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Tuberous sclerosis is an autosomal dominant neurocutaenous disorder or neuroectodermatosis affecting multiple organ systems with variable clinical manifestations. We are reporting a case of a 26 years old female with history of epilepsy with mental retardation presented with fever and convulsions following an episode of stillbirth on first time with normal fetal outcome on second time. She had facial angiofibromas, shagreen patch, ash-leaf macules, periungual and subungual fibromas. She also had bilateral renal angiomyolipomas with haemorrhages and sub ependymal cortical tubers in brain. We report such a unique case having all clinically diagnostic physical sings of tuberous sclerosis with complicated obstetric history.

Ablation of meteors leaves a large number of dust particles of sizes ranging from nanometers to several micrometers in the upper mesospheric region. These dust particles can affect the equatorial E-region conductivities in several ways. Most of them remain electrically neutral and can affect the electron and ion collision frequencies, especially in the lower E- region, and thereby alter the electrical conductivity of this region. This can lift the Cowling conductivity maximum by a few kilometers making it coincide with the observed electrojet current maximum. Charged dust particles in the lower E-region can considerably reduce the electrojet current density in this region, by capturing a large number of free electrons from this region. A clear evidence for this is the large difference between the electron and positive ion number densities observed in this region by in situ probes. Positive ion densities, at times, are seen to be an order of magnitude higher than the electron number densities in the upper mesospheric region. Rocket observations have also shown the presence of dust layers in this region charged positively on top and negatively at the bottom. Such dust layers can reverse the vertical polarization field locally and can even produce the phenomenon of counter electrojet. Model calculations of the electrojet current density taking into account these effects of dust particles are presented here.

La ablación de meteoritos deja un gran número de partículas de polvo de tamaños que van de los nanómetros a los micrómetros en la región mesosférica alta. Estas partículas de polvo pueden afectar las conductividades de la región E ecuatorial de muchas maneras. La mayoría de ellas permanecen eléctricamente neutras y pueden afectar las frecuencias de colisión del electrón y del protón, especialmente en la región E inferior, y eventualmente alterar la conductividad eléctrica de esta región. Esto puede subir el máximo de la conductividad de Cowling por varios kilómetros haciéndolo coincidir con el máximo de la corriente del electrojet observado. Las partículas de polvo cargadas en la capa E inferior pueden reducir considerablemente la densidad de corriente del electrojet en la región al capturar un número importante de electrones libres de dicha región. Una evidencia clara de esto es la gran diferencia entre las concentraciones de iones positivos y electrones observada en esta región por sondas in situ. Algunas veces se ha visto que la concentración de iones positivos es un orden de magnitud más grande que la de los electrones en la región mesosférica alta. Las observaciones mediante cohetes también han mostrado la presencia en esta región de capas de polvo cargadas positivamente en la parte superior y negativamente en la parte inferior. Estas capas de polvo pueden invertir el campo de polarización vertical localmente y aun producir el fenómeno de contra electojet. En este trabajo se presentan los cálculos del modelo de densidad de corriente del electrojet tomando en cuenta estos efectos debidos a las partículas de polvo. doi: https://doi.org/10.22201/igeof.00167169p.2008.47.3.74

