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An 11-year-old girl was brought to us with complaints of restriction of movements of the left shoulder and a deformity of the back for the past 1 year, which had gradually progressed over 1 year. The child was yet to attain menarche. On examination, her physical development was found to be Tanner

Computer vision techniques are an emerging trend today. Digital image processing is gaining popularity because of the significant upsurge in the usage of digital images over the internet. Digital image processing is a practice that can help in designing sophisticated high-end machines, which can hold the ophthalmic functionality of the human eye. In agriculture, leaf examination is important for disease identification and fair warning for any deficiency within the plant. Many prominent plant species are facing extinction because of a lack of knowledge. A proper realization of computer vision techniques aid in extracting a significant amount of information from leaf image. This necessitates the requirement of an automatic leaf disease detection method to diagnose disease occurrences and severity, for timely crop management, by spraying pesticides. This study focuses on techniques of digital image processing and machine learning rendered in plant leaf disease detection, which has great potential in precision agriculture. To support this study, techniques exercised by various researchers in recent years are tabulated.

Introduction: Osteosarcoma is a malignant tumor, the treatment of which is controversial between amputation and limb salvage surgery. Osteosarcoma occurring in a child is a challenge to manage due to the arrest of limb and the resultant limb length discrepancy. The management options for a child less than eight years of age are very limited. Case report: We present a case of a six year old child who was diagnosed to have osteosarcoma of proximal tibia. She was started on neoadjuvant chemotherapy, after which, she underwent wide resection and reconstruction with free vascularised fibular graft. The joint was fused using a locking compression plate and screws. The locking screws were inserted avoiding the distal femoral physis, enabling growth of the physis in future. Adjuvant chemotherapy was then given. Follow up radiographs showed Harris growth lines indicating growth to be occurring at the distal femoral physis. She was not found to have recurrence on last follow up four years after surgery. Conclusion: We found reconstruction using free fibular graft and arthrodesis using plate and screws, provided satisfactory results. An attempt can be made to preserve the distal femur physis.

Introduction:Osteoid osteoma is a benign, bone forming tumor which accounts for nearly 10% of all benign bone tumors. The foot is very rarely involved, with only around 2% of osteoid osteomas being reported to occur in bones of the foot. Osteoid osteoma of the talus could present as symptoms mimicking monoarticular arthritis of the ankle. We present a case of osteoid osteoma occurring in the neck of talus, presenting such a diagnostic dilemma. Case Report:A 13-year-old male child had complaints of pain and swelling in his right ankle since 1 year. The pain was predominantly aggravated at night and partially relieved by non-steroidal anti-inflammatory drugs. On examination, we found a diffuse, ill-defined, and soft swelling over the anteromedial aspect of the right ankle, which was anterior and inferior to the medial malleolus. The movements at the ankle joint were restricted and painful. Lateral radiograph of ankle revealed a solitary, osteolytic, and circular lesion involving the neck of the talus. Computed tomography (CT) scan showed a well-defined, lucent, and intramedullary lesion with a sclerotic rim in the neck of talus. The child was diagnosed to have osteoid osteoma of the neck of talus. We performed percutaneous CT-guided radiofrequency ablation (RFA) of the lesion. The child had complete relief of pain after the procedure. The child was followed up for 3 years and had no complaints of pain. Conclusion:Osteoid osteoma very rarely occurs in the talus. It can present as monoarticular arthritis involving the ankle joint and requires a high degree of suspicion to be identified. A CT scan remains the most accurate investigation to confirm the diagnosis. We found percutaneous CT-guided RFA to have yielded good outcome without recurrence. Keywords:Osteoid osteoma, ankle arthritis, talus, radiofrequency ablation.

