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Background: Posterior Fossa Extra Dural Hematoma (PFEDH) is a rare entity but certain crucial structures are supposed to be injured. Because of limited space in the posterior fossa, a clinical small volume of hematoma can deteriorate patients. Therefore timely diagnosis and prompt intervention are required. Objective: This study is done to analyse factors like demographic profile, mode of injury, clinical features in relation to PFEDH and its management and how they influence the outcome. Materials & methods: This is a retrospective analysis of patients who presented with PFEDH from July 2016 to July 2021 at RNT Medical College and M.B. group of Hospitals Udaipur, India. Patients were evaluated on the basis of demographic profile, mode of injuries, GCS on admission & discharge, and associated radiological findings. Result: A total of 25 patients with PFEDH were included in this study. Amongst these, 18 (72%) were males, and10 (40%) were less than 18 years of age. On admission 19 (76%) had GCS 13-15.22 (88%) patients underwent surgery and 3 (12%) were planned for conservative management. At 6-month follow-up, 22 (88%) patients had good outcomes with GOS 3-5 and 1 was lost to follow up while 2 (8%) had poor outcomes with GOS 1-2. Conclusion: GCS on admission is a good predictor of outcome. The volume of EDH was one of the key factors in deciding the line of management. PFEDH can sometimes be rapidly fatal due to expansion of hematoma and compression of posterior cranial fossa space which leads to brain stem compression therefore time management is the most important factor for a good outcome.

With the increase in transistor integration in Very Large Scale Integration (VLSI) design, energy efficiency plays a major role as a design parameter. One of the key ideas used in reducing power consumption is by reducing the transistor switching. One of the effective solutions for achieving low power is by using an adiabatic logic style. As the technology grows, along with the device scaling, designers have to spend more time in debugging errors, which causes an increase in overall design and verification time. Since synchronisation of the power-clock phases is complex, the functional verification of four-phase adiabatic logic is time taking. A new adiabatic logic (MPFAL) based on positive feedback adiabatic logic (PFAL) circuit is proposed, which resolves the above problems. To show the feasibility of the proposed circuit, some available circuit styles like 2N2P, 2N-2N2P, differential cascode and pre-resolved adiabatic logic and PFAL are selected, and their power delay product at various frequencies (10–500 MHz) is compared with the proposed circuit. Monte Carlo simulation results show that the proposed circuit has better performance as compared to the existing adiabatic circuits. [ABSTRACT FROM AUTHOR]

Study design: Prospective hospital-based study. Background: Annual incidence of bilateral chronic subdural hematoma (CSDH) is increasing due to an increase in the ageing population, associated medical comorbidities such as haemodialysis, anticoagulant and/or antiplatelet therapy. Objectives: 1. To determine the socio-demographic and clinical profile of bilateral CSDH patients. 2. To determine treatment outcome and its association with the socio-demographic profile. Method: A prospective hospital-based study was carried out on 100 confirmed patients of bilateral CSDH. Information of patients such as socio-demographic profile, clinical presentation and laboratory investigation, along with treatment and outcome were recorded and analysed. Results: Among 100 patients, male and female were 74% and 26%. The mean age of patients was 63.03±13.57 years. A history of head injury was reported by 49% of patients. The mean Glasgow coma scale (GCS) was 12.14±2.38. Common presenting symptoms were hemiparesis (69%), headache (58%), aphasia (18%) and complete loss of consciousness (16%). Clinical improvement was observed in 81% while 09% had no change, 06% shows clinical deterioration and 04% of patients die during treatment. Conclusion: Bilateral CSDH is common in the elderly and prognosis is poor with increasing age however gender has no association with poor outcomes. More than 80% of patients recover with timely interventions. Key message: Surgery leads to achieving good outcomes in cases of bilateral chronic SDH, but not all such patients will recover completely. Similarly, good functional outcomes can also be achieved in those presented early after symptom onset when managed promptly.

AbstractIn the present investigation, the low hydrogen ferrite consumable weldment (weldment-1) and austenitic stainless steel consumable weldment (weldment-2) of rolled and homogenous armor steel (RHA) have been prepared with manual metal arc welding (MMAW). Further, the influence of weldments (weldment-1 and weldment-2) microstructure on the dynamic fracture toughness (J1d), strength, ductility and hardness has been evaluated and compared. The three different approaches have been utilized to estimate J1d for RHA weldments. Further, all three approaches’ outcomes have been compared with the elastic-plastic fracture mechanics (EPFM) approach through Jp-R curve. The results revealed that weldment-1 (yield strength 504.24 MPa and ultimate tensile strength 763.03 MPa) exhibited 26.93 and 25.07% more yield and tensile strength respectively than weldment-2 (yield strength 384.55 MPa and ultimate tensile strength 593.05 MPa). Further, the elongation of weldment-2 (elongation 42%) is 26.72% more than weldment-1 (elongation 32.10%). The joint efficiency and fusion zone hardness of weldment-1 are 5.85 and 57.56%, respectively more than weldment-2. The EPFM approach has good agreement with the correction factor approach (approach 2) and the compliance change rate approach (approach 3) with less than 7% difference in the estimation of dynamic fracture toughness of base metal and weldments (weldment-1 and weldment-2). Further, the percentage difference between maximum load point approach (approach 1) and the EPFM approach is more than 15% difference. The fractographic investigation confirms the ductile fracture in all under-investigated materials. [ABSTRACT FROM AUTHOR]

