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Objective: Orbital apex syndrome (OAS) is a rare condition with multiple cranial nerve involvement caused by varied etiologies. It is not only a threat to the patient's vision but also life-threatening due to the intracranial spread of infection, if not diagnosed early and treated accurately. To study the outcome of endoscopic sinus surgery (ESS) for OAS secondary to sinusitis concerning resolution of ptosis, improvement of ophthalmoplegia, visual prognosis, intracranial spread of infection, and mortality. Methods: A retrospective review of patients with OAS secondary to sinusitis who underwent ESS from 2011 to 2021 was tabulated and analyzed. Results: Twenty-seven patients (mean age: 55.11+/-16 years; male 62%) were included in this study. At presentation, blurring of vision (81%), headache (66%), diplopia (63%) ptosis (63%) were the most common symptoms, and ophthalmoplegia (100%) was the most common sign. Five patients had no perception of light and the rest had various degrees of vision impairment. The most common etiopathology of sinusitis was fungal sinusitis (12 mucormycosis and four aspergillus). The final visual prognosis at three months follow-up post-ESS showed vision stabilization (no improvement or worsening) in 13 (48%) patients, improvement in seven (26%) patients, and vision deterioration in two (7%) patients. There was a significant improvement in ptosis (70%) and ophthalmoplegia (85%). There was no intracranial spread of infection or recurrence with a mortality rate of 3.7% (one patient). Conclusion: ESS coupled with appropriate antimicrobials effectively treats OAS secondary to sinusitis with decreased morbidity and mortality.
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Orbital defects due to congenital causes, cancer, and trauma can compromise appearance and function, creating a deep psychological impact on an individual's life. The prosthetic rehabilitation of such patients is challenging. The objective of prosthetic treatment of an ocular defect is to provide a well-fitting ocular prosthesis that closely resembles the original eye, restoring the patient's self-confidence and social acceptance. Ocular prostheses can be customized or prefabricated. The challenge encountered with prefabricated eye prostheses is a poor fit. Customized prostheses exhibit better fit, aesthetic outcome, and comfort to the patient in the long term. The article describes a technique to fabricate an ocular prosthesis with a stock iris and customized sclera that is both functional and aesthetically pleasing.
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Objective This study aims to evaluate the effects of immersion in alcoholic beverages on the surface roughness and color stability of two types of milled zirconia. Materials and methods The sample size included 60 cuboid-shaped samples of two types of zirconia (Z1 and Z2), 30 in each group. Zirconia was milled and sintered at 1,500°C for eight hours. The samples were immersed in artificial saliva (control), red wine, and whiskey three times a day over a 30-day period. After each post-immersion cycle, samples were cleaned ultrasonically. Surface roughness and color parameters were measured using an atomic force microscope (AFM) and spectrophotometer before and after immersion. The collected data was organized into tables, and statistical analysis was conducted using the Statistical Package for the Social Sciences (SPSS) version 27 software (IBM SPSS Statistics, Armonk, NY). For surface roughness, a paired t-test was conducted, while for color change, one-way analysis of variance (ANOVA) and Tukey's honestly significant difference (HSD) tests were done. Results The mean values of pre- and post-immersion values reveal that whiskey causes the highest difference in surface roughness for Z1 (137.09 nm) and Z2 (86.15 nm) groups, while red wine causes maximum discoloration in both Z1 (2.41) and Z2 (1.94) groups. The paired t-test revealed significant surface roughness changes in Z1 with artificial saliva and red wine, while whiskey (p<0.05), although showing changes, lacked statistical significance (p>0.05). The whiskey group demonstrated a moderate linear association (0.599) between pre- and post-immersion values. For Z2, artificial saliva, red wine, and whiskey (p<0.05) induced statistically significant surface roughness alterations. ANOVA tests indicated significant color changes post-immersion in all three subgroups of Z1 and Z2 (p<0.05 for both). Tukey's HSD test showed significant differences between artificial saliva and red wine (p<0.05), as well as artificial saliva and whiskey (p<0.05) in Z1 and Z2. However, no significant difference was found between red wine and whiskey in both Z1 and Z2 groups (p>0.05). Conclusion Whiskey, red wine, and artificial saliva increased zirconia's surface roughness. Alcoholic solutions altered zirconia's colorimetric parameters, with no significant differences among them.
