Search

INTRODUCTION: The acromioclavicular joint (ACJ) is a major link connecting the upper limb to the torso. The acromioclavicular and coracoclavicular (CC) ligaments help in stabilising the joint. We feel it is prudent to address both these ligament injuries, to achieve optimum result. This study was undertaken to analyse the results of a simple frugal surgical technique we used to deal with this injury considering stabilisation for both these ligaments. MATERIALS AND METHODS: In this retrospective study, skeletally mature patients with Type III, IV or V ACJ dislocations who underwent open reduction and stabilisation of the joint with temporary K-wires, repair of the capsule and augmentation of CC ligaments with suture anchors were included. Clinico-radiological and functional outcome was evaluated. Functional assessment of the upper limb was analysed using the Disabilities of Arm, Shoulder, and Hand Score (DASH), Constant shoulder score (CSS) and Oxford shoulder score (OSS). RESULTS: Clinical and radiological evaluation of the 32 patients who had completed two years from the index surgery, was done. Out of the 37 patients included initially, five were lost in follow-up. Majority of the subjects included were males and type V was the most common injury. Mean pre-operative CC distance on the affected side was 13.92±4.94mm. In the immediate post-operative radiograph, it was 7.63±2.08mm and in the final follow- up was 9.36±2.75mm. Measurements were taken by two independent investigators and inter, and intra-observer reliability were analysed by Interclass correlation coefficient. Excellent functional outcome was noted despite the 1.81±1.50mm average loss of correction. At final follow- up, mean DASH score was 4.67±4.18, Oxford shoulder score was 44.06±2.44 and Constant shoulder score was 86.37±5.81. The severity of the injury had no significant effect on the functional outcome post our method of stabilisation and rehabilitation. CONCLUSION: Bifocal fixation restores the multidirectional stability of the disrupted ACJ. Adequate radiological reduction, good functional outcome and simplicity of execution make this technique an undemanding one for use in regular practice.

No abstract available. Article truncated after 150 words. A 58-year-old man with a history of human immunodeficiency virus on antiretroviral therapy, bullous emphysematous lung with right upper lobe cavity presented with hemoptysis for three days. On presentation, he was afebrile, with normal oxygen saturation on room air and reduced bilateral breath sounds. Computed tomography (CT) of the chest showed a thick wall cavity at the right upper lobe, with a 3 cm heterogeneous mass at the posterior aspect of the cavity (Figure 1 A). When the patient was placed in the prone position, the soft tissue lesion displaced anteriorly (Figure 1B) showing gravity-dependency (Monod's sign). His serum Aspergillus fumigatus antibodies were also positive. The patient was diagnosed with aspergilloma and started on voriconazole initially. However, because of recurrent hemoptysis, the patient was scheduled to undergo surgical excision. Saprophytic aspergillosis is the causative organism for the development of an aspergilloma (1). It results from colonization of fungus in a …

No abstract available. Article truncated after 150 words. A 70-year-old woman with a history of hypertension presented with left-sided weakness, headache, nausea, and vomiting. She denied loss of consciousness or seizure activity. On examination, she had receptive aphasia. Pupils were equal, round and reactive. She had neck pain on flexion. Her left upper extremity was plegic. Computed tomography of the brain showed acute hemorrhage involving the right thalamus, extending into the ventricular system, and a midline mass. She underwent a computed tomography angiogram, which showed a large, complex arteriovenous malformation (AVM) with a dilated branch of the right suprasellar internal carotid artery feeding the AVM, which then drained into the vein of Galen and straight sinus (Figure 1). She was monitored in the intensive care unit without worsening neurological deficit. She was discharged to a rehabilitation facility, having had no intravascular or surgical intervention. AVMs are intracranial vascular anomalies which occur in 0.1% of the population (1). Clinical …

No abstract available. Article truncated at 150 words. A 42 year-old man with a past medical history of insomnia, post-traumatic stress disorder, depression and both migraine and tension headaches was referred for an overnight sleep study. He had presented to the sleep clinic with symptoms of obstructive sleep apnea. Medications included sumatriptan, amitryptiline, sertraline, and trazodone. His sleep study showed: sleep efficiency of 58.2%, apnea-hypopnea index of 33 events per hour, and arousal index of 14.5/hr. Periodic limb movement index was 29.2/hr. The time spent in the sleep stages included N1 (3.6%), N2 (72.5%), N3 (12.9%), and REM (10.9%). Figure 1 is representative of the several brief waveforms seen on his EEG and chin EMG. Sleep bruxism (SB) is a type of sleep-related movement disorder that is characterized by involuntary masticatory muscle contraction resulting in grinding and clenching of the teeth and typically associated with arousals from sleep (1,2). The American academy of sleep medicine (AASM) criteria for ...