Study design: Prospective long term follow-up study Background: Hydrocephalus remains a common cause of admission in pediatric neurosurgery units. Of the two prevalent modalities of treatment for hydrocephalus in infants, i.e. endoscopic third ventriculostomy and ventriculoperitoneal shunt, which one is a better option, especially in a tribal setting, is a matter of debate. Aim: To determine and compare the effectiveness of endoscopic third ventriculostomy versus ventriculoperitoneal shunt for the treatment of infants in a tribal population. Methods: A prospective follow-up study was carried out on 70 patients of hydrocephalus with age less than or equal to 12 months during a period of 7 years from August 2014 to June 2021. A detailed history, physical examination, and computed tomography scan were done in all the cases. Based on patient condition, aetiology and parents choice, 30 patients were treated by Endoscopic third ventriculostomy and 40 patients were treated by ventriculoperitoneal shunt. At enrolment, baseline clinical data were collected. Postoperative data were collected, including assessments of complications and treatment failures. Results: A total of 70 infants with hydrocephalus were enrolled in the study and out of them, 30 (42.86%) underwent ETV and 40 (57.14%) underwent VP shunt for the initial treatment of their hydrocephalus. The mean age of patients was 6.4±1.2 months with a range of 18 days to 342 days. Clinical improvement was shown in 76.67% and 70% in ETV and VP shunt groups respectively. No significant difference (p=0.53) was observed in clinical outcomes in both groups. In the 1 to 6 months of age group, 07 (30.43%) clinically improved patients were from the ETV group, while in the VP shunt group, 10 (35.71%) patients showed improvement. In the 7 to 12 months age group, 16 (69.57%) clinically improved patients were from the ETV group and 18 (64.29%) patients were from the VP shunt group (p=0.69). Association of treatment success with gender, term of gestation and aetiology of hydrocephalus was not statistical significant (p>0.05). Out of 70 patients with hydrocephalus, postoperative complications such as infection, CSF leak, haemorrhage and blockage was found in 09 (12.86%), 08 (11.43%), 05 (7.14%) and 08 (11.43%) patients respectively. A significant higher proportion of infection (p=0.043) and blockage (p=0.023) was found in the VP shunt group than in the ETV group. Conclusion: Treatment success was high in both procedures. VP shunt was found to be more successful than ETV in terms of clinical outcome in both age groups. However, the results were statistically insignificant. A significantly higher proportion of complications was found with VP shunt than ETV therefore greater benefits can be achieved using ETV. Thus for a tribal population, where patient compliance is poor and healthcare accessibility, as well as regular follow-up, is difficult, a procedure like ETV can be considered better than VP shunt.

Study design: Retrospective study with prospective long-term clinical follow-up. Background: Cauda equina syndrome (CES) is a neurosurgical emergency, mostly caused by herniated lumbar disc for which urgent surgical decompression is indicated. Data on long-term clinical outcome of bladder, bowel & sexual function following decompression are elusive. Aim: To evaluate the effectiveness of surgical decompression on recovery of CES symptoms at long-term follow-up & role of timing of surgery on the outcome. Methods: Records of 35 CES patients who underwent surgical decompression for herniated lumbar disc during a five years period retrospectively analysed & patients called for follow-up visits. Outcome measures comprised of history & clinical examination pertinent to bladder, bowel & sexual function. Results: Twenty-four patients (68.5%) were included for final evaluation who attended follow-up visits, with a minimum follow-up period of one year. Most common complaint at presentation was bladder dysfunction (100%) with urinary retention in 16 patients (66.6%), faecal incontinence in 11 (45.8%), saddle anaesthesia in 22 (91.6%) & erectile dysfunction in 6 patients (out of 15 males). Only four patients underwent surgery within 48 hours of CES symptom onset, rest cases after 48 hours duration. At follow-up, bladder dysfunction present in 33.3% with urinary retention in 16.6%. Faecal incontinence persisted in 4 patients (16.6%) & saddle anaesthesia in 7 (29.1%). Sexual dysfunction was the most persistent complaint. Conclusion: Long-term follow-up shows significant recovery of sphincteric function in CES patients after surgical decompression. Urinary & bowel dysfunction improve significantly. Timing to surgery didn’t affect the long-term outcome.

The automotive and aerospace industries are replacing monolithic conventional materials with composite materials for making variety of components. The aluminum metal matrix composites (AMCs) are a lightweight high perforce materials. The aluminum matrix composites (AMCs) have high strength to weight ratio as well as high corrosion resistance properties. Many automobile and aerospace components are made of AMCs. The stir casting fabrication technique is mostly used by researchers for the fabrication of aluminum matrix composites. In this research, Al 6063 matrix composites were fabricated by reinforcing varying percentages of TiB2 through the stir casting process. The wt% of TiB2 varied from 1 to 3% in Al 6063. The mechanical behavior of developed composites was analyzed. The result showed that tensile strength, hardness, and impact strength of composites were enhanced by 55.51%, 63.98%, and 28.13% respectively in comparison with the matrix material. [ABSTRACT FROM AUTHOR]