Bulldog Scalp Syndrome.

Bulldog scalp syndrome or cutis verticis gyrata (CVG) is a rare cutaneous disorder with an incidence of just 0.026 to 1 per 100,000 population and cosmetic problems should not be ignored as they can affect the quality of life of patients in social and psychological aspects. In CVG the scalp thickens to form folds resembling sulci and gyri just as the skin fold of bulldog. It is a clinical diagnosis with various etiologies. It is classified as primary essential or nonessential and secondary CVG. It can manifest with symptoms ranging from mild to severe intensity. Cosmetic problems are the major concern that can affect patients' social and psychological health. If the folds are heavy, they can cause mass symptoms. Thus, surgery remains the definitive treatment option for improving the cosmetic appearance. Both our cases have different etiologies, however, were managed surgically with removal of skin folds (gyrae) and scoring of aponeuroses of the scalp followed by stretching of the scalp and closure to improve appearance. The surgical team as well as patients were satisfied with the appearance of the scalp after healing. CVG though a rare disease with various etiologies is a benign condition with good prognosis with no reports of malignant transformation so far.

Precision and Progress: Machine Learning Advancements in Plastic Surgery.

Machine learning has emerged as a powerful tool in various healthcare domains, and its application in plastic surgery has shown significant promise. Plastic surgery aims to enhance and reconstruct physical appearance and function, making it an ideal field for integrating machine learning techniques. This abstract presents an overview of the applications, challenges, and potential benefits of machine learning in plastic surgery. One of the key areas where machine learning has been applied is in the preoperative assessment and surgical planning process. By analyzing large datasets of patient images and clinical data, machine learning algorithms can assist plastic surgeons in predicting surgical outcomes, identifying optimal surgical techniques, and minimizing potential complications. These algorithms can learn from past cases and provide valuable insights to improve surgical decision-making and optimize patient care. Furthermore, machine learning has shown promise in facial recognition and analysis, which is crucial in plastic surgery procedures involving the face. Algorithms can accurately detect facial landmarks, assess facial symmetry, and simulate potential surgical outcomes. This technology gives plastic surgeons a more comprehensive understanding of the patient's facial structure and aids in designing personalized treatment plans. Additionally, machine learning algorithms have been employed to automate the analysis of large-scale clinical databases, assisting in identifying patterns, risk factors, and treatment outcomes. By leveraging these algorithms, plastic surgeons can gain valuable insights into patient populations, surgical trends, and postoperative complications. This information can inform clinical decision-making, improve patient safety, and enhance the overall quality of care. Despite the numerous advantages, several challenges need to be addressed when integrating machine learning into plastic surgery. These include the need for high-quality and diverse datasets, algorithm interpretability, ethical considerations, and regulatory compliance.

Retrospective diagnosis by parental testing in the next generation sequencing era and utility of reanalysis of exome data.

OBJECTIVE: Genetic diseases are an important cause of neonatal and childhood mortality. For couples with a history of demise of previous children, screening for carrier status can be done by exome sequencing (ES) of the parents. Our aim was to describe the clinical utility of "targeted parental ES" in such couples and to assess the utility of reanalysis of parental ES data. METHOD: We analyzed previous records, including ES reports, of 52 families with demise of previous offspring with a suspected genetic disorder. We also retrieved and reanalyzed raw data of parental ES in FASTQ format from the testing lab. RESULTS: A potential diagnosis was obtained in 30/52 (57.7%) of couples. We found 38/70 (54.3%) novel variants in this cohort. Shared carrier status for more than one autosomal or X-linked recessive disorder was identified in 18% of couples. Reanalysis of raw data resulted in a reclassification of variants in 15% of cases. CONCLUSION: Targeted parental ES can be helpful for families with demise of previous offspring with a suspected genetic disorder.

Transcriptome Analysis Revealed Osmoregulation Related Regulatory Networks and Hub Genes in the Gills of Hilsa shad, Tenualosa ilisha, during the Migratory Osmotic Stress.