Ameloblastomas have been categorized broadly into three biologic variants: cystic (unicystic), solid, and peripheral. The term plexiform unicystic ameloblastoma refers to a pattern of epithelial proliferation that has been described in cystic lesions of the jaws. Although the histology suggests that cystic ameloblastomas follow a biologically low-grade course, recent evidence suggests that they may often behave clinically as biologically aggressive tumors. This is supported by the high incidence of cortical perforation, tooth resorption, lesion size, bony destruction, and a high rate of recurrence after simple enucleation. This article tries to provide an insight for pediatric dentists regarding this biologically distinct entity. A literature review on the topic has been added along with a case report highlighting the state-of-the-art approach and management of such ameloblastomas, in pediatric patients.

Plexiform neurofibroma is a non-circumscribed, thick, and irregular benign tumor of the peripheral nerve sheath. It is a virtually pathognomonic and often disabling feature of neurofibromatosis type I. The diffuse and soft nature of plexiform neurofibroma is often compared to ′a bag of worms′ and is difficult to distinguish from a vascular malformation or a lymphangioma, thus necessitating thorough clinical and histopathological examination and imaging of the lesion. We present a case of plexiform neurofibroma in a 12-year-old male child.

Aim: To assess the efficacy of topical negative pressure moist wound dressing as compared to conventional moist wound dressings in improving the healing process in chronic wounds and to prove that negative pressure dressings can be used as a much better treatment option in the management of chronic wounds. Materials and Methods: This is a prospective comparative study of data from 112 patients with chronic wounds, of which 56 patients underwent topical negative pressure dressings (17 diabetic, 10 pressure sores, nine ischemic, two varicose, 10 post-infective raw areas and eight traumatic - six had bone exposed, two orthopaedic prosthesis exposed). The remaining 56 patients underwent conventional moist dressings (20 diabetic, two ischemic, 15 pressure sores, three varicose, eight post-infective raw areas and eight traumatic - five had bone exposed, three orthopaedic prosthesis exposed). The results were compared after 10 days. The variables compared were, rate of granulation tissue formation as a percentage of ulcer area covered, skin graft take up as the percentage of ulcer surface area and duration of hospital stay. The variables were compared using Unpaired Student′s t test. A " P" value < 0.05 was considered significant. Results: Out of 56 patients who underwent topical negative pressure dressings, six (10.71%) were failures, due to failure in maintaining topical negative pressure due to defective sealing technique; these were included into the study group. After 10 days, the mean rate of granulation tissue formation was 71.43% of ulcer surface area. All these 56 cases underwent split-thickness skin grafting. The mean graft take-up was 79.29%. The mean hospital stay was 32.64 days. In the remaining 56 patients, the mean rate of granulation tissue formation was 52.85% of ulcer surface area. The mean graft take-up was only 60.45% of the total ulcer surface area. The mean hospital stay was 60.45 days. Conclusion: To conclude, topical negative pressure dressings help in faster healing of chronic wounds and better graft take-up and reduce hospital stay of these patients.

Background Education of ‘108' ambulance personnel involved in transporting neonates may improve outcomes. We assessed i) perceptions/practices of ‘108’ ambulance personnel for transporting neonates, ii) clinical parameters of transported neonates at arrival, and iii) outcomes such as survival/mortality and NICU stay (before and after skill-based educational intervention). Methods We conducted a single-arm intervention study (pre-and post) over 18 months. We assessed the perceptions and practices of 77 ambulance personnel on neonatal transport pre- versus post-intervention. Checklists assessed ambulance equipment availability/usage in both phases. We compared clinical parameters and outcomes of transported neonates between the pre-intervention (n=62) and post-intervention (n=53) phases. We analyzed data using SPSS version 25. Results Post-intervention, there was a significant reduction in the levels of hypothermia (p < 0.001), hypoglycemia (p=0.010), and prolonged capillary refill time (p=0.042), along with improvement in the use of intravenous fluids (p (p < 0.001) in the perceptions/practices of ambulance personnel towards neonatal transport. There was an improvement in the ambulance equipment availability/usage post-intervention. Conclusions The perceptions and practices of the ‘108’ ambulance towards transporting neonates had significantly improved post-educational intervention. Further, a significant decrease in hypothermia, hypoglycemia, and duration of NICU stay was seen in neonates transported post-intervention.

