Single-stage functional reconstruction of the post-burn lower lip

Burn scar contracture of the lower face and neck is one of the most difficult subjects to solve because it produces problems with function and appearance. The lip is a part of the face that is frequently affected by burn injury. Lower lip deformity can be due to an extrinsic or intrinsic cause. Post-burn sequelae in this area results in cosmetic disfigurement and psychological trauma to patients as it is often associated with ectropion of the lower lip, severe microstomia leading to poor oral access for intubation, drooling, difficulty in eating, speaking and oral hygiene. The aim is to describe a single-stage correction to address all of these problems for a successful outcome. The technique was applied to 30 post-burn scar contractures of the lower lip. We classified the deformities of the lower lip and based on this classification the surgical procedure was executed to obtain functional improvement. At 2 months post-surgery the patient is able to demonstrate speech clarity with full functional oral range of movement. Neck release combined with vermillionectomy and comissuroplasty of the lip is a rational approach for preserving the function. A good planning of reconstructive procedures, facilitate patient recovery and optimize functional and aesthetic outcomes.     

Predicting hypoglycemia in critically Ill patients using machine learning and electronic health records

Hypoglycemia is a common occurrence in critically ill patients and is associated with significant mortality and morbidity. We developed a machine learning model to predict hypoglycemia by using a multicenter intensive care unit (ICU) electronic health record dataset. Machine learning algorithms were trained and tested on patient data from the publicly available eICU Collaborative Research Database. Forty-four features including patient demographics, laboratory test results, medications, and vitals sign recordings were considered. The outcome of interest was the occurrence of a hypoglycemic event (blood glucose?<?72 mg/dL) during a patient’s ICU stay. Machine learning models used data prior to the second hour of the ICU stay to predict hypoglycemic outcome. Data from 61,575 patients who underwent 82,479 admissions at 199 hospitals were considered in the study. The best-performing predictive model was the eXtreme gradient boosting model (XGBoost), which achieved an area under the received operating curve (AUROC) of 0.85, a sensitivity of 0.76, and a specificity of 0.76. The machine learning model developed has strong discrimination and calibration for the prediction of hypoglycemia in ICU patients. Prospective trials of these models are required to evaluate their clinical utility in averting hypoglycemia within critically ill patient populations.

     

Aortopulmonary window with patent ductus arteriosus and interrupted aortic arch: A case report

Indian Journal of Thoracic and Cardiovascular Surgery -     

The Toughness of Cortical Bone and Its Relationship with Age

Toughness is a quantitative measure of bone quality in terms of its susceptibility to fracture. Thus, to elucidate the underlying mechanisms of age-related bone fractures, it is necessary to understand age-related changes in the toughness of bone. The objective of this review is to provide current understanding on the structure-function relationships of cortical bone and its correlation with the toughness of the tissue from the perspective of basic engineering principles. The review is written for the readers in the musculoskeletal research field, who may not have a strong engineering background. For better understanding of toughening mechanisms, this review intends to focus on correlations of the toughness of cortical bone with its constituents and microstructural characteristics. In addition, a special emphasis is placed on age-related changes in the toughness of bone.     

A novel and accurate technique of photographic wound measurement

Context:

Wound measurement is an important aspect of wound management. Though there are many techniques to measure wounds, most of them are either cumbersome or too expensive.

Aims:

To introduce a simple and accurate technique by which wounds can be accurately measured.

Settings and Design:

This is a comparative study of 10 patients whose wounds were measured by three techniques, i.e. ruler, graph and our technique.

Materials and Methods:

The graph method was taken as the control measurement. The extent of deviation in wound measurements with our method was compared with the standard technique. The statistical analysis used was ANOVA.

Results:

The ruler method was highly inaccurate and overestimated the wound size by nearly 50%. Our technique remained consistent and accurate with the percentage of over or underestimation being 2-4% in comparison with the graph method.

Conclusions:

This technique is simple and accurate and is an inexpensive and non-invasive method to accurately measure wounds.KEY WORDS: Digital planimetry, photography, wound measurement

You can’t manage what you can’t measureW. Edwards Deming