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The aim of the present study was to evaluate the haemodynamics of uterine blood flow in uterine torsion and record the period of resumption of ovarian cyclicity in cattle with uterine torsion. Crossbred cows with term gestation and straining for parturition due to post-cervical uterine torsion were selected for the study. Transrectal ultrasonographic assessment for measuring the doppler indices of middle uterine artery for both ipsilateral and contralateral side before and after detorsion was studied. Haemodynamic parameters such as blood flow volume (BFV), time-averaged peak velocity (TAP), resistance index (RI) and pulsatility index (PI) were assessed by using minimum three cardiac cycles. Blood samples were collected for haematological and biochemical assessment. Before detorsion, the PI value was high in ipsilateral side of uterine torsion and significant decrease could be observed after detorsion. However, BFV significantly increased after detorsion in both ipsilateral and contralateral side of uterine torsion when compared to the pre-detorsion values. Haematological and serum biochemical values were within the reference values and no significant observation could be made out of this in torsion affected cows. Two out of six animals (33.33%) exhibited the heat signs within three months of calving. In conclusion the blood flow volume was evidently increased after detorsion; however, the viability of the fetus was decided by the occurrence, duration and degree of uterine torsion.

Background Diabetic hand infections are associated with significant morbidity and disability. Amputations cause permanent disability, and multiple surgical procedures lead to morbidity. Diabetic foot infections have been well-studied but literature on hand infections is limited. We undertook a retrospective study of patients with diabetic hand infections operated at our center to study the factors at presentation with significant association with amputation and number of surgical procedures. Patients and Methods Demographic data of 51 patients was collected. The six parameters, namely, duration of diabetes, “onset of symptoms to presentation” interval, presence of comorbidities, HbA1c level, random blood sugar (RBS) levels at admission, and culture characteristics were selected for statistical analysis to find a relationship with the two outcome variables: number of procedures done and need for amputation. Results On bivariate analysis, Gram-negative infection was found to have a significant relationship with the need for multiple of procedures (p = 0.014). The mean difference between the “onset of symptoms to presentation” interval between the amputation/non-amputation groups (2.9 days, p = 0.04) and the multiple procedures/non-multiple procedure groups (4.4 days, p = 0.02) was found to be statistically significant. Presence of comorbidities, long duration of diabetes, HbA1c, and RBS levels at admission did not show any statistically significant association with the two outcome variables studied. Conclusion In the present study, we found that infection with Gram-negative organisms is significantly related to the need for multiple surgical procedures. A delay in presentation can influence the risk of amputation as well as multiple procedures. Institution of early appropriate care is important to get a good outcome.

Background: Multiple gingival recession (MGR) coverage, especially in esthetic area, demands a high patient satisfaction. Coronally advanced flap modifications, namely Zucchelli's technique (ZT) and vestibular incision subperiosteal tunnel access (VISTA), are techniques, recommended in the correction of MGR. Aim: The purpose was to comparatively analyze the ZT and VISTA technique reinforced with the platelet-rich fibrin membrane in the management of MGR. Materials and Methods: This split-mouth, randomized study comprised 16 consenting, systemically healthy participants. The bilateral Miller's multiple class I and II lesions were managed with ZT and VISTA technique and had a follow-up period of 18 months. Gingival thickness (GT), mean percentage of root coverage, and patient-centered outcome scales, including patient comfort score, patient esthetic score, and hypersensitivity score, were the primary outcome measures. Further clinical parameters assessed were gingival index, probing depth, clinical attachment level, and width of keratinized gingiva. Statistical Analysis and Results: Paired t-test and unpaired t-test were used for intragroup comparison and intergroup analysis, respectively. While both the techniques exhibited high root coverage percentage (VISTA: 93.95% and ZT: 96.84%), statistically significant difference was noted with patient esthetic score and surgical mortality score in VISTA. Conclusion: Both ZT and VISTA were effective in terms of root coverage and GT augmentation in MGR management. From the patient's perspective, they preferred VISTA technique over ZT, stating its minimal postoperative morbidity and improved esthetic outcome. Hence, within the limitations of this study, the VISTA technique was found to be a superior alternative compared to that of ZT in MGR management.