A 45-year-old woman with a past medical history of hypertension and chronic headaches was referred to the sleep laboratory for high clinical suspicion for sleep apnea based on a history of snoring, witnessed apnea and excessive daytime sleepiness. An overnight sleep study was performed. Images during N3 Sleep and REM sleep are shown (Figures 1 and 2). Alpha intrusion in delta sleep is seen in patients with fibromyalgia, depression, chronic fatigue syndrome, anxiety disorder, and primary sleep disorders like psychophysiological insomnia, obstructive sleep apnea, circadian disorders and narcolepsy (1). Bursts of alpha waves during REM sleep may be more common during phasic REM than tonic REM. The REM alpha bursts (alpha activity lasting at least 3 seconds without an increase in EMG amplitude) may represent microarousals (2). Hypersynchronous theta activity should be differentiated from the spike and waveform activity seen in seizures.

Internal hernia may be either congenital or acquired. Its incidence has been reported to be 1-2%. Herniation may be persistent or intermittent. Internal hernia is a rare cause of small bowel obstruction with a reported incidence of 0.2-0.9%. The most common type is paraduodenal. Less common types include mesocolic hernia, which occurs following abdominal surgery. We report mesocolic hernias in two young patients, which presented as small bowel obstruction without any prior abdominal surgery.

A 79-year-old man with known Parkinson’s disease and status post deep brain stimulator (DBS) implantation underwent an overnight polysomnogram for clinical suspicion of obstructive sleep apnea. Artifact was seen on the polysomnogram recording (Figures 1 & 2). Patient-related electrical artifacts may be seen from devices such as pacemakers, deep brain stimulators and vagal nerve simulators. Abrupt discontinuation of DBS is associated with a high likelihood of worsening of symptoms in patients with Parkinson’s disease (1). Patients with DBS are most commonly programmed in monopolar mode. Bipolar configuration, forms a short electrical dipole that affects a relatively smaller volume of tissue and generates far less artifact, suggesting that this may be an effective option in a Parkinsonian patient with indications for polysomnography (2).

A 61-year-old man, with a past medical history significant for hypertension, COPD and morbid obesity with a body mass index (BMI) of 45.81 is referred for an overnight sleep study for suspicion of obstructive sleep apnea. Artifact was noted on the polysomnogram recording as shown above (Figures 1-3). Sweat artifact is characterized by slow undulating movement of the baseline recording in the affected channels due to perspiration altering the potential of the involved electrodes (1). Sweat artifact may mimic delta waves and scored as non-rapid eye movement (NREM) stage 3 sleep. Lowering the room temperature, using a fan on the scalp or replacing the conductive paste on the electrodes may help eliminate the artifact.

No abstract available. Article truncated after 150 words. A 78 year-old man with a past medical history of Parkinson’s disease (PD) presented to the sleep medicine clinic for evaluation of obstructive sleep apnea (OSA). An overnight polysomnogram (PSG) study was consistent with sleep apnea and revealed frequent leg and arm movements and sleep-talking during rapid eye movement (REM) sleep. REM sleep behavior disorder (RBD) is a parasomnia characterized by repeated episodes of abnormal behavior occurring during REM sleep (1,2). On PSG, REM sleep without atonia is seen while features of “normal REM” such as number of REM periods and REM cycling remain intact (2). RBD emerges most often in the context of alpha-synucleinopathies, and occurs in up to 60% of PD patients (3). The presence of RBD may be an important preclinical symptom prior to the onset of PD. Cases of PD with RBD are associated with a unique phenotype with an older age of onset, longer disease ...

A 54 year-old man with a past medical history of attention deficit hyperactivity disorder (ADHD), low back pain, and paroxysmal supraventricular tachycardia presented to the sleep laboratory for evaluation of sleep disordered breathing. Pertinent medications include fluoxetine, ambien, and clonazepam. His Epworth sleepiness score was 18. He had a total sleep time of 12 min. On the night of his sleep study, the patient was restless and repeatedly changed positions in bed. Figures 1 and 2 show the artifact determined to be lead displacement of O1M2 after the patient shifted in bed, inadvertently removing one of his scalp electrodes. The sine waves are 60 Hz in frequency. Once the problem was identified, the lead was quickly replaced to its proper position.

A 59-year-old man with a past medical history significant for hypertension, obesity and depression underwent an overnight polysomnogram for high clinical suspicion for obstructive sleep apnea. His current medications include doxepin, fluoxetine, bupropion, ambien and amlodipine. A snapshot during NREM sleep is shown (Figure 1). Fluoxetine (Prozac®) is a potent selective serotonin reuptake inhibitor (SSRI).“Omnipause” neurons in the brainstem inhibit saccadic eye movements. NREM eye movements result from the potentiation of serotonergic neurons that inhibit these neurons (1). These eye movements occur during all stages of NREM sleep. These atypical eye movements have been reported to be present with a lower incidence with use of other antidepressants, benzodiazepines and neuroleptics and they tend to persist even after discontinuation of the medication (2). The clinical significance of these eye movements is unknown.

