Postauricular Tubed Flap in the Reconstruction of Auricular Margin Defects: Revisited

Background  Reconstruction of the auricular margin defects is challenging due to the ear’s intricate architecture. Tubed flap raised from the postauricular area is a simple and reliable option for reconstructing marginal defects. Methods  Eight patients with various auricular margin defects were reconstructed, using a postauricular tubed flap in a staged manner. Parameters like flap survival, reliability, complications, and cosmesis were assessed. Results  Out of eight patients, one patient had marginal necrosis, which was managed with debridement and lengthening of the flap. All the flaps settled well with a good aesthetic outcome. Conclusion  Postauricular tubed flap is a reliable and efficient method for reconstructing auricular margin defects.     

Substrate controlled,regioselective carbopalladation for the one-pot synthesis of C4-substituted tetrahydroisoquinoline analogues

6-Exo-trig cyclization reaction through regioselective carbopalladation was demonstrated with N-(2-halobenzyl)-N-allylamines to furnish the corresponding C4-substituted tetrahydroisoquinoline derivatives. The scope of the reaction was extended to the synthesis of C4-quaternary tetrahydroisoquinoline derivatives also. The nature of the substituent on the olefin moiety dictates the course of the carbopalladation sequence. Regioselective carbopalladation is substantiated by performing the reaction with unsymmetrical diallylated amine substrates.

6-Exo-trig cyclization reaction through regioselective carbopalladation was demonstrated with N-(2-halobenzyl)-N-allylamines to furnish the corresponding C4-substituted tetrahydroisoquinoline derivatives.     

Use of Preexpanded Forehead and Neck Skin in Case of Giant Facial Hairy Naevus: Planning and Technique

A congenital nevi is a pigmented patch which requires complete surgical excision for cosmetic reasons. Here, we report a case of a patient with facial hairy pigmented lesion, occupying the right half of her face since birth, who underwent complete surgical excision and staged reconstruction utilizing, preexpanded forehead and neck skin. We used two rectangular tissue expanders with 150 and 300 cubic cm of volumes inserted in the forehead and the neck, respectively. The length of the expanders selected were equal to 1.2 to 1.5 times the length of their respective lesions, whereas the width of the base of the expanders were approximately similar to the width of their defects. It is concluded with this case report that tissue expansion provides a good cosmetic and anatomical correction to cover large defects, with adjacent skin having similar properties.     

CDC Kerala 5: Developmental Therapy Clinic Experience – Use of Child Development Centre Grading for Motor Milestones

Objectives

To document the experiences of the intervention given to children who attended the developmental therapy clinic of Child Development Centre (CDC) Kerala, a specialized clinic for providing developmental intervention/therapy for babies less than two years with developmental delay/disability.

Methods

All the babies referred to this speciality clinic from developmental screening/evaluation clinics of CDC were registered in the clinic and re-evaluation was done using CDC grading for head holding, sitting, standing, Amiel Tison passive angles, and Trivandrum Developmental Screening Chart (TDSC) 0–2 y.

Results

Out of a total of 600 consecutive babies below 2 y with developmental delay/disability referred to developmental therapy clinic, on comparing the test results at enrollment and after 6 mo of intervention, a statistically significant reduction was observed (i) in the 2–4 mo age group with regard to abnormal TDSC (25.5 %), (ii) in the 4–8 mo age group with regard to abnormal head holding grade (87.1 %) and abnormal TDSC (19.4 %), (iii) in the 8–12 mo age group, with regard to abnormal sitting grade (71.7 %) and (iv) in the above 12 mo age group with regard to abnormal sitting grade (35.3 %) and abnormal standing grade (78.8 %).

Conclusions

The experience of organizing the developmental intervention/therapy clinic at CDC Kerala has shown that therapy services by developmental therapists in a centre and supportive therapy by mother at home is useful in improving the developmental status of children with developmental delay.

