective and DPP-4 inhibitor was expensive but effective.

Background During general anaesthesia, intubation of trachea and extubation of trachea are often associated with increase in haemodynamic response. Laparoscopic cholecystectomy is a minimal access surgery; postoperatively patients may experience moderate to severe pain. It is well known that lignocaine is useful in attenuating haemodynamic response to intubation and extubation. Previous studies also state that perioperative lignocaine infusion provides postoperative analgesia as well. We hypothesize that perioperative intravenous lignocaine infusion can both attenuate haemodynamic responses to intubation and extubation of trachea and also provide good postoperative analgesia in laparoscopic cholecystectomy surgeries. Methods Double blinded randomized controlled trial was undertaken at the department of anesthesia, Sri Siddartha medical college. In group A, 0.9% normal saline was used as placebo for perioperative intravenous infusion. In group B, preservative free 1.5 mg/kg 2 % lignocaine (Loxicard) diluted with normal saline to 1% given at 10 minutes to induction as bolus, followed by an infusion of 1.5 mg/kg/h. till 1 hour postoperatively. Results In Group B there was a statistically less rise in heart rate [HR] and mean blood pressure [MBP] during intubation and extubation of trachea compared to group A. In group B there was a statistically significant increase in the mean pain free period postoperatively compared to group A. Conclusions Perioperative intravenous infusion of lignocaine attenuates haemodynamic response during the intubation and extubation of the trachea. In addition, it also increases the mean pain free period postoperatively.

Aim and Objectives: To find out the effectiveness of moxifloxacin prophylaxis in HIV patients having contact history of MDR-TB. Materials and Methods: This is an observational prospective cohort study of HIV patients divided in to two groups, moxifloxacin prophylaxis group and non-prophylaxis group. These groups are followed for four years from March 2012 to March 2016 to appraise the incidence of tuberculosis and mortality in these two cohorts. Results: The tuberculosis incidence in more in non-prophylaxis group when compared to prophylaxis group. Crude tuberculosis incidence is 275 per 1000 person/years in non-prophylaxis group when compared to 42 per 1000 person/years in prophylaxis group (p

Agents that are capable of killing pathogenic microorganisms are known as Antimicrobial Substances. These are of low molecular weight and used for the sterilization of water, as antimicrobial drugs, as food preservatives, and for soil sterilization. Due to their potential to provide quality and safety benefits to many materials antimicrobials gain interest from both industry and academic research. However, antimicrobial agents with low molecular weight suffer from many disadvantages, such as the antimicrobial ability to short-term and environment toxicity. Antimicrobial functional groups can be introduced into polymer molecules to overcome problems associated with the low molecular weight antimicrobial agents. For enhancing the efficacy of some existing antimicrobial agents, selectivity, increasing their efficiency and prolonging the lifetime of the antimicrobial agents the use of antimicrobial polymers can be employed. The development of antimicrobial polymers research represents a great a challenge for both the academic world and industry. The polymer research that presents great modern interest, yet has received lacking consideration, is that of the development of polymers with antimicrobial activities, commonly known as polymeric biocides. Biocides immobilized on dendrimers can be more effective if the target sites are cell walls or membranes. It has been shown that small quaternary ammonium compounds exert their antimicrobial action by disintegrating and disrupting the cell membrane, converting functional end groups of dendrimer to ammonium salts, dendrimer biocides can be synthesized. These dendrimer biocides have been shown to be more potent than their small molecule counterparts as they bear high local density active groups. Thus, dendrimer biocides may be very beneficial in terms of activity, reduced toxicity, localization in specific organs and increased duration of action. This chapter will find complete solution for an antimicrobial agent facing problems and advantages of the dendrimeric biocides.

β-Lapachone (3, 4-dihydro-2,2-dimethyl-2H-naphthol [1,2-b] pyran-5,6-dione), was originally isolated from the lapacho tree (Tabebuia avellanedae) of South America. It is a lipophilic ortho-naphthoquinone. β-Lapachone has antimicrobial, antifungal, antiviral antitumor and anti-trypanosomal activities. In a number of tumors (e.g., breast, colon, lung, and pancreatic cancers) with high NAD (P) H expression levels of: quinone oxidoreductase (NQO1), β-lapachone activates a novel apoptotic response. β-Lapachoneis a major constituent of the species Tecomaria capensis (Thunb.) Spach. On silica gel GF254 TLC plates and the chromate plate analytical thin layer chromatography was accomplished. It was developed withToluene: Ethyl acetate (7:3 v/v) as mobile phase. In this study isolation of β-Lapachone was achieved by preparative TLC. The compound thus isolated was characterised by Mass, H1 NMR and FT-IR spectral analysis. Mass spectral data shows molecular ion peak of m/z=242. Antifungal activity was measured against Candida albicans and Aspergillus nigrus fromethyl acetate extracts of selected species.