Introduction: Aneurysmal bone cyst (ABC) is a rare, benign, and cystic lesion. The most common sites are the femur, tibia, humerus, and spine. It is more common in females and usually occurs during the second decade of life. Case Report:A 5-year-old female child had a trivial fall, following which she developed pain in her left hip. Radiographs revealed an expansile, lytic lesion in the metaphysis of the left proximal femur. Cortical breach was present resulting in a pathological fracture. Biopsy of the lesion showed blood filled cystic spaces confirming the diagnosis of ABC. We performed an extended curettage of the lesion, bone grafting, and angle blade plate fixation. The angle blade plate was removed 1 year after the surgery. Two years later, she complained of pain in the left hip. Radiographs showed a geographic lytic lesion surrounding the previously inserted bone graft. Magnetic resonance imaging revealed multiple blood fluid levels. We performed an extended curettage with high speed burr. We filled the cavity with bone substitute and stabilized the region using a proximal humerus internal locking system plate. The histopathological examination of intraoperative samples confirmed the diagnosis of recurrence of ABC. We found no further recurrence of the tumor after 3 years of follow-up. Conclusion:ABCs can present with pathological fractures and requires management of the cyst and stabilization of the bone. Recurrent ABCs can be managed by re-curettage of the lesion and prophylactic internal fixation. The curettage has to be extensive through a large cortical window and using a high speed burr. Keywords:Aneurysmal bone cyst, recurrence, pathological fracture, treatment.

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are commonly performed surgeries worldwide. The number of joint replacement surgeries being performed has increased considerably over the past two decades, but it has also seen an increase in litigation associated with it. The purpose of our study was to review and consolidate literature regarding medico-legal issues pertaining to THA and TKA cases. We looked at the causes of litigation, medico legal aspects of pre-operative requirements, optimisation of medical condition, indications and contraindications for arthroplasty, informed consent, implants, mixing of components from different manufacturers and post-operative rehabilitation. We also wanted to analyse available literature and legal proceedings regarding these cases in India specifically.

Background It is estimated that around 20–25% of world's adult population have metabolic syndrome. Moreover, the prevalence is also high among south Asians and Indians and about one third of the urban population in large cities has varying degrees of Metabolic Syndrome.5 Objectives To study the prevalence among adults who are at risk of metabolic syndrome, gender difference of the same. To study the association of socio-demographic factors, family history and personal history, biochemical parameters, lifestyle addictions, dietary pattern and adequacy with the risk of metabolic syndrome. Methodology A descriptive study was undertaken in Udupi District, Karnataka, India in which a total of 420 adults (aged >20 years) from the general population were studied. Anthropometric measurement like height, weight, waist circumference, BMI waist hip ratio (WHR) was measured. Biochemical parameters like Blood Pressure, Fasting Glucose level, Post Prandial, HDL, LDL, TG, Triglyceride level from the existing records was recorded. Lifestyle addictions/habits like smoking, alcohol, Tobacco chewing and Drugs was assessed. Dietary assessment was done using 24-h recall in the diet software. Chi-square test, Correlation analysis and Paired t-test were used when appropriate using SPSS package. Results and discussion On the basis of metabolic syndrome risk assessment score of biochemical parameters, 50% of the samples are at moderate/at risk category, while 46.4% of the samples are at low/no risk and 3.6% of the samples showed the prevalence of metabolic syndrome. On the basis of lifestyle addiction, 73.1% of the samples were at moderate risk of metabolic syndrome while 13.8% were at high risk and 13.1% were at no/low risk of metabolic syndrome. This explains that more than 50% of the samples are at moderate risk group. The statistically significant risk factor for metabolic syndrome were females (p = 0.000), advancing age (p Conclusion With urbanization and economic development, a nutritional transition characterized by improved dietary habits, improvements in socio-economic status and increasingly sedentary lifestyles have been observed which has contributed to the increasing prevalence of risk of metabolic syndrome among the population of Udupi, Karnataka.