     

CDC Kerala 7: Effect of Early Language Intervention Among Children 0–3 y with Speech and Language Delay

Objective

To assess the effect of systematic clinic and home based early language intervention program in children reporting to the early language intervention clinic with full partnership of specially trained developmental therapist and the parents.

Methods

All babies between 0 and 3 y referred to Child Development Centre (CDC) Kerala for suspected speech/language delay were assessed and those without hearing impairment were screened first using Language Evaluation Scale Trivandrum (LEST) and assessed in detail using Receptive Expressive Emergent Language Scale (REELS). Those having language delay are enrolled into the early language intervention program for a period of 6 mo, 1 h at the CDC clinic once every month followed by home stimulation for rest of the month by the mother trained at CDC.

Results

Out of the total 455 children between 0 and 3 y, who successfully completed 6 mo intervention, the mean pre and post intervention language quotient (LQ) were 60.79 and 70.62 respectively and the observed 9.83 increase was statistically significant. The developmental diagnosis included developmental delay (62.4 %), global developmental delay (18.5 %), Trisomy and other chromosomal abnormalities (10.5 %), microcephaly and other brain problems (9.9 %), misarticulation (8.4 %), autistic features (5.3 %) and cleft palate and lip (3.3 %) in the descending order.

Conclusions

In the present study among 455 children between 0 and 3 y without hearing impairment, who successfully completed 6 mo early language intervention, the mean pre and post intervention LQ were 60.79 and 70.62 respectively and the observed 9.83 increase was statistically significant.

     

CDC Kerala 12: Socio-demographic Factors Among Children (2–6 y) with Autism – A Case Control Study

Objectives

To compare the socio-demographic factors among children between 2 and 6 y of age with autism and a control group of normal children.

Methods

One hundred forty three confirmed cases of 2–6 y-old children with autism, attending autism clinic of Child Development Centre, who had a CARS score of more than 30 were included in the study. Two hundred normal children in the same age group were recruited from the well-baby/immunization clinic of SAT Hospital, Thiruvananthapuram. Data was collected using a structured pre-piloted questionnaire consisting of 11 socio-demographic possible risk factors.

Results

The multivariate analysis on socio-demographic characteristics as possible risk factors for autism has shown that (i) upper and upper middle socioeconomic status (OR: 7.13; CI: 3.26–15.57) and (ii) male gender (OR: 3.95; CI: 2.22–7.04) were significant risk factors for autism, whereas place of residence, rural (OR: 0.41; CI: 0.24–0.68) is a protective factor.

Conclusions

This case control study involving 143 children between 2 and 6 y with autism as per CARS criteria and a control group of 200 normal children has shown that upper and upper middle socioeconomic status and (ii) male gender are significant risk factors for autism, whereas place of residence, rule is a protective factor.

     

Skip segment Hirschsprung’s disease: a case report and novel management technique

Skip segment Hirschsprung’s disease is a condition where an area of normally ganglionated intestine is interspersed proximally and distally by aganglionic segments. The occurrence of skip segment has no clear embryological explanation, contrary to the present concept of failure of cranio-caudal migration of neural crest-derived cells in Hirschsprung’s disease. Only 25 case reports have been published in literature so far and this is possibly the first to be reported from Asia. We report one such case with novel surgical management.     

Yoga based cardiac rehabilitation after coronary artery bypass surgery: One-year results on LVEF,lipid profile and psychological states – A randomized controlled study

Objective

To compare the long term effects of yoga based cardiac rehabilitation program with only physiotherapy based program as an add-on to conventional rehabilitation after coronary artery bypass grafting (CABG) on risk factors.

Methods

In this single blind prospective randomized parallel two armed active control study, 1026 patients posted for CABG at Narayana Hrudayalaya Institute of Cardiac Sciences, Bengaluru (India) were screened. Of these, 250 male participants (35–65 years) who satisfied the selection criteria and consented were randomized into two groups.Within and between group comparisons were done at three points of follow up (i.e. 6th week, 6th month, and 12th month) by using Wilcoxon''s signed ranks test and Mann Whitney U test respectively.

