Evaluation of labial versus labio-inferior lines of osteosynthesis using 3Dminiplate for fractures of anterior mandible: A finite element analysis with a pilotclinical trial

Purpose: The fractures of anterior mandible are subject to severe torsional forces due to muscles acting in opposite directions. 3D miniplate has been suggested as a good alternative by some researchers. How ever, finite element model (FEM) studies indicate that labio-inferior positioning of two miniplates perpendicular to each other offers better stability as compared to labial positioning. This study aims at combining the advantages of a single 3D miniplate and labio-inferior positioning of two conventional miniplates, which was assessed by finite element analysis along with a pilot clinical trial. Methods: Two FEM models were created using CT data of a 24-year-old patient with Angle class I oc clusion: control model with labial plating and study model with labio-inferior plating. The models were processed with MIMICS® (materialise, Leuven, Belgium), CATIA® (Dassault Systemes) and finite element analysis softwares. Parameters adopted for analysis were (1) displacement (mm) of fracture fragments during each screw fixation, (2) lingual splay and post fixation stability of fracture fragments with masticatory load, and (3) stress distribution (MPa) across fracture fragments. Moreover, a pilot clinical trial including five patients with anterior mandible fracture was conducted. The fractures were managed by intraoral open reduction and 3D miniplate fixation in labio-inferior position. Intraoperative inter fragmentary gap, post fixation lingual splay and radiographic fracture union and complications were assessed clinically. Results: Labio-inferior plating demonstrated less displacement (mm) of fracture fragments during screw fixation (0.059 vs. 0.079) as well as after application of masticatory load (1.805 vs. 1.860). Negligible lingual splay and less stress distribution (MPa) across fracture fragments (1.860 vs. 1.847) were appre ciated in the study group as compared to control group. Clinical trial support the favorable outcome related to intraoperative and postoperative assessment parameters. Conclusion: FEM analysis and clinical trial reveal better results with labio-inferior positioning of 3D miniplate when compared to labial positioning.     

Development of a Robust Algorithm for Detection of Nuclei and Classification of White Blood Cells in Peripheral Blood Smear Images

Peripheral Blood Smear analysis plays a vital role in diagnosis of many diseases such as leukemia, anemia, malaria, lymphoma and infections. Unusual variations in color, shape and size of blood cells indicate abnormal condition. We used a total of 117 images from Leishman stained peripheral blood smears acquired at a magnification of 100X. In this paper we present a robust image processing algorithm for detection of nuclei and classification of white blood cells based on features of the nuclei. We used novel image enhancement method to manage illumination variations and TissueQuant method to manage color variations for the detection of nuclei. Dice similarity coefficient of 0.95 was obtained for nucleus detection. We also compared the proposed method with a state-of-the-art method and the proposed method was found to be better. Shape and texture features of the detected nuclei were used for classifying white blood cells. We considered classification of WBCs using two approaches such as 5-class and cell-by-cell approaches using neural network and hybrid-classifier respectively. We compared the results of both the approaches for classification of white blood cells. Cell-by-cell approach offered 1.4% higher sensitivity in comparison with the 5-class approach. We obtained an accuracy of 100% for lymphocyte and basophil detection. Hence, we conclude that lymphocytes and basophils can be accurately detected even when the analysis is limited to the features of nuclei whereas, accurate detection of other types of WBCs will require analysis of the cytoplasm too.     