Applicant: Bosch Termotecnologia SA

Giant cell tumour (GCT) is a primary benign neoplasm of bone. It is classically described as a locally invasive tumour that occurs close to the joint of a mature bone. It accounts for 5% of all skeletal tumours. It usually originates from long bones. Giant Cell Tumour of the small bones of the hand and foot are relatively uncommon. Giant Cell Tumour of talus is a rare occurrence. We report a rare presentation of giant cell tumour of the talus in a 62-year-old farmer treated by talectomy and tibiocalcaneal fusion, who later presented with features suggestive of recurrence and secondaries in chest within six months following surgical resection of the primary. Below knee amputation was performed to manage the recurrence. At two years follow-up the patient showed no further progression of pulmonary metastasis or local recurrence.

An osteochondroma is a benign tumour of bone, which is located mainly in the metaphysis of long bones. It does not commonly occur in the scapula. On the ventral surface of the scapula, it can produce various manifestations due to mass effect. We are reporting a rare presentation of an osteochondroma at superomedial angle of ventral aspect of the scapula in a 31-year-old female. She initially presented with a painful shoulder and radiating pain in the arm. The scapular mass produced pseudo winging of the scapula and erosion of the ribs on the same side. The patient was successfully managed by open excision, using a parascapular approach. The patient had no evidence of recurrence at one year’s follow-up and is currently able to carry on her day to day activities without any discomfort.

Objective To describe the cytologic findings of medulloblastomas on intraoperative crush preparation smears and compare them with the findings of other central nervous system tumors. Study design The intraoperative crush preparation smears of 19 cases of medulloblastoma were studied (6 undifferentiated type and 13 well-differentiated type). The findings were compared with those of a control group consisting of 31 astrocytomas, 22 ependymomas, 18 oligodendrogliomas, 27 meningiomas, 17 schwannomas, 17 pituitary adenomas, 3 lymphomas, 5 hemangioblastomas, 5 chordomas and 11 metastatic tumors. Results Medulloblastomas revealed clusters and isolated small, round malignant cells with hyperchromatic nuclei and indistinct cytoplasm. Typical Homer-Wright rosettes were seen in the well-differentiated type, but they were poorly formed in the undifferentiated type. Tumor cannibalism, target inclusions, cytoplasmic vacuoles and prominent multiple nucleoli were noticed frequently in the undifferentiated type. The control group (metastatic tumors and high grade astrocytomas) rarely showed tumor cannibalism or multiple nucleoli. Conclusion Smears of the undifferentiated type of medulloblastomas frequently revealed tumor cannibalism, cytoplasmic vacuoles, target inclusions and prominent multiple nucleoli. These findings have been rarely reported. The prognosis of the undifferentiated type of medulloblastoma was poor.

OBJECTIVE: To study the role of liver fine needle aspiration (FNA) in the diagnosis of kala-azar with an atypical presentation. STUDY DESIGN: The study group consisted of 23 patients (aged 18-37). All were admitted to Shiraz University Hospitals for the investigation of fever of unknown origin. The immuno-fluorescent antibody titer for kala-azar was positive (>1:256 dilution). However, routine abdominal sonography revealed multiple small, hypoechoic lesions in the liver, more suggestive of metastatic tumor or miliary tuberculosis. The lesions were aspirated for cytologic diagnosis. RESULTS: The smears revealed many atypical hepatocytes, groups of epithelioid histiocytes and, in 15 patients, macrophages containing few to many Leishman bodies, allowing a diagnosis of kala-azar. The liver needle biopsy specimens confirmed the cytologic diagnosis of kala-azar and liver cell atypia. The patients were given glucantime therapy, and 21 recovered; 1 patient was lost to follow-up, and 1 died during treatment. CONCLUSION: Liver FNA is a useful procedure for the diagnosis of kala-azar, particularly in cases with atypical clinical presentations.

Objective: To study fine needle aspiration (FNA) cytological findings of splenic lesions and assess the role of FNA in the diagnosis of splenomegaly or splenic tumours. Methods: This study consisted of 48 cases, 25 males and 23 females. The ages ranged between 3 and 71 years. Most of these cases were aspirated under ultrasonographic guidance and a small number were also aspirated directly by using a 22- to 23-gauge needles. The smears were stained with Wright–Giemsa and Papanicolaou methods. Special stains were used whenever necessary. Results: In this study 14 cases were diagnosed as lymphoma-leukaemia, 7 cases as tuberculosis, 12 cases as kala-azar, 2 cases as hydatid cyst, 3 cases as storage diseases, 3 cases as simple cyst, 2 cases as myeloproliferative disorders, 2 cases as malignant tumours and 3 cases as hamartomas (these were wrongly diagnosed as malignant tumours). Conclusion: Splenic aspiration is a safe procedure and is very useful in the diagnosis of parasitic and infectious diseases, especially in endemic countries like Iran.