Results

Yoga group had significantly (p = 0.001, Mann Whitney) better improvement in LVEF than control group in those with abnormal baseline EF (<53%) after 1 year. There was a better reduction in BMI in the yoga group (p = 0.038, between groups) in those with high baseline BMI (≥23) after 12 months. Yoga group showed significant (p = 0.008, Wilcoxon''s) reduction in blood glucose at one year in those with high baseline FBS ≥110 mg/dl. There was significantly better improvement in yoga than the control group in HDL (p = 0.003), LDL (p = 0.01) and VLDL (p = 0.03) in those with abnormal baseline values. There was significantly better improvement (p = 0.02, between groups) in positive affect in yoga group. Within Yoga group, there was significant decrease in perceived stress (p = 0.001), anxiety (p = 0.001), depression (p = 0.001), and negative affect (p = 0.03) while in the control group there was reduction (p = 0.003) only in scores on anxiety.

Conclusion

Addition of yoga based relaxation to conventional post-CABG cardiac rehabilitation helps in better management of risk factors in those with abnormal baseline values and may help in preventing recurrence.     

Impact of Cu doping on the structural,morphological and optical activity of V2O5 nanorods for photodiode fabrication and their characteristics

In this paper, we report a wet chemical precipitation method used to synthesize pure and Cu-doped V₂O₅ nanorods with different doping concentrations (Cu_xV₂O₅ where x = 3, 5 or 7 at%), followed by annealing at 600 °C and characterizations using several techniques. Indeed, a growth mechanism explaining the morphological evolution under the experimental conditions is also proposed. The XRD patterns revealed that all of the studied samples consist of a single V₂O₅ phase and are well crystallized with a preferential orientation towards the (200) direction. The presence of intrinsic defects and internal stresses in the lattice structure of the Cu_xV₂O₅ samples has been substantiated by detailed analysis of the XRD. Apart from the doping level, there was an assessment of identical tiny peaks attributed to the formation of a secondary phase of CuO. SEM images confirmed the presence of agglomerated particles on the surface; the coverage increased with Cu doping level. XPS spectral analysis showed that Cu in the V⁵⁺ matrix exists mainly in the Cu²⁺ state on the surface. The appearance of satellite peaks in the Cu 2p spectra, however, provided definitive evidence for the presence of Cu²⁺ ions in these studied samples as well. Doping-induced PL quenching was observed due to the absorption of energy from defect emission in the V⁵⁺ lattice by Cu²⁺ ions. We have proposed a cost-effective, less complicated but effective way of synthesizing pure and doped samples in colloidal form, deposited by the nebulizer spray technique on p-Si to establish junction diodes with enhanced optoelectronic properties.

A wet chemical precipitation method was used to synthesize pure and Cu-doped (3, 5 or 7 at%) V₂O₅ nanorods and photodiodes were fabricated.     

The perils of relying on anti-hepatitis B total core antibody in screening individuals infected with HIV

Co-infection with HIV and hepatitis B virus (HBV) has serious long-term consequences. We describe a case of an HIV-infected heterosexual black African man with a delayed diagnosis of HBV infection. Baseline HBV screening was performed using a sequential testing algorithm starting with a total core antibody (anti-HBc) test, which was negative. He had no evidence of immunity against HBV and subsequently received three unsuccessful courses of HBV vaccination. He had mild but persistent elevation of liver enzymes over a five-year period despite maintaining full suppression of HIV replication on efavirenz, lamivudine and zidovudine; the latter was changed to abacavir due to lipoatrophy. Further testing revealed e-antibody positive chronic HBV infection with undetectable anti-HBc reactivity. High-grade HBV viraemia associated with L180M and M240V drug-resistance mutations was confirmed. He was subsequently switched to a tenofovir-based regimen, which achieved HBV suppression. Adopting effective HBV screening strategies in HIV-infected patients is recommended.