Replantation of digital amputations is now the accepted standard of care. However, rarely will a replantation surgeon be presented with amputated fingers which have been previously replanted. In our literature search, we could find only one publication where a replanted thumb suffered amputation and was successfully replanted again. We report the technical challenges and the outcome of replanting two fingers which suffered amputation 40 months after the initial replantation and were successfully replanted again. Replantation was critical since the amputated fingers were the only two complete fingers in that hand which had initially suffered a four-finger amputation. The second-time replantation of previously replanted fingers is reported to allay the concern of the reconstructive surgeon when faced with this unique situation of “repeat amputation of the replanted finger.” Second-time replantation is feasible and is associated with high-patient satisfaction. Replantation must be attempted especially in the event of multiple digit amputations.

Background: Peri implant infection in dental implantology is a frequently encountered clinical problem. Titania nanotubes (TNTs) are recent improvement in surface characterization, showing promising results. Aim: The nanosurface parameter tweaking has been implicated with profound change in the microbiological and biological response. Hence, it was proposed that alteration in the nanotube diameter could have positive influence in its antibacterial activity against salient periodontal pathogens. Materials and Methods: Commercially, pure titanium discs of 8-mm diameter and 1.5-mm thickness were prepared. Polished titanium discs were used as control (Group A). Vertically oriented, structured TNTs were fabricated by anodization technique and grouped as B and C, having nanotube diameter, 40 and 80 nm subsequently. The surface characterizations of the samples were done by scanning electron microscope analysis. The antibacterial activity was evaluated with the bacterial colony counting method, at 24 h, 72 h, and 1-week intervals. Statistical Analysis: The one-way analysis of variance and Tukey's honest significance post hoc test were employed to assess the statistical significance. Results: The 80 nm nanotubes showed better antibacterial activity comparatively, at all three-time intervals investigated. Conclusion: The optimal TNT diameter of 80 nm was the most effective from an antimicrobial stand point of view.

Aim: Three-dimensional (3D) printed models are contemporary volumetric bone graft assessment technique for secondary alveolar bone grafting (SABG) in cleft lip and palate (CLP) patients. The study aimed at evaluation of long-term stability of iliac autograft in SABG using multislice computed tomography (CT) and 3D-printed model-based volumetric analysis. Materials and Methods: Twenty-eight patients were included in this prospective clinical study. CT image (T1) was taken after orthodontic maxillary expansion, correlating with the presurgical image. Furthermore, 3D-printed model was prepared, and volumetric assessment of graft needed was ascertained with water displacement technique. SABG was carried on with the anterior iliac crest autografting procedure. After 1-year follow-up, postoperative CT analysis (T2) was followed upon. Results: The stability of bone graft at the 1-year postoperative was found to be 43.74% with mean bone loss of 56.26% (95% confidence interval; P < 0.005). The moderate scale of CLP cases has shown statistically significant bone stability compared to that of severe and mild cases. Furthermore, the 3D-printed model has shown a significant difference to that of T1 CT imaging (P < 0.005). Conclusion: Within the limitations of the study, it seems appropriate to conclude that 3D-printed models serves as better reference than CT imaging in the context of planning and execution of precise bone grafting in SABG.

Extensor indicis proprius (EIP) tendon transfer is a standard operation for restoration of the thumb extension following rupture of extensor pollicis longus (EPL). In its standard form often the EIP is transferred to the EPL without inspection of the extensor tendons in the fourth compartment and it is retained in its anatomical fourth compartment. However, in a setting of EPL rupture in relation to the distal radius fracture (with or without fixation), concomitant injury to the extensor tendons to the index finger may result in failure of the transfer and even a loss of index finger extension (index finger drop) further complicating the reconstruction and resulting in immense patient dissatisfaction. We herein present two such rare cases to highlight this clinical scenario and how an awareness of this possibility and inspection of the extensor tendons to the index finger before EIP transfer allowed us to prevent this complication. In essence, if we know it, we can prevent it.