The structural property of the search graph plays an important role in the success of local search-based metaheuristic algorithms. Magnification is one of the structural properties of the search graph. This study builds the relationship between the magnification of a search graph and the mixing time of Markov Chain (MC) induced by the local search-based metaheuristics on that search space. The result shows that the ergodic reversible Markov chain induced by the local search-based metaheuristics is inversely proportional to magnification. This result indicates that it is desirable to use a search space with large magnification for the optimization problem in hand rather than using any search spaces. The performance of local search-based metaheuristics may be good on such search spaces since the mixing time of the underlying Markov chain is inversely proportional to the magnification of search space. Using these relations, this work shows that MC induced by the Metropolis Algorithm (MA) mixes rapidly if the search graph has a large magnification. This indicates that for any combinatorial optimization problem, the Markov chains associated with the MA mix rapidly i.e., in polynomial time if the underlying search graph has large magnification. The usefulness of the obtained results is illustrated using the 0/1-Knapsack Problem, which is a well-studied combinatorial optimization problem in the literature and is NP-Complete. Using the theoretical results obtained, this work shows that Markov Chains (MCs) associated with the local search-based metaheuristics like random walk and MA for 0/1-Knapsack Problem mixes rapidly.

Background Transitioning from pediatric to adult health care is associated with significant psychosocial and clinical morbidity. Adolescents not only transition their medical care, but also experience vast changes in the physical, social, and psychological spheres of their lives. The medical team must help navigate these changes to provide optimal care. IBD in adolescence is associated with increased hospitalizations and surgery. This is due to several factors, including medication non-adherence and a failure to attend medical appointments. There has been a greater focus on improving care for this unique population. McMaster Children’s Hospital has integrated the AYA IBD clinic for patients between the ages of 16 and 22. The goal is to transition patients using a developmentally appropriate framework to facilitate self-efficacy and help identify comorbid mental health conditions while building resilience. Aims To explore the impact of the implementation of a dedicated transition clinic on attendance at medical visits for AYA patients with IBD. Methods The total numbers of patients booked in the AYA IBD Clinic was compared to an age matched subset of the patients in the adult McMaster Complex IBD (CIBD) Clinic. These visits were assessed based on whether the visit was: attended, cancelled, or no showed. Visits were then stratified between in-person and virtual visits. Unpaired t tests was performed to compare the AYA IBD clinic and the CIBD clinic. Findings were deemed significant based on p-values Results The percentages of patients that attended visits (in-person or virtually) was similar between both clinics at 86% versus 79% Year 1 (Y1) and 76% versus 81% Year 2 (Y2). The number of patients seen in the AYA clinic increased from Y1 (n=92) to Y2 (n=131). The CIBD clinic saw fewer patients between Y1 (n=202) and Y2 (n=79). There were a higher number of patients who cancelled or no showed in Y2 versus Y1 for the AYA virtual visits (13 versus 8) compared to the CIBD clinic (Y2,1 versus Y1,1). Conclusions Our results highlight the challenges of transitioning adolescent patients with IBD. Our retrospective study was not powered to show significance. Given the increase in cancellation and no-show rates in Y2, the AYA clinic has incorporated a patient navigator to issue reminder phone calls and facilitate communication with patients between clinics. Future studies will re-assess how the presence of a patient navigator impacts attendance and cancellation rates. Future studies will also assess how the AYA clinic impacts transition readiness and self-efficacy, which is being measured through validated questionnaires in our clinic. Funding Agencies Grants-In-Aid

The treatment and outcome of tibial stress fractures concomitant with knee osteoarthritis (OA) are complicated. The aim of this study was to evaluate the functional and radiological outcome of total knee arthroplasty with long tibial stem as a treatment for patients having knee OA and tibial stress fracture.Patients who were diagnosed to have proximal tibia stress fracture along with knee OA at our institution between June 2013 and November 2018 were included in our study. All patients underwent total knee arthroplasty with long tibial stem. Preoperative and postoperative functional assessments were done according to range of movement of the knee joint, knee society score and knee injury and OA outcome score. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.Twelve patients were included in the study. All patients were found to have stress fractures in the proximal half of tibia and extra-arthrosis. Four patients had non-union/delayed union, and 8 patients had acute fractures. The average preoperative range of movement was 88.1°, which improved to 116.3° at 3 months following surgery. It was found that the fracture has healed in all cases. Mean knee society score improved from 32.9 preoperatively to 89.3 at 1 year follow-up. Knee injury and OA outcome score improved from a mean score of 28.3 preoperatively to 81.1 at 1 year follow-up.Stress fractures can occur in the proximal tibia in patients with knee OA. Total knee arthroplasty with tibial stem provides a suitable solution for both conditions. Additional plating or bone graft is unlikely to be required.