Tenualosa ilisha (Hilsa shad), an anadromous fish, usually inhabits coastal and estuarine waters, and migrates to freshwater for spawning. In this study, large-scale gill transcriptome analyses from three salinity regions, i.e., fresh, brackish and marine water, revealed 3277 differentially expressed genes (DEGs), out of which 232 were found to be common between marine vs freshwater and brackish vs freshwater. These genes were mapped into 54 KEGG Pathways, and the most significant of these were focal adhesion, adherens junction, tight junction, and PI3K-Akt signaling pathways. A total of 24 osmoregulatory genes were found to be differentially expressed in different habitats. The gene members of slc16 and slc2 families showed a dissimilar pattern of expressions, while two claudin genes (cldn11 & cldn10), transmembrane tm56b, and voltage-gated potassium channel gene kcna10 were downregulated in freshwater samples, as compared to that of brackish and marine environment. Protein-protein interaction (PPI) network analysis of 232 DEGs showed 101 genes to be involved in PPI, while fn1 gene was found to be interacting with the highest number of genes (36). Twenty-five hub genes belonged to 12 functional groups, with muscle structure development with seven genes, forming the major group. These results provided valuable information about the genes, potentially involved in the molecular mechanisms regulating water homeostasis in gills, during migration for spawning and low-salinity adaptation in Hilsa shad. These genes may form the basis for the bio-marker development for adaptation to the stress levied by major environmental changes, due to hatchery/culture conditions.

Spatio-temporal analysis of rainfall in relation to monsoon teleconnections and agriculture at Regional Scale in Haryana, India.

This study examined the long-term (1980-2019) spatio-temporal trends, variability and teleconnections of Indian summer monsoon rainfall (ISMR) of all districts of Haryana, India and their impact on agricultural productivity. The gridded datasets of India Meteorological Department (IMD) were used to statistically analyse the rainfall distribution, trend, coefficient of variation and intensity of rainfall. The gridded datasets of European Centre for Medium-Range Weather Forecasts (ECMWF) atmospheric reanalysis V5 (ERA5) were examined for lower and upper tropospheric wind circulation (850 hPa and 200hpa), vertically integrated moisture transport (VIMT) and surface moisture flux (SMF). The datasets of National Oceanic and Atmospheric Administration (NOAA) were correlated with ISMR and composite deviation of rainfall and rainfall intensity during El Niño and La Niña from neutral years was examined at district level. Our analysis revealed that districts lying in eastern agroclimatic zone (EAZ) of Haryana received more ISMR during each month of monsoon season as compared to the ones situated in western agroclimatic zone (WAZ). Trend-free pre-whitening Mann-Kendall (TFPW-MK) test revealed that Kurukshetra, Panipat, Ambala, Rohtak, Faridabad, Jhajjar, Sonipat, Fatehabad and Palwal have shown a decreasing trend while Mahendragarh and Panchkula have shown an increasing trend of rainfall. During the El Niño years, most of the locations in the state received deficient to large deficient category, whereas during the La Niña episodes, most of the locations received excess to large excess category of ISMR, which is indicative of the influence of El Niño-Southern Oscillation (ENSO) on the regional scale. The influence of ISMR on bajra productivity for the districts lying in WAZ and rice productivity for the districts lying in EAZ was undertaken. This study is beneficial for understanding the impacts of climate change and climate variability on ISMR dynamics in Haryana which may further guide the policy-makers and beneficiaries for optimising the use of hydrological resources.

Atypical Presentation of a Giant Hemorrhagic Ovarian Cyst.

Hemorrhagic ovarian cysts (HOCs) are frequently seen in reproductive age women, developing in the luteal phase of ovulatory cycles. Giant HOCs are rare, as bleeding inside a closed space causes acute pain leading to early diagnosis. Anovulation or oligoovulation is a defining feature of polycystic ovarian syndrome (PCOS), and hence, functional cysts are uncommon in PCOS patients. This report describes a young girl with PCOS and amenorrhea, presenting with a giant hemorrhagic ovarian cyst. Most hemorrhagic cysts undergo spontaneous resolution with follow-up. Our patient presented as a surgical emergency following torsion and rupture with hemoperitoneum. Torsion causes an obstruction in the blood flow leading to infarction and loss of ovarian viability. Early diagnosis and detorsion may help to preserve ovarian function.