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INTRODUCTION: Hip fractures cause severe pain during positioning for spinal anesthesia (SA). Intravenous systemic analgesics can lead to various complications in elderly patients, hence peripheral nerve blocks are emerging as a standard of care in pain management for hip fractures, among which femoral nerve block (FNB) is widely known and practiced. Pericapsular nerve group (PENG) block is a recently described technique that blocks the articular nerves of the hip with motor-sparing effects and is used to manage positional pain in hip fractures. This study aims to evaluate the analgesic efficacy of PENG block over FNB in managing pain during positioning before SA in hip fractures. MATERIALS AND METHODS: This was a prospective, randomized, double-blinded study. After ethical clearance, 70 patients undergoing hip fracture surgery under SA in a tertiary-care hospital were recruited and randomized to receive either ultrasound-guided PENG block or FNB with 20 ml of 0.25% bupivacaine before performing SA. We compared pain severity using the visual analog scale (VAS) 15 and 30 minutes after the block and during positioning. The sitting angle, requirement of rescue analgesia for positioning, and anesthesiologist and patient satisfaction scores were also analyzed. Continuous data were analyzed with an unpaired t-test while the chi-square test was used for categorical data. RESULTS: There was a significant reduction in VAS scores after PENG block (PENG: 0.66 ± 1.05 and FNB: 1.94 ± 1.90; p = 0.001) with lesser requirement of rescue analgesia for positioning compared to FNB. The anesthesiologist and patient satisfaction scores were also significantly better in the PENG group. CONCLUSION: PENG block offers better analgesia for positioning before SA than FNB without any significant side effects, and improves patient and anesthesiologist satisfaction, thus proving to be an effective analgesic alternative for painful hip fractures.
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To obtain a correlation between endoscopic findings, radiological findings and clinical features in children with symptomatic Chronic Adenoid hypertrophy. A cross sectional study was conducted in 42 pediatric patients (3-14 years) who visited the Department of Otorhinolaryngology in a tertiary care centre from November 2019 to April 2021 (18 months). The patients were subjected to complete history taking; ENT examination, Rigid nasal endoscopic examination, a lateral X-ray nasopharynx were performed prior to surgery after obtaining consent from the parents of the patients. The endoscopic findings were assessed using ACE grading system and the X-ray nasopharynx was assessed using Adenoid- Nasopharyngeal ratio. A male predominance was noted with mouth breathing, snoring, nasal obstruction and recurrent rhinitis as common presentation. Grade 3 hypertrophy was the most common finding in X-ray Nasopharynx (Mean ANR-0.682). Children with Grade 3 adenoid hypertrophy with more than 50% choanal obstruction and Eustachian tube abutment in nasal endoscopy were noted to be the most symptomatic clinically. A positive correlation between reduced hearing (p value-0.004) and blocked ear sensation (p value- < 0.01) with eustachian tube abutment was noted. The children with more symptoms did not show higher-grade adenoid hypertrophy radiographically in our study. The adenoid- nasopharyngeal ratio on X-ray correlated with endoscopic grading of adenoid hypertrophy (p value-0.006) and degree of choanal obstruction (p value-0.003) but not with the abutment of the eustachian tube. The endoscopic grading correlated with clinical grading, but not the X-ray grading. Hence, endoscopic grading appears to be more accurate in assessing the adenoid size and endoscopic grading is nearer to clinical grading than X-ray grading. Though, the digital X-ray nasopharynx lateral view is a more convenient method, nasal endoscopy is the gold standard method to determine whether the adenoid hypertrophy is clinically significant or not.
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Covid-19 has posed a serious threat to the existence of the human race. Early detection of the virus is vital to effectively containing the virus and treating the patients. Profound testing methods such as the Real-time reverse transcription-polymerase chain reaction (RT-PCR) test and the Rapid Antigen Test (RAT) are being used for detection, but they have their limitations. The need for early detection has led researchers to explore other testing techniques. Deep Neural Network (DNN) models have shown high potential in medical image classification and various models have been built by researchers which exhibit high accuracy for the task of Covid-19 detection using chest X-ray images. However, it is proven that DNNs are inherently susceptible to adversarial inputs, which can compromise the results of the models. In this paper, the adversarial robustness of such Covid-19 classifiers is evaluated by performing common adversarial attacks, which include the Fast Gradient Sign Method (FGSM) and Projected Gradient Descent (PGD). Using these attacks, it is found that the accuracy of the models for Covid-19 samples decreases drastically. In the medical domain, adversarial training is the most widely explored technique to defend against adversarial attacks. However, using this technique requires replacing the original model and retraining it by including adversarial samples. Another defensive technique, High-Level Representation Guided Denoiser (HGD), overcomes this limitation by employing an adversarial filter which is also transferable across models. Moreover, the HGD architecture, being suitable for high-resolution images, makes it a good candidate for medical image applications. In this paper, the HGD architecture has been evaluated as a potential defensive technique for the task of medical image analysis. Experiments carried out show an increased accuracy of up to 82% in the white box setting. However, in the black box setting, the defense completely fails to defend against adversarial samples.