A 63-year-old man who was known to have chronic liver disease underwent a CT of the abdomen for evaluation of liver morphology. In the CT abdomen, he was coincidentally found to have an osteolytic lesion of the left proximal femur. He did not have any problems involving his left hip or thigh. On

Introduction: In patients with advanced cancer, prolongation of life with treatment often incurs substantial emotional and financial expense. Among hospitalized patients with cancer since acute kidney injury (AKI) is known to be associated with much higher odds for hospital mortality, we investigated whether renal replacement therapy (RRT) use in the intensive care unit (ICU) was a significant independent predictor of worse outcomes. Methods: We retrospectively reviewed patients admitted in 2005 to 2014 who were diagnosed with stage IV solid tumors, had AKI, and a nephrology consult. The main outcomes were survival times from the landmark time points, inpatient mortality, and longer term survival after hospital discharge. Logistic regression and Cox proportional regression were used to compare inpatient mortality and longer term survival between RRT and non-RRT groups. Propensity score-matched landmark survival analyses were performed with 2 landmark time points chosen at day 2 and at day 7 from ICU admission. Results: Of the 465 patients with stage IV cancer admitted to the ICU with AKI, 176 needed RRT. In the multivariate logistic regression model after adjusting for baseline serum albumin and baseline maximum Sequential Organ Failure Assessment (SOFA), the patients who received RRT were not significantly different from non-RRT patients in inpatient mortality (odds ratio: 1.004 [95% confidence interval: 0.598-1.684], P = .9892). In total, 189 patients were evaluated for the impact of RRT on long-term survival and concluded that RRT was not significantly associated with long-term survival after discharge for patients who discharged alive. Landmark analyses at day 2 and day 7 confirmed the same findings. Conclusions: Our study found that receiving RRT in the ICU was not significantly associated with inpatient mortality, survival times from the landmark time points, and long-term survival after discharge for patients with stage IV cancer with AKI.

The present paper encorporates the effet of magnetic field on the incompressible Casson fluid flow between two parallel infinite rectangular plates approaching towards or away from each other with suction or injection at the porous plates. Using similarity transformations the governing Navier-Stokes equations are reduced to a nonlinear ordinary differential equation. Semi-analytical solution is obtained based on the Homotopy perturbation method. Further, the solution is compared with the classical finite difference method separately. The effect of magnetic field on velocity, skin friction and pressure is analysed on flow between two plates with suction or injection, where two plates moving towards or away from each other.

Background: The choice between preserving, sacrificing or substituting the posterior cruciate ligament (PCL) is always a controversial topic in total knee replacement (TKR). Dished polyethylene insert with PCL resection enables correction of the commonly present fixed flexion and varus deformities. Additionally, the risk of premature wear of polyethylene is less because of the confirming articular geometry between the femoral and tibial component.Methods: This is a retrospective study in which we studied 120 knees in 95 consecutive patients undergoing primary TKR by the senior author at our institute. We used TKR system with dished metal backed polyethylene tibial component. PCL resection was performed in all cases. Pre-operative and post-operative functional assessment were done using knee society clinical scores and Western Ontario and McMaster universities osteoarthritis index (WOMAC). All radiographs were assessed using the knee society Roentgenographic scoring system (KSRES). Statistical analysis was performed using paired student t tests. Survivorship was determined using Kaplan-Meier survivorship curves. Results: Mean follow-up was 8 years. Range of motion increased from 75 degrees to 110 degrees. The knee society pain score increased from 30 to 94. The knee society function score increased from 35 to 75. WOMAC score increased in terms of pain, stiffness and physical function.Conclusions: We conclude that deep dish bearing is a viable option in presence of deficient PCL and provides adequate stability and functional outcome. We need a larger sample size, multicentre trial and longer follow-up to see for complication rate, revision rate and survival.