Producing items that are of both high quality and long lasting is a difficult task for companies right now. There is a huge need for a wide range of engineering materials in today’s technologically advanced globe. The strength and qualities of the material determine the amount of material that may be used. Due to its excellent mechanical qualities and low density, aluminum-7075 alloy is mostly employed in transportation applications such as aerospace, marine, and vehicle production. This study addresses the fabrication and characterization of Al7075 semisolid metal matrix composite (MMC) reinforced with graphene nanoparticles. Samples are made with and without stirring graphene in aluminum-7075 at various temperatures of 800°, 830°, 860°, 890°, and 920°C. At these temperatures, the material is semisolid, so graphene is introduced and stirred into the molten liquid. The specimens meet the requirements of the American Society for Testing and Material (ASTM). The hardness, tensile strength, impact strength, and compression strength of various materials are evaluated and compared. Temperature lowers tensile strength, hardness, and compression. A scanning electron microscope (SEM) is used to examine the microstructure. The specimen is evaluated using ANSYS. Specimens with stirring have better mechanical characteristics. Graphene has high hardness and strength.

Context: The substantial knowledge concerning ergonomics and its practical application is vital for forestalling musculoskeletal disorders. The role of equipment ergonomics (EE) in preventing these work-related ailments is significantly noteworthy. Aim: The aim of the study was to assess the prevailing perception of postgraduates (PGs) and interns regarding EE and preparing the Indian dental workforce for the challenges of India's growing economy and population. Settings and Design: Authors conducted a cross-sectional survey between December 2013 and February 2014 amidst the interns and PG dental students of Davangere city, Karnataka, India. Subjects and Methods: The data were collected using 21-item custom designed proforma, comprising of questions evaluating student's basic knowledge about EE. Statistical Analysis Used: Statistical analysis was done using Chi-square test in each group (PGs and interns) and Mann–Whitney test was implemented for comparison between both groups. Results: Of 358 subjects surveyed, 48% PGs and 52% interns affirmed that they came across EE only through this survey. In addition, 91.18% of PGs and 90.59% interns believed that the accentuation on EE is less in the current dental curriculum. Conclusions: Comprehensive understanding and practical application of EE among the participants was found to be lacking. The importance of microbreaks and chair side exercises should be emphasized and training should be initiated at an early stage before improper postural habits develop.

Background and Objective: Transmucosal analgesic delivery is a promising approach to periodontal postoperative pain management. The purpose of this clinical trial is to appraise the effectiveness of transmucosal drug delivery system with meloxicam films and to identify its minimum effective dosage via this route after periodontal flap surgery. Materials and Methods: The analgesic mucoadhesive films were formulated using meloxicam and hydroxypropyl methyl cellulose polymer by solvent casting method. The sample size consisted of 60 chronic periodontitis patients who require periodontal flap surgery. The subjects were randomized using lottery method into four groups (Group A - 45 mg; B - 30 mg; C - 20 mg; D - 10 mg meloxicam per film). After periodontal flap surgery, the respective meloxicam mucoadhesive films were placed over the surgical site and were removed on 4 th day of postsurgery. The primary outcome measure was postsurgical pain level and recorded at 1 st , 2 nd , 3 rd , 4 th , 5 th , 24 th , and 48 th h using a 0-10 mm visual analog scale with markings from 0 = no pain to 10 = extreme pain. Results: The postoperative pain control observed in Groups A and B was found to be effective, and the patient comfort level was very satisfactory. Whereas in Group C, it was found to be high in the first 3 h postsurgically, after which adequate pain relief was seen. Group D exhibited inadequate pain relief. No adverse reactions were noted after applying the film in any of the groups. Conclusion: Transmucosal delivery of meloxicam was found to be effective and safe in postsurgical pain control of periodontal flap surgery. The minimum effective dosage via this route for meloxicam was found to be with 30 mg mucoadhesive films.