Education,enjoyment, and empowerment: Outcomes of an adolescent transplant camp (I own it)

Peer group camping experiences have a positive influence on adolescents with chronic illnesses, but the data in solid organ transplant recipients are lacking. The aim of this study was to evaluate the outcomes of adolescent transplant attendees of an educational camp. A weekend camp, “I own it” was organized which provided educational training regarding career and health choices, money matters, and managing medications following which a knowledge assessment was performed. The ACLSA questionnaire was also administered. To test the adolescents’ medication knowledge, they were asked to provide written documentation of their medications, which was compared with their medical records. In the ACLSA questionnaire, 32% reported deficiency in work/study, 46% in housing/money management, and 3% in the remaining categories. A significant improvement in knowledge was noted in areas of career choices, money matters, and managing medications, but not in healthy choices. In the medication recall, 75% did not know their medication list, and 92% could not recall dosages or frequencies. In conclusion, adolescents showed quantitative improvements in certain areas while identifying deficiencies in others, areas which were targeted in future initiatives. Prospective longitudinal studies addressing the impact of camps on post‐transplant outcomes should be conducted to better alter the course post‐transplant.     

Maxillofacial trauma in a pregnant patient: Contemporary managementprinciples with a case report & review of literature

Trauma during pregnancy deserves special attention because of its management objectives,i.e.well-being of both pregnant woman and foetus.Maxillofacial trauma directly affects the nutrition of foetus by interfering with the normal functions in a pregnant woman such as mouth opening.mastication and breathing,Hence early restitution of form and function of maxillofacial skeleton is essential.However,the gravid status is associated with numerous anatomical and physiological changes which present with clinical dilemma related to imaging and treatment.A careful scrutiny of the patient's systermic and gestational status is absolutely essential before,during and after instituting any interventional proced-ures.We present a case of bilateral condyle fracture in a 30-year-old pregnant woman in the third trimester(32 weeks).She was treated with inter maxillary fixation using orthodontic brackets&elastics.After successful restitution of occlusion,the patient was advised aggressive physiotherapy which ensured normal mouth opening.Two weeks later,the patient delivered uneventfully.The patient was followed up at one month and 3 month and demonstrated restitution of normal occlusion,mouth opening and lower|acial height.This article aims at analyzing the contermporary principles in management of maxillfacial trauma in a pregnant woman and clarifying the common misconceptions.     

A study of eye care service utilization among diabetic patients visiting a tertiary care hospital in Coastal Karnataka,southern India

International Journal of Diabetes in Developing Countries - The purpose of this study was to understand the eye care service utilization of diabetic patients visiting a tertiary care center. This...     

Evidence-based practice of periodontics

Evidence-based practice involves complex and conscientious decision making based not only on the available evidence but also on patient characteristics, situations, and preferences. It recognizes that care is individualized and ever-changing and involves uncertainties and probabilities. The specialty of periodontics has abundant high-level evidence upon which treatment decisions can be determined. This paper offers a brief commentary and overview of the available evidence commonly used in the private practice of periodontics.     

Wilson’s Disease Diagnosed Postnatally Due to Neurological Manifestation

The Journal of Obstetrics and Gynecology of India -     

ST-Elevation Myocardial Infarction in the Presence of Biventricular Paced Rhythm

Background

In the diagnosis of acute myocardial infarction (AMI), the presence of baseline left bundle branch block or a permanent pacemaker rhythm poses a challenge.

Objective

We present a case report highlighting this challenge, along with a review of pertinent literature.

Case Report

A 70-year-old female with known severe idiopathic dilated cardiomyopathy and moderate coronary artery disease who was status post−biventricular pacemaker/implantable cardioverter defibrillator insertion was brought to our institution via Emergency Medical Services with recurrent firing of her implantable cardioverter defibrillator and syncope. After stabilization in the Emergency Department and treatment with intravenous amiodarone, the patient admitted to having ongoing chest pains. The electrocardiogram revealed evidence of biventricular pacing with superimposed ST-segment elevations in the anterolateral leads indicative of myocardial injury. She underwent prompt angiography, thrombectomy, and bare-metal stent insertion to a totally occluded proximal left anterior descending coronary artery, with resolution of her chest pain and improvement in the ST-segment changes.

Conclusions

Despite proposed criteria that aid in the recognition of AMI with underlying left bundle branch block and paced rhythm; the advent of new pacing modalities and the potential variability of pacing sites impose additional diagnostic challenges requiring higher level of suspicion and better physician awareness.