Informed consent is an exercise to provide patients with adequate information before undergoing a medical procedure. Orthopaedic surgeons need to be aware of all aspects of informed consent and also certain modifications it requires as per the diagnosis/procedure planned. Extensive literature was reviewed regarding informed consent in orthopaedic cases. Medico-legal verdicts relating to orthopaedic cases where the informed consent played a vital part were analysed in detail. Specific orthopaedic cases and the common complications occurring after them were also analysed.

Background: There are many forms of topical fluoride available today, making the decision as to which is most effective to manage the immediate caries risk problem at hand, very difficult. The objective of this project was to determine the concentration and pattern of fluoride ion uptake into enamel from a variety of categories of topical fluoride recently available in Australia. Methods: Extracted, intact molar teeth were sectioned to provide six plates of smooth surface enamel. Windows of enamel 2 times 6mm were exposed to a variety of topical fluorides for periods simulating those used in vivo. Following drying, the slates of enamel were exposed to 2ml of 0.1M HCl as a chemical biopsy agent for incremental periods of time. The concentrations of fluoride ion in the biopsy solutions for both test and background (control) slates of enamel were determined directly using a fluoride combination selective electrode in conjunction with a high impedance pH meter. Cumulative amounts of fluoride were determined for each topical fluoride agent. Results: The concentrations of fluoride ion taken up into enamel were generally proportional to those present in each agent. However, those from APF gel greatly exceeded the amounts taken up from NaF gel. Also, the concentrations taken up from some of the highly concentrated metal fluorides were surprisingly low. Prior etching of enamel increased uptake and prolonged application of APF gel provided no extra benefit. Conclusions: Some topical fluorides, e.g., APF gel, provided a greatly increased uptake and to a greater depth than other self-application products. However, the frequency of its use should be considered with caution where patients have glass-based restorations.

Sensors used in applications such as agriculture, weather, etc., monitoring physical parameters like soil moisture, temperature, humidity, will have to sustain their battery power for long intervals of time. In order to accomplish this, parameter which assists in reducing the consumption of power from battery need to be attended to. One of the factors affecting the consumption of energy is transmit and receive power. This energy consumption can be reduced by avoiding unnecessary transmission and reception. Efficient routing techniques and incorporating aggregation whenever possible can save considerable amount of energy. Aggregation reduces repeated transmission of relative values and also reduces lot of computation at the base station. In this paper, the benefits of aggregation over direct transmission in saving the amount of energy consumed is discussed. Routing techniques which assist aggregation are incorporated. Aspects like transmission of average value of sensed data around an area of the network, minimum value in the whole of the network, triggering of event when there is low battery are assimilated., 20 pages 16 figures, 7 tables

Objective: To describe the clinical, angiographic profile and management strategies of patients of coronary pulmonary arterial fistulas presenting to a tertiary care center in a developing country. Methods: All patients with coronary pulmonary artery fistula (CPAF) diagnosed using coronary angiogram in last two years i.e. 2011-2013 in a tertiary care center in South India were included in the study. Ten adult patients were treated for coronary pulmonary artery fistulas . Results: Mean age was 56± 7.7 years (range 45-80 years) with no gender preponderance. Chest pain was the predominant symptom in 60 % of patients followed by giddiness and syncope. Only 20 % patients were found to have continuous or systolic murmur on auscultation. Majority of the fistulas were found to be originating from the left anterior descending artery (LAD), most commonly from proximal segment (n = 5). Majority (n = 9) responded to conservative management while one patient required surgical intervention. Conclusion: Coronary pulmonary arterial fistulas are rare coronary anomaly which often goes unnoticed. CPAF was most frequently seen in middle age with male preponderance arising from proximal LAD. Patients present with diverse clinical presentations and subtle clinical findings. Majority of them being functionally insignificant, need only conservative measures.