Recurrent Neural Model to Analyze the Effect of Physical Training and Treatment in Relation to Sports Injuries.

Artificial intelligence has rapidly grown and has made the scenario that no field can function without it. Like every field, it also plays a vital role in the sports field nowadays. In certain sports, injuries happen very often due to heavy training and sudden speedy actions, especially in athletics and football. Here arises a need to analyze the effect of physical training in sportsperson by collecting data from their daily training. With the help of artificial intelligence, a recurrent neural model is developed to analyze the effect of physical training and treatment concerning sports injury. A Recurrent Neural Network (RNN) can be a subsection of Artificial Neural Networks (ANN) that uses the neural nodes connected in a temporal sequence. The temporal sequence is one of the essential terms in this research, which denotes a data sequence of events in a given timeframe. The recurrent neural model is an intelligent machine learning method that comprises a neural schema replicating humans. This neural schema studies the data it collects from the athletes/players and processes it by analyzing previous injuries. Sports injuries have to be analyzed because, in some cases, it becomes more dangerous to the sportsperson that they may even lose their career due to disability. Sometimes it may cause a massive loss to the club or company that hired the sportsperson for the sport. The prediction process can give the player rest until he recovers, thus becoming the safest approach in sports. Therefore, it is essential to analyze the sportsperson's track data to keep an eye on his health. In this research, RNN model is compared with the existing Support Vector Machine (SVM) in concerning to the effect of physical training and treatment for sports. The results show that the proposed model has achieved 99% accuracy, which is higher than the existing algorithm.

Transcriptome analysis revealed hub genes for muscle growth in Indian major carp, Catla catla (Hamilton, 1822).

Catla (Catla catla) is the fastest growing Indian major carp species and forms an important component of the freshwater aquaculture systems in the Indian sub-continent. The molecular mechanisms of growth of the species in response to seasonal water temperature variations hitherto are still unknown. In the current study, high-throughput transcriptome sequencing was used to study the differential gene expression pattern in catla muscle tissues between pre-winter and post-winter fingerling groups and fast-growing table size fish. Transcriptome analysis identified 1677 differentially expressed genes (DEGs) in three different growth stages and 236 common DEGs between fingerling at low temperature and table fish post-winter, including four genes under GH/IGF1 axis and 163 genes under signature for compensatory muscle growth. Molecular pathways for the mapped genes identified 42 KEGG pathways and the critical pathways under Environmental Information Processing identified were PI3K-Akt signaling, AMPK signaling pathway, Calcium signaling pathway and MAPK signaling pathway. In this study, 14 differentially expressed potential regulatory hub genes for growth were identified, for the first time and categorized into three major GO groups: unfolded protein binding, rNA processing and biogenesis and muscle development and differentiation. These regulatory hub genes, except acta1, were found to be upregulated in fast-growing table size and post-winter fingerling groups. The results provided valuable information about the key genes, with potential to be used as biomarkers of growth in breeding programs and contributed to our understanding of the molecular mechanisms and pathways regulating muscle growth, in response to temperature fluctuations and different growth stages in C. catla.

Impact of monsoon teleconnections on regional rainfall and vegetation dynamics in Haryana, India.

Our study has investigated the impact of El Niño-Southern Oscillation (ENSO) on spatio-temporal dynamics of Indian summer monsoon rainfall (ISMR) as well as vegetation for a period of 1980 to 2019 at regional scale in Haryana, India. The gridded rainfall datasets of India Meteorological Department (IMD) were examined on monthly and seasonal scale using various statistical methods like mean climatology, coefficient of variation, slope of linear, Sen's slope, Mann-Kendall Z statistic, and hierarchical cluster analysis. The influence of ENSO on spatial distribution of ISMR was observed, where we found increasing and decreasing rainfall patterns during La Niña and El Niño years, respectively. We attempted to establish a link between ISMR and various teleconnections using time series of the National Oceanic and Atmospheric Administration (NOAA) Physical Sciences Laboratory, and statistically significant and positive correlation was observed with the Southern Oscillation Index (SOI), whereas significantly negative correlations were observed with SST of Niño 3, Niño 3.4, and Niño 4 regions. The gridded datasets of the European Centre for Medium-Range Weather Forecasts (ECMWF) atmospheric reanalysis V5 (ERA5) were used to evaluate the influence of ENSO on atmospheric dynamics using lower and upper tropospheric wind circulation (850 hPa and200 hpa), vertically integrated moisture transport (VIMT), and surface moisture flux (SMF). We have used satellite-based normalised difference vegetation index (NDVI) datasets of the Global Inventory Monitoring and Modeling System (GIMMS) to investigate the impact of ENSO on vegetation dynamics of Haryana and found that NDVI values were higher and lower in case of La Niña and El Niño years, respectively.