A recent result of Zheng and Tse states that over a quasi-static channel, there exists a fundamental tradeoff, referred to as the diversity-multiplexing gain (D-MG) tradeoff, between the spatial multiplexing gain and the diversity gain that can be simultaneously achieved by a space-time (ST) code. This tradeoff is precisely known in the case of independent and identically distributed (i.i.d.) Rayleigh fading, for T >= n(t) + n(r) - 1 where T is the number of time slots over which coding takes place and n(t), n(r) are the number of transmit and receive antennas, respectively. For T < n(t) + n(r) - 1, only upper and lower bounds on the D-MG tradeoff are available.In this paper, we present a complete solution to the problem of explicitly constructing D-MG optimal ST codes, i.e., codes that achieve the D-MG tradeoff for any number of receive antennas. We do this by showing that for the square minimum-delay case when T = n(t) - n, cyclic division-algebra (CDA)-based ST codes having the nonvanishing determinant property are D-MG optimal. While constructions of such codes were previously known for restricted values of n, we provide here a construction for such codes that is valid for all n. For the rectangular, T > n(t) case, we present two general techniques for building D-MG-optimal rectangular ST codes from their square counterparts. A byproduct of our results establishes that the D-MG tradeoff for all T >= n(t) is the same as that previously known to hold for T >= n(t)+n(r)-1.

The problem of constructing space-time (ST) block codes over a fixed, desired signal constellation is considered. In this situation, there is a tradeoff between the transmission rate as measured in constellation symbols per channel use and the transmit diversity gain achieved by the code. The transmit diversity is a measure of the rate of polynomial decay of pairwise error probability of the code with increase in the signal-to-noise ratio (SNR). In the setting of a quasi-static channel model, let n(t) denote the number of transmit antennas and T the block interval. For any n(t)

Objective To describe the cytologic findings in 13 cases of carotid body tumors (CBTs) and discuss the differential diagnoses. Study design Cytologic smears were obtained from 13 cases of carotid body tumors by fine needle aspiration. All tumors were clinically suspected and later confirmed by arteriography or color Doppler ultrasonography. The cytomorphologic findings are described. Results The smears revealed hypercellularity, a bloody background, isolated and clusters of round to oval cells with indistinct cytoplasm, reticular chromatin, no prominent nucleoli, giant bare nuclei, anisocytosis, acinar structures and plasmacytoid cells. These findings suggested metastatic tumors. Conclusion The cytologic diagnosis of CBTs is very difficult. The aspiration findings can be easily mistaken for those of metastatic tumors. However, when used with clinical and color Doppler findings, fine needle aspiration plays an important role in the preoperative diagnosis and management of CBTs.

Formation of silicon carbide in the Acheson process was studied using a mass transfer model which has been developed in this study. The century old Acheson process is still used for the mass production of silicon carbide. A heat resistance furnace is used in the Acheson process which uses sand and petroleum coke as major raw materials.: It is a highly energy intensive process. No mass transfer model is available for this process. Therefore, a mass transfer model has been developed to study the mass transfer aspects of the process along with heat transfer. The reaction kinetics of silicon carbide formation has been taken from the literature. It has been shown that reaction kinetics has a reasonable influence on the process efficiency. The effect of various parameters on the process such as total gas pressure, presence of silicon carbide in the initial charge, etc. has been studied. A graphical user interface has also been developed for the Acheson process to make the computer code user friendly.

The Acheson process is used to manufacture silicon carbide (SiC) in a resistor furnace using petroleum coke and silica as raw materials. The process is highly inefficient, as only 10 to 15 pet of the charge gets converted into silicon carbide. No published attempt has been made to optimize this century-old process by applying mathematical modeling. Therefore, a simultaneous heat- and mass-transfer model has been developed for the resistance-heating furnace, considering silicon carbide formation as a typical carbothermal reaction. Coupled transient partial differential equations have been worked out. These equations have been solved numerically, using the implicit finite-difference method in their nondimensional form, to obtain the profiles of solid temperature and volume fraction reacted in the furnace. The trend of the computed results appears to be realistic; comparison of the results with published experimental work validates the applicability of the model's predictions. The effects of various parameters on the process have been studied. These include void fraction, power inputs, initial concentration of silicon carbide present in the charge, etc.

Two hundred fifteen cases of Hirschsprung's disease (HD) had follow-up after definitive surgical treatment, which had been performed between September 1983 and August 1994. Of these, 20 (9.3%) had recurrence of obstructive symptoms that was unresponsive to conservative treatment. Nine cases were improved by posterior anorectal myectomy (PARM). The other 11 patients, who did not have improvement after PARM, had a re-pull-through. Reoperation consisted of excision of the descending and left transverse colon with pull-through of the right colon, regardless of the histology of the colon. The blood supply was based on the ileocolic vessels, with or without division of the right colic artery. To provide a smooth course for these blood vessels, without kinking, and to obtain adequate length of the right colon with less dissection, the entire bowel was derotated clockwise. Re-pull-through was then performed from the left side of the abdomen. The excised bowel from both operations was examined, using H&E staining, for possible evidence of intestinal neuronal dysplasia (IND) or acquired aganglionosis. All had ganglion cells in the remaining colon and at the distal limit of the pull-through. Histological signs of IND were present in all patients in the previously pulled-through colon. Apart from one mentally retarded child, all had satisfactory bowel movement in a 10 to 54-month follow-up period. IND should be considered a cause of surgical failure in HD. Subtotal colectomy and pull-through of the right colon after clockwise derotation of the entire bowel appears to be effective when symptoms persist after conservative therapy or PARM.