Langerhans cell histiocytosis (LCH) accounts for less than 1% of all orbital tumours. Though rare, orbital involvement in LCH is not uncommon. Most reports so far have been in Western literature. We report here a case of LCH of orbit with intracranial extension. To the best of our knowledge, this is the first case of single system multifocal LCH reported from India.

The local compositional heterogeneity associated with the lack of long-range ordering of Mg2+and Nb5+in PbMg1/3Nb2/3O3(PMN) is correlated with its characteristic "relaxor" ferroelectric behavior. Earlier work [Shetty et al., Adv. Funct. Mater. 29, 1804258 (2019)] examined the relaxor behavior in PMN thin films grown at temperatures below 1073 K by artificially reducing the degree of disorder via synthesis of heterostructures with alternate layers of Pb(Mg2/3Nb1/3)O3and PbNbO3, as suggested by the "random-site model." This work confirmed the development of ferroelectric domains below 150 K in long-range-ordered films, epitaxially grown on (111) SrTiO3substrates using alternate target timed pulsed-laser deposition of Pb(Mg2/3Nb1/3)O3and PbNbO3targets with 20% excess Pb. In this work, the first through third-harmonic dielectric charge displacement densities and complex dielectric susceptibilities were analyzed as a function of temperature and frequency in zero-field-cooled PMN films with short- A nd long-range ordering. The long-range ordering decreased the dispersion in the first- A nd third-harmonic dielectric charge displacement densities relative to short-range-ordered films. It was found that the one-dimensional ordering achieved in the long-range-ordered film is insufficient to achieve a fully normal ferroelectric state. In the presence of quenched random electric fields, these films require a small ac field to facilitate percolation of the polar nano-regions, enabling normal ferroelectric-like behavior at lower temperature (T < 240 K). The films behave like a typical relaxor near room temperature. With reduced ordering, the short-range films exhibit greater dispersion in linear and higher order harmonic dielectric charge displacement density.

The local compositional heterogeneity associated with the short-range ordering of Mg and Nb in PbMg1/3Nb2/3O3 (PMN) is correlated with its characteristic relaxor ferroelectric behavior. Fully ordered PMN is not prepared as a bulk material. This work examines the relaxor behavior in PMN thin films grown at temperatures below 1073 K by artificially reducing the degree of disorder via synthesis of heterostructures with alternate layers of Pb(Mg2/3Nb1/3)O3 and PbNbO3, as suggested by the random-site model. 100 nm thick, phase-pure films are grown epitaxially on (111) SrTiO3 substrates using alternate target timed pulsed-laser deposition of Pb(Mg2/3Nb1/3)O3 and PbNbO3 targets with 20% excess Pb. Selected area electron diffraction confirms the emergence of (1/2, 1/2, 1/2) superlattice spots with randomly distributed ordered domains as large as ≈150 nm. These heterostructures exhibit a dielectric constant of 800, loss tangents of ≈0.03 and 2× remanent polarization of ≈11 µC cm−2 at room temperature. Polarization–electric field hysteresis loops, Rayleigh data, and optical second-harmonic generation measurements are consistent with the development of ferroelectric domains below 140 K. Temperature-dependent permittivity measurements demonstrate reduced frequency dispersion compared to short range ordered PMN films. This work suggests a continuum between normal and relaxor ferroelectric behavior in the engineered PMN thin films.

The incorporation of filler materials to enhance the properties of fibre-reinforced plastics is a prevalent practise in materials science. Calcium carbonate is a commonly used inorganic filler in composite fabrication. Eggshell, a rich source of calcium carbonate, offers an organic alternative to conventional inorganic fillers. This study investigates the efficacy of different types of eggshells as filler materials. Three variants, viz., unhatched raw eggshell, unhatched boiled eggshell, and post-hatched eggshell, were used to fabricate composite variants, which were then subjected to mechanical characterization and compared with unfilled composites. The results indicated that composites filled with unhatched eggshells outperformed those with post-hatched eggshells. Tensile testing revealed a significant enhancement in the tensile properties of all eggshell-filled composites in comparison to the unfilled ones. The composite variant filled with unhatched raw eggshell filler showcased the utmost tensile modulus and strength, with a notable 36% improvement in comparison with the unfilled variant. Similarly, flexural tests demonstrated a 53% increase in flexural strength for unhatched raw eggshell-filled composites over unfilled composites. SEM imaging confirmed these findings by showing crack arrests, deviations, particle distribution, and strong interfacial bonding in the eggshell-filled composites. [ABSTRACT FROM AUTHOR]