The prospective study of change of perception of postgraduate students on objective structured clinical examination in burns and plastic surgery.

BACKGROUND: In this study, we attempted to assess the change of perception of postgraduate students on objective structured clinical examination (OSCE) in burns and plastic surgery after first five OSCE. METHODS: A prevalidated feedback questionnaire was used to assess and score the perception of postgraduate students on OSCE in burns and plastic surgery. The opinion of postgraduate students on the feedback questionnaire after first and fifth assessment tests based on OSCE was analyzed. The results were compiled on a data sheet and analyzed using Microsoft Excel and plotted as graphical interpretation. The statistical analysis was done using MedCalc software. RESULTS: The results of the study showed that there is a positive change in perception of students in favor of monthly assessment based on OSCE in burns and plastic surgery after fifth assessment. The mean students' favorable perception score after the first assessment with was 30.2 ± 2.828 (mean ± standard deviation [SD]) and after fifth assessment, 43 ± 2.828 (mean SD) with Student's test t = 10.119 and P < 0.0001 which is highly significant statistically in favor of OSCE after fifth assessment. CONCLUSIONS: We observed in our study that the monthly assessment based on OSCE is well accepted by the students of our subspecialty after few assessments; however, further studies are required to augment the evidence.

Management of Ulnar Nerve Tuberculoma: A Challenge to Plastic Surgeons.

Tuberculoma is a well-circumscribed, space-occupying lesion. However, the involvement of peripheral nerves is rare. Here, we report a rare case of left ulnar nerve tuberculoma managed by surgical exploration and tangential excision of tuberculoma lesion sparing, most of the nerve fibers followed by antitubercular treatment. The patient responded well to the management strategy with improvement in motor and sensory activity of the affected limb.

Harmonic Lingual Frenotomy for Ankyloglossia: A Newer Novel Technique.

The objective of this is to report a newer novel technique of harmonic scalpel frenotomy, a day care procedure under local infiltration anesthesia that could achieve quick bloodless adequate ankyloglossia release and excellent healing with subsequent improved articulation and speech. The procedure was performed, patient followed up for six months and excellent results noted. A 37-year-old male patient presented with type II ankyloglossia on Coryllos ankyloglossia grading scale and class III on Kotlow's assessment. A quick bloodless frenotomy with adequate release of ankyloglossia was achieved using harmonic scissors. Patient experienced no discomfort. Patient was observed for two hours and discharged the same day with chlorhexidine mouth gargles and analgesics. Postoperative healing was excellent with adequate tongue protrusion and improvement in articulation and speech. We report this newer novel technique of harmonic scissors frenotomy, a day care procedure under local infiltration anesthesia, that achieved quick bloodless adequate ankyloglossia release, excellent healing and evident improvement in articulation and speech.

Various Options for Scrotal Reconstruction: A Prospective Observational Study.

Background Scrotal defects in developing countries are common challenges for the reconstructive surgeon and hence this work has been done with the aim to compare the outcome, advantages and disadvantages of different modalities of scrotal reconstruction. Methods The prospective observational hospital-based study of reconstruction of scrotal defects following trauma and Fournier's gangrene was done over a period of three years. Scrotal defect reconstruction was done in 35 patients by scrotal advancement flap, split thickness skin grafting, medial thigh flap, anterolateral thigh flap and groin flap keeping in mind the various indication of different modalities. The reconstructed scrotums were observed for flap survival and skin graft intake for seven to 10 days in the hospital and then were followed for three months in a follow-up clinic. Results and observations The mean age of our patients was 48.57±5.01 years. Most of the soft tissue defects of the scrotum were post-traumatic (83%). Scrotal reconstruction was done often by flaps and more frequently used flap for reconstruction of scrotum was scrotal advancement flap. All flaps and grafts survived well. Mean hospitalization time was highest for groin flap cover whereas mean operative time was highest for anterolateral thigh flap cover. Conclusion Every case of scrotal defect needs an individual approach for scrotal reconstruction depending upon patient age, general condition of the patient, wound status, and the patient's requirement.

