Cranioplast fabrication in a comatose patient: A clinical report

Cranioplasty may be necessary after decompressive craniectomies to aid in the restoration of the esthetic, morphological, functional, and psychosocial stability of those affected. This clinical report describes the management of a comatose road traffic accident victim with a history of autogenous cranial implant failure after decompressive craniectomy. The challenges posed by the nonambulatory state of the patient and his inability to follow commands were overcome by using reverse engineering and rapid prototyping to fabricate a 3D patient-specific polymethylmethacrylate cranial implant. A digital evaluation technique with grids as measuring tools was successfully implemented in the patient’s absence. The use of a custom clamp flask aided in the accommodation and subsequent investing, dewaxing, and polymerization of the carved cranial wax pattern. As a result, a custom cranioplast with optimum marginal fit, acceptable contour, adequate thickness, and reduced surgical duration of placement was obtained through a successful combination of conventional and digital techniques.     

Modified graphene supported Ag–Cu NPs with enhanced bimetallic synergistic effect in oxidation and Chan–Lam coupling reactions

Herein, well dispersed Ag–Cu NPs supported on modified graphene have been synthesized via a facile and rapid approach using sodium borohydride as a reducing agent under ambient conditions. Dicyandiamide is selected as an effective nitrogen source with TiO₂ as an inorganic material to form two kinds of supports, labelled as TiO₂–NGO and NTiO₂–GO. Initially, the surface area analysis of these two support materials was carried out which indicated that N-doping of GO followed by anchoring with TiO₂ has produced support material of larger surface area. Using both types of supports, ten nano-metal catalysts based on Ag and Cu were synthesized. Benefiting from the bimetallic synergistic effect and larger specific surface area of TiO₂–NGO, Cu@Ag–TiO₂–NGO is found to be a highly active and reusable catalyst out of other synthesized catalysts. It exhibits excellent catalytic activity for oxidation of alcohols and hydrocarbons as well as Chan–Lam coupling reactions. The nanocatalyst is intensively characterized by BET, SEM, HR-TEM, ICP-AES, EDX, CHN, FT-IR, TGA, XRD and XPS.

Cu@Ag–TiO₂–NGO prepared from modified graphene by simple methodology exhibits enhanced catalytic activity towards oxidation and Chan–Lam coupling due to the synergistic effect between Ag and Cu NPs.     

Evaluation of thyroid functions in leprosy. III. Circulating auto-antibodies against thyroid and nuclear components.

Sera from twenty six patients of various types of leprosy were tested for the detection of circulating auto-antibodies and nuclear components against thyroid using various methods. Four patients of lepromatous leprosy had higher levels of thyroid auto-antibodies by latex agglutination. Three patients showed the presence of anti-nuclear antibodies, two belonged to the TT and one to the LL group.     

rIL-22 as an adjuvant enhances the immunogenicity of rGroEL in mice and its protective efficacy against S. Typhi and S. Typhimurium

Salmonella infection, ranging from mild, self-limiting diarrhea to severe gastrointestinal, septicemic disease and enteric fever, is a global health problem both in humans and animals. Rapid development of microbial drug resistance has led to a need for efficacious and affordable vaccines against Salmonella. Microbial heat shock proteins (HSPs), including HSP60 and HSP70, are the dominant antigens that promote the host immune response. Co-administration of these antigens with cytokines, such as IL-22, which plays an important role in antimicrobial defense, can enhance the immune response and protection against pathogens. Therefore, the aim of the present study was to determine the immunogenicity of rGroEL (Hsp60) of S. Typhi, alone or administered in combination with murine rIL-22, and its protective efficacy against lethal infection with Salmonella, in mice. There was appreciable stimulation of the humoral and cell-mediated immune responses in mice immunized with rGroEL alone. However, co-administration of rGroEL with rIL-22 further boosted the antibody titers (IgG, IgG1 and IgG2a), T-cell proliferative responses and the secretion of both Th1 and Th2 cytokines. Additionally, rGroEL alone accorded 65%–70% protection against lethal challenge with S. Typhi and S. Typhimurium, which increased to 90% when co-administered with rIL-22.     