Background and objectives: Proton pump inhibitors are used widely for gastroesophageal reflux disease and ulcer type dyspepsia. Majority of the patients require long term medication. H2 receptor antagonist are also used for relief of symptoms. Though tachyphylaxis has been reported, symptom response is seen with long term use. The aim of the present study was to study the effects of long-term acid suppressants on gastric antral histology. Methods: Patients who received long-term acid suppressants such as ranitidine and omeprazole for gastroesophageal reflux disease or dyspepsia were included. All of them had an antral biopsy for histology and H. pylori status at baseline, at 6 months and 12 months. Patients on acid suppressants for less than a year or on long-term non-steroidal anti inflammatory drugs were excluded from the study. The grading of gastritis was classified as chronic active gastritis, atrophic gastritis, intestinal metaplasia and dysplasia. Results: Thirty patients received ranitidine and 28 omeprazole. In H. pylori positive group, the median duration of ranitidine and omeprazole were 3 years (1.5 to 8 years) and 4 years (1 to 10 years) respectively. Two thirds of patients had chronic active gastritis (ranitidine: 35.5%; omeprazole:26.6%); 10 had gastric atrophy (ranitidine: 6.6%; omeprazole:15.5%) and 7 had intestinal metaplasia (ranitidine4.4%; omeprazole11.1%). Four of the 10 patients on omeprazole showed progression of histology as against only one of the 13 patients on ranitidine at one year of follow up. In omeprazole pylori negative patients, the median duration of ranitidine and omeprazole was 2.5 years (range 1 to 6 years) and 3 years (range 2 to 7 years) respectively. Irrespective of the acid suppressants, the baseline histology was either chronic active gastritis (78.5%) or gastric atrophy (21.5%). None had intestinal metaplasia. Also there was no progression in histology staging during the follow up. Conclusions: Long-term acid suppressants irrespective of the H. pylori status are not associated with significant histological changes in gastric mucosa. Despite a significant drop out of cases, among the cases followed up no significant progression in histological staging was seen during a one year follow-up.

Cerebral palsy is the musculoskeletal manifestation of a nonprogressive central nervous system lesion that usually occurs due to a perinatal insult to the brain. Though the cerebral insult is static the musculoskeletal pathology is progressive. Some patients with cerebral palsy whose hands are affected can be made better by surgery. The surgical procedures as such are not very technically demanding but the assessment, decision-making, and selecting the procedures for the given patient make this field challenging. When done well, the results are rewarding not only in terms of improvement in hand function but also in appearance and personal hygiene, which leads to better self-image and permits better acceptance in the society. This article focuses on the clinical examination, patient selection, and decision-making while managing these patients.

Background: Grip strength after wrist arthrodesis is reported to be significantly less than normal. One of the reasons suggested for this decrease in grip strength is that the arthrodesis was performed in a suboptimal position. However, there is no consensus on the ideal position of wrist fusion. There is a paucity of studies evaluating the effect of various fixed positions of the wrist on grip strength and therefore, there is no guide regarding the ideal position of wrist fusion. The authors′ aim was to determine the grip strength in various fixed positions of the wrist and subsequently to find out in which position of wrist fusion the grip strength would be maximal. Materials and Methods: One hundred healthy adults participated in the study. For the purpose of this study, the authors constructed splints to hold the wrist in five different fixed positions: 45, 30 and 15 degrees of wrist extension, neutral and 30 degrees of wrist flexion. The grip strength in all the participants was measured bilaterally, first without a splint and then with each splint sequentially. Results: The average grip strength without the splint was 34.3 kg for right and 32.3 kg for the left hand. Grip strength decreased by 19-25% when the wrist was splinted. The maximum average grip strength with a splint on was recorded at 45 degrees of extension (27.9 kg for right and 26.3 kg for left side). There was a gradual increase in the grip strength with increase in wrist extension but the difference was not statistically significant (P = 0.29). The grip strength was significantly less in flexed position of the wrist (P < 0.001).

Fingertip amputations are one of the most common injuries faced in an emergency department. Finger tip replantation though technically possible, are not regularly done due to the presumed complexity of the procedure and doubts about the outcome. This article deals with our experience of 24 fingertip replantations in 24 patients done over a period of 8 years since the year 2000. Twenty-one fingertips survived. The most common affected digit in the series was thumb followed by index, middle, and ring. The overall success rate was 87%. Both arterial and venous repair were done in all cases. Replantation was not done if no suitable vein was found for anastomosis. Nine patients did not have nerve repair. Seven of them survived and all of them had satisfactory sensation when examined after 1 year. No patient suffered from cold intolerance. All patients were satisfied with the functional outcome and aesthetic appearance. This article highlights the technical considerations and the outcome of these fingertip replants.