Dirofilaria is parasitic nematodes of domestic and wild animals that can infect humans accidentally via vectors. Its occurrence in the oral cavity is extremely rare. The most frequent presentation of human dirofilariasis is a single submucosal nodule without signs of inflammation. We hereby, report a case of human dirofilariasis affecting the buccal mucosa in a 32-year-old farmer caused by D. repens.

Study Design Prospective cohort study. Purpose To determine whether there was any change in the quality of life of patients in sedentary/non sedentary occupations treated with epidural steroid injection for lumbar disc herniations using the 8 components of the SF 36 questionnaire.Overview of Literature: No previously done similar study published. Overview of Literature No previously done similar study published. Methods Ninety patients comprising sedentary and non sedentary occupations with lumbar disc herniations on magnetic resonance imaging who were treated with epidural steroid injection at St. John's Hospital Bangalore who met the Spinal Outcomes Research Trial eligibility criteria from April 2009 to May 2010. Results Of the 90 patients evaluated 44 were of Sedentary and 46 were of non sedentary activity levels, At 6 months primary outcomes physical functioning (p = 0.573, in difference between sedentary and non sedentary, improvement p = 0.001) energy/fatigue (difference between the two p = 0.917, improvement p = 0.001), emotional well being (difference p = 0.912, improvement, p = 0.001), social functioning (difference p = 0.523, improvement p = 0.232), pain (difference p = 0.535, improvement p = 0.001), general health (difference p = 0.738, improvement p < 0.001). Conclusions There was a statistically significant improvement in patients of both the sedentary and non sedentary groups p < 0.001 in all components of the SF36 in both sedentary and non sedentary patients except social functioning where the improvement was not statistically significant, and there was no significant difference between non sedentary and sedentary populations over time.

Syntheses of racemic forms of the main secondary metabolites of Quararibea funebris, (+/-)-funebrine, (+/-)-funebral, and their biogenetic precursor (+/-)-(2S,3S,4R)-gamma-hydroxyalloisoluecine lactone have been developed. In synthetic studies, a new variation of the Paal-Knorr condensation employing titanium isopropoxide was utilized to construct the pyrrole lactone moiety. Two efficient synthetic approaches to the key (+/-)-gamma-amino lactone have been developed, one based on Claisen chemistry and the other on addition reactions to the butenolide ring of beta-angelicalactone. The restricted rotation around the C(sp(3))-N(sp(2)) bond in the pyrrole lactone structures of (+/-)-funebrine, (+/-)-funebral, and related aldehydes has been probed by conformational dynamic studies, and the barriers for interconversion between conformations have been measured by full NMR line-shape analysis. Molecular mechanics (MMX) and a (1)H-(1)H NOE study indicate a distinct preferred conformation for (+/-)-funebrine.

Between June 1994 and December 1995, one hundred and fifteen tumours and tumour-like lesions of the breast were studied in the Department of Pathology, Kasturba Medical College, Mangalore. Neoplasms constituted 80.9% and tumour like lesions accounted for 19.13%. Among the tumours, 51.6% were benign and 48.4% were malignant. Tumour-like lesions included the entire spectrum of fibrocystic disease. Tumours were common between 2nd and 8th decades while tumour-like lesions were uncommon above 6th decade. Whereas benign tumours exhibited ground substance, collagen and reticulin fibres in varying amounts, tumour-like lesions and carcinoma showed more of collagen fibres and less of ground substance. Elastosis and lymphoplasmacytic infiltrate were prominent features in carcinomas rather than in benign lesions.