Immediate Versus Late Flap Coverage for Traumatic Soft Tissue Defects of Lower Extremity: A Comparative Observational Study.

Background The lower extremity trauma in patients often gets operated on late for the wound coverage and is associated with more health costs and other resources. Therefore, this study has been conducted to compare the outcome in terms of flap survival, complication rates, and hospital stay between immediate and late flap coverage of lower extremity traumatic wounds. Methods The comparative analysis of outcome is done in terms of flap survival, complication rates, and hospital stay after immediate and late flap coverage of 25 (n = 25) patients of lower extremity traumatic wounds in each group. The patients were observed, and data obtained were tabulated in a Microsoft Excel spreadsheet. The statistical analysis was done using IBM SPSS (V26.0, IBM Corporation, Armonk, NY, USA) statistical software. The chi-square test was used for descriptive data and the student's unpaired t-test for discrete-continuous data analysis. The p-value of less than 0.05 is considered significant. Results The mean defect size with SD in the immediate flap cover group is 54.5 ± 29.5 cm2, while in the late flap cover group, it is 85 ± 65 cm2 with a significant p-value of 0.0378. The mean flap size with SD in the immediate flap coverage group is 70.5 ± 34.5 cm2, while in the late flap coverage group, it is 117 ± 87.5 cm2, and the difference is statistically significant. The mean hospital stay with SD in the immediate flap coverage group is 7.5 ± 2.5 days. In contrast, in the late flap coverage group, it is 29.5 ± 8.5 days, and the difference is statistically very significant. Conclusion There are equivalent results in patients undergoing immediate and late flap coverage for the traumatic soft tissue defects of the lower extremity. There is a significant decrease in the hospital stay after immediate flap reconstruction, which subsequently reduces both direct and indirect health costs. However, there is a larger size flap requirement in cases of immediate lower extremity wound coverage.

Photogrammetric Anthropometry to Determine the Female Waistline.

BACKGROUND: In this study, we attempted to develop a reference guide to determine the female waistline based on the golden ratio for waist sculpting in females, which may help in waist sculpting by liposuction or non-invasive techniques. MATERIAL AND METHODS: To understand the anatomy of the waist, we studied the 60 photographs of females and measured the distances between important anatomical landmarks. The different values and proportions obtained were compared between different groups of heights and two groups of BMI using Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY) through analysis of variance (ANOVA). RESULTS: There is a golden ratio in the distances between xiphoid to waist and waist to the abdominal crease that is close to 1:1.66, and the waist is at the junction of the upper 2/5th and lower 3/5th of the height from xiphoid to abdominal crease. The location of the waist is at one-third of the whole length of the abdomen (the whole length of the abdomen being the length from the xiphoid to the pudendal cleft). CONCLUSIONS: We observed in our study that there is a definite mathematical relationship between the length of the abdomen and the waist position, which may be applied for female waist sculpting.

Free Vascularized Supraclavicular Autologous Heterotopic Lymph Node Transfers Without Skin Paddle for Lymphedema Lower Limb.

Free vascularized lymph node transfer (VLNT) is one of the new and highly efficacious procedures in the cases of lymphedema. In this case, we present a case of lower-limb lymphedema which was managed by this procedure where a supraclavicular LN was harvested and transferred to the lower leg. VLNT from the supraclavicular region is a very effective treatment for physiological restoration of the lymphatic flow in established cases of lower-limb lymphedema because of well-hidden favorable scar and minimal chances of secondary iatrogenic lymphedema in the donor region unlike other sites such as groin and axilla. The VLNT should be preferred over manual lymphatic drainage because it is very effective treatment for physiological restoration of the lymphatic flow, however, the further analytical studies are required to confirm statistically the effectiveness of the same over other modalities.