rhabdomyosarcoma is a rare malignant tumour occurring in the hand. though the prognosis for this tumour is poor, when it occurs in the hand, early diagnosis is possible, since the swelling becomes clinically obvious. radical surgical excision even at the cost of significant functional loss is recommended with possible reconstruction once the disease is under control. advances in chemotherapy protocols and radiotherapy in selected cases has improved the prognosis. Rhabdomyosarcoma arising in the thumb of a four-year-old child is presented. he was treated by amputation of the thumb at the carpometacarpal joint level followed by chemotherapy. when he was disease-free at 18 months, thumb was reconstructed by pollicisation of the index finger. the child has remained recurrence-free at 30 months from diagnosis. the patient details are presented with review of the relevant literature.

Aim: Supernumerary teeth are considered as one of the most significant dental anomalies during the primary and early mixed dentition stage. The main objective of the study was to determine the prevalence rate of supernumerary teeth in the patients who reported to the Department of Oral Medicine and Radiology and to study the associated clinical complications. Materials and Methods: A longitudinal observational study was conducted of 2216 patients for a period of 4 months with the documentation of demographic data, the presence of supernumerary teeth, their location, and associated complications such as mechanical trauma, dental caries, and associated pathology. Results: The study recorded 27 supernumerary teeth from the examined 2216 patients. This yields a prevalence of 1.2%, with greater frequency in males which was 1.49% and in females the frequency was 0.85%. The greatest proportion of supernumerary teeth was found in the maxillary anterior region (77.8%). Out of this, 85.7% were classified as mesiodens based on their location. The displacement of adjacent teeth was the most common finding, followed by dental caries. Conclusion: The prevalence of supernumerary teeth in this study was 1.2% which is in agreement with that reported in similar studies and the maxillary mesiodens was the most common location. Displacement of adjacent teeth was the most common finding.

Five finger-tip amputations and two fingers with pulp-loss were covered with reverse digital artery island flaps from the same finger. The flap was successful in all cases and provided cosmetically and functionally acceptable results. One patient had venous congestion, but the flap survived. This flap would be particularly useful when the nature of injury precludes the use of local advancement flaps and cross-finger flaps.

Complex dislocations of the metacarpophalangeal joints are rare injuries. When they, occur, they are relatively common in the thumb, index and little fingers. Isolated complex dislocation of the metacarpophalangeal jont of the middle finger is extremely rare because of the inherent anatomical stability in that joint. We are reporting a case of isolated complex dorsal dislocation of the middle finger.

Subclavian perivascular approach has been attempted for brachial plexus block for upper extremity surgery in 160 consecutive cases. In eight patients the approach could not be used since paraesthesia could not be elicited. Twelve patients needed peripheral nerve block supplementation. Four patients needed general anaesthesia with an overall success rate of 85 per cent. There were no complications attributable to the technique. This is our anaesthetic technique of choice for upper extremity surgeries.

Volar dislocation of PIP joint or MCP joint is a rare injury. They are seldom seen acutely and hence literature is sparse on the ideal method of management of these injuries. We had a patient who presented with a rare combination of volar dislocations of PIP and MCP joints of the ring finger with a classic dorsal dislocation of the PIP joint of the little finger. All dislocations underwent successful closed reduction in the acute stage followed by appropriate method of immobilisation and physiotherapy.

A significant role in educational assessment is played by measuring behavioural changes based on clearly specified educational objectives and meaningfully interpreting the results. One of the most significant strategies for evaluating a student's learning performance in the classroom is formative assessment. Formative assessment systems concurrently improve the science and art of teaching and learning. Teachers can help the students grow as students by actively hopeful them to self-assess their skills, test their knowledge retention, giving clear commands and providing the necessary feedback to put them on track. This paper aims to demonstrate the various Formative Assessment Tools for Effective Classroom. The conclusions derived from the teaching fields are then merged to produce an incorporated summing with clear implications for effective didactic academic performance. The assessment of students by the teachers has a powerful direct impact on their learning performance, which may be positive and thus be worthy of very attractive and fruitful learning.