Co-administration of rIpaB domain of Shigella with rGroEL of S. Typhi enhances the immune responses and protective efficacy against Shigella infection

Shigella species cause severe bacillary dysentery in humans and are associated with high morbidity and mortality. The Invasion plasmid antigen (IpaB) protein, which is conserved across all Shigella spp., induces macrophage cell death and is required to invade host cells. The present study evaluates the immunogenicity and protective efficacy of the recombinant (r) domain region of IpaB (rIpaB) of S. flexneri. rIpaB was administered either alone or was co-administered with the rGroEL (heat shock protein 60) protein from S. Typhi as an adjuvant in a mouse model of intranasal immunization. The IpaB domain region (37 kDa) of S. flexneri was amplified from an invasion plasmid, cloned, expressed in BL21 Escherichia coli cells and purified. Immunization with the rIpaB domain alone stimulated both humoral and cell-mediated immune responses. Furthermore, robust antibody (IgG, IgA) and T-cell responses were induced when the rIpaB domain was co-administered with rGroEL. Antibody isotyping revealed higher IgG1 and IgG2a antibody titers and increased interferon-gamma (IFN-γ) secretion in the co-administered group. Immunization of mice with the rIpaB domain alone protected 60%–70% of the mice from lethal infection by S. flexneri, S. boydii and S. sonnei, whereas co-administration with rGroEL increased the protective efficacy to 80%–85%. Organ burden and histopathological studies also revealed a significant reduction in lung infection in the co-immunized mice compared with mice immunized with the rIpaB domain alone. This study emphasizes that the co-administration of the rIpaB domain and rGroEL protein improves immune responses in mice and increases protective efficacy against Shigella infection. This is also the first report to evaluate the potential of the GroEL (Hsp 60) protein of S. Typhi as an adjuvant molecule, thereby overcoming the need for commercial adjuvants.     

Factors Influencing Treatment Plan and Post Operative Compliance in TMJ Ankylosis Patients: A Retrospective Analysis of Long Term Post Surgical Evaluation

Background and objective

Ankylosis of the temporomandibular joint is a clinical entity significant for a maxillofacial surgeon. Since time immemorial humanity is battling with this condition which is not just disfiguring the normal anatomy of the face but severely hampers the function of mastication. In this study we have tried to evaluate and correlate various factors leading to causation of ankylosis of TM Joint along with clinical manifestation and treatment planning as well as outcomes.

Study design

This is a retrospective study, records of 60 patients were selected out of which 28 patients reported for recall. Based on a predefined format, patients were evaluated and correlation was looked up on various accounts such as age of occurrence and age of reporting to the surgeon, probable etiology, sex distribution, treatment modality and postoperative outcome.

Results

The mean age of onset or occurrence was 4–7 years of age whereas age of reporting to the clinic was 16–17 years. Highest percentage of patients had trauma as an etiology (64 %) and the lowest percentage had congenital deformity (21 %). Three surgical techniques were evaluated and compared for their post surgical mouthopening, gap arthroplasty was done in 61 %, interpositional arthroplasty in 39 % and low ramus osteotomy in 21 %.

Conclusion

This study was aimed at analyzing the clinical form and function of the post surgical patient reviewing the recent radiographs to analyze the surgical site. The data collected was (1) Age of occurrence and age of reporting with the deformity (2) Etiological history (3) Sex and Side predisposition (4) Procedure used for correction of deformity (5) Recall (follow up) data especially recurrence and physiotherapy. We arrived at a conclusion that mean age of occurrence of deformity was approximately 4.7 years and age at which patient reported to clinic was 16.2 years. The main etiological factor was trauma (51 %) and ear infection (21 %). 57 % patients presented with unilateral deformity, with both the sides equally effected. The effectiveness of gap arthroplasty, interpositional arthroplasty and low ramus osteotomy procedures was evaluated. Gap arthroplasty and interpositional arthroplasty were found to be effective procedures. The importance of post operative physiotherapy was emphasised yet again through this study.