Primary Hypothyroidism in Patients Exposed to Therapeutic External Beam Radiation: Non-randomized Comparative Study.

Background Cancer patients are not routinely assessed for thyroid function after external beam radiotherapy (EBRT) to the neck, despite hypothyroidism being a known side effect of EBRT. So, this study aimed to assess the incidence of hypothyroidism after therapeutic external beam radiotherapy to the neck and to determine the time for the development of hypothyroidism. Methodology A non-randomized prospective comparative study was done at a tertiary care center from April 2018 to September 2020. Any cancer patients who were euthyroid before radiotherapy and are planned to receive EBRT to the neck were included as cases, whereas controls were selected from the patients who were euthyroid before radiotherapy and were planned to receive EBRT to the site other than the neck. A total of 100 participants in each case and control group were selected. Data were collected on participants' age, gender, primary tumor site, treatment modality, total radiation dose along with concurrent chemoradiation regimens. Details of blood chemistry including thyroid hormone levels were collected during the pre-radiation phase and post-radiation phase. After the completion of radiotherapy, both the patients and controls were followed up periodically at three months, six months, nine months, 12 months, and finally at 15 months post-radiation. Data were analyzed and interpreted to pursue defined objectives by using tables and graphs using Microsoft Excel and IBM SPSS, version 26.0 (Armonk, NY: IBM Corp.). The chi-square test was applied to find out the association of different variables with the development of hypothyroidism. P-values<0.05 were considered significant throughout. Results According to our findings, the incidence of hypothyroidism following external beam radiotherapy to the neck where radiation portals included a portion or the entire thyroid gland was 16% and 4%, when the radiation given to sites other than neck region. The difference in incidence between the case and control groups was found to be statically significant (p<0.05). However, it was found that age, gender, the primary tumor site, total radiation dose, and treatment modality had no significant effects on hypothyroidism development. The median time duration to become hypothyroid after EBRT was 12 months. Conclusions The monitoring of thyroid function should become a part of routine follow-up procedures in all cancer patients who receive neck radiation as part of their treatment.

Discovery of alternatively spliced isoforms and long non-coding RNA in full length brain transcriptomes of anadromous Hilsa shad, Tenualosa ilisha (Hamilton, 1822).

BACKGROUND: Full length transcriptomes, achieved through long-read sequencing, along with the isoform analysis can reveal complexities in the gene expression profiles, as well as annotate the transcriptomes of non-model organisms. METHODS AND RESULT: Full length transcripts of brain transcriptome of Tenualosa ilisha, Hilsa shad, were generated through PacBio single molecule real-time sequencing and were characterized. A total of 8.30 Gb clean reads were generated, with PacBio RSII, which resulted in 57,651 high quality consensus transcripts. After removing redundant reads, a total of 19,220 high-quality non-redundant transcripts and 17,341 full length ORF transcripts were classified to 7522 putative ortholog groups. Genes involved in various neural pathways were identified. In addition, isoform clusters and lncRNAs were discovered, along with Hilsa specific transcripts with coding frames and 29,147 SSRs in 944 transcripts (1141 annotated). CONCLUSION: The present study provided, for the first time, a comprehensive view of the alternative isoforms of genes and transcriptome complexity in Hilsa shad brain and forms a rich resource for functional studies in brain of this anadromous fish.

NBUVB Phototherapy at the Donor Site Can Enhance the Graft Uptake in the Nonhealing of Ulcers of Mycosis Fungoides: A Case Report.

Mycosis fungoides is a rare form of non-Hodgkin's lymphoma, which is formed of mature, skin homing, clonal, malignant T lymphocytes. It can sometimes present with skin ulcers that are difficult to heal because of the presence of large number T lymphocytes and antigen-presenting cells. We present a case of nonhealing ulcers in a patient with mycosis fungoides, which was treated by narrow band ultraviolet B targeted phototherapy followed by split-thickness skin grafting. The graft uptake was well and the donor area also healed without any complications.