La definición explícita de prioridades en intervenciones de salud representa una oportunidad para México de equilibrar la presión y la complejidad de una transición epidemiológica avanzada, con políticas basadas en evidencias generadas por la inquietud de cómo optimizar el uso de los recursos escasos para mejorar la salud de la población. La experiencia mexicana en la definición de prioridades describe cómo los enfoques analíticos estandarizados en la toma de decisiones, principalmente los de análisis de la carga de la enfermedad y de costo-efectividad, se combinan con otros criterios -tales como dar respuesta a las expectativas legítimas no médicas de los pacientes y asegurar un financiamiento justo para los hogares-, para diseñar e implementar un grupo de tres paquetes diferenciados de intervenciones de salud. Éste es un proceso clave dentro de un conjunto más amplio de elementos de reforma dirigidos a extender el aseguramiento en salud, especialmente a los pobres. Las implicaciones más relevantes en el ámbito de políticas públicas incluyen lecciones sobre el uso de las herramientas analíticas disponibles y probadas para definir prioridades nacionales de salud; la utilidad de resultados que definan prioridades para guiar el desarrollo de capacidades a largo plazo; la importancia de favorecer un enfoque para institucionalizar el análisis ex-ante de costo-efectividad; y la necesidad del fortalecimiento de la capacidad técnica local como un elemento esencial para equilibrar los argumentos sobre maximización de la salud con criterios no relacionados con la salud en el marco de un ejercicio sistemático y transparente.Explicit priority setting presents Mexico with the opportunity to match the pressure and complexity of an advancing epidemiological transition with evidence-based policies driven by a fundamental concern for how to make the best use of scarce resources to improve population health. The Mexican priority-setting experience describes how standardised analytical approaches to decision making, mainly burden of disease and cost-effectiveness analyses, combine with other criteria -eg, being responsive to the legitimate non-health expectations of patients and ensuring fair financing across households- to design and implement a set of three differentiated health intervention packages. This process is a key element of a wider set of reform components aimed at extending health insurance, especially to the poor. The most relevant policy implications include lessons on the use of available and proven analytical tools to set national health priorities, the usefulness of priority-setting results to guide long-term capacity development, the importance of favouring an institutionalised approach to cost-effectiveness analysis, and the need for local technical capacity strengthening as an essential step to balance health-maximising arguments and other non-health criteria in a transparent and systematic process.

This paper describes the rehabilitation proposal, methodology of evaluation of distress and likely remedial measures for 100 years old steel bridge on Ulhas river, near Mumbai. The bridge is constructed in year 1914 during British era apparently now heritage bridge as it was constructed with unique structural arrangement of jack arch decking and warren truss girder with verticals. After structural audit in 2000, it revealed the deterioration of steel parts and concrete initiated long back because of humid atmosphere and pollution in the area. Durgadee bridge showed various signs of bridge distress like major cracks in masonry abutments, heavy corrosion of Mild Steel (MS) structural members, non -functioning of expansion joints and bearings, failure of jack arch roof plates, de-bonding of concrete and exposed reinforcement etc. Paper discusses recommendations for rehabilitation and corrosion protection.

Abstract Background: There are various approaches to perform an ultrasound guided Quadratus Lumborum Block (QLB). The lateral, posterior, anterior or trans muscular and subcostal paramedian are the various approaches described for performing a QLB. Each of these blocks are aimed to achieve a maximum spread with high volume and low concentration of local anesthetics. Case report: In this novel approach a curvilinear ultrasound probe was used with the patient lying in supine position. The probe was placed longitudinally in the mid axillary line to visualize Quadratus Lumborum Muscle (QLM) in the coronal plane. The needle was then introduced from cranial to caudal direction and catheters were inserted in the Anterior Thoracolumbar Fascia (ATLF) up to a distance of 4-5 cm in 24 patients for an anterior approach to acetabulum fractures. The needle tip and the Local Anesthetic (LA) spread was visible in all patients. All patients except 4 had excellent perioperative pain relief considering stable hemodynamics and VAS 2-3/10 for the first 48 hours. All patients received 1 g intravenous paracetamol each 8 hours. VAS in postoperative period was 2-3/10, in 20/24 patients. In the postoperative period, 4 patients complained of persistent pain, requiring intravenous fentanyl boluses and multimodal analgesia. Mean VAS score was 2.87 from 0-12 hours, 3.14 from 12-24 hours and 3.35 from 24-48 hours. There were no block-related complications in any patient. Conclusion: The supine midaxillary coronal approach to anterior QLB is an effective and feasible approach to QLB which can be performed in supine position.