Two centuries of biodiversity discovery and loss in Singapore.

There is an urgent need for reliable data on the impacts of deforestation on tropical biodiversity. The city-state of Singapore has one of the most detailed biodiversity records in the tropics, dating back to the turn of the 19th century. In 1819, Singapore was almost entirely covered in primary forest, but this has since been largely cleared. We compiled more than 200 y of records for 10 major taxonomic groups in Singapore (>50,000 individual records; >3,000 species), and we estimated extinction rates using recently developed and novel statistical models that account for "dark extinctions," i.e., extinctions of undiscovered species. The estimated overall extinction rate was 37% (95% CI [31 to 42%]). Extrapolating our Singapore observations to a future business-as-usual deforestation scenario for Southeast Asia suggests that 18% (95% CI [16 to 22%]) of species will be lost regionally by 2100. Our extinction estimates for Singapore and Southeast Asia are a factor of two lower than previous estimates that also attempted to account for dark extinctions. However, we caution that particular groups such as large mammals, forest-dependent birds, orchids, and butterflies are disproportionately vulnerable.

A new efficient referential genome compression technique for FastQ files.

Hospitals and medical laboratories create a tremendous amount of genome sequence data every day for use in research, surgery, and illness diagnosis. To make storage comprehensible, compression is therefore essential for the storage, monitoring, and distribution of all these data. A novel data compression technique is required to reduce the time as well as the cost of storage, transmission, and data processing. General-purpose compression techniques do not perform so well for these data due to their special features: a large number of repeats (tandem and palindrome), small alphabets, and highly similar, and specific file formats. In this study, we provide a method for compressing FastQ files that uses a reference genome as a backup without sacrificing data quality. FastQ files are initially split into three streams (identifier, sequence, and quality score), each of which receives its own compression technique. A novel quick and lightweight mapping mechanism is also presented to effectively compress the sequence stream. As shown by experiments, the suggested methods, both the compression ratio and the compression/decompression duration of NGS data compressed using RBFQC, are superior to those achieved by other state-of-the-art genome compression methods. In comparison to GZIP, RBFQC may achieve a compression ratio of 80-140% for fixed-length datasets and 80-125% for variable-length datasets. Compared to domain-specific FastQ file referential genome compression techniques, RBFQC has a compression and decompression speed (total) improvement of 10-25%.

Suprascapular nerve block is faster and as effective as hydrodistension in relieving frozen shoulder-associated pain and disability: A prospective, single-blind observational study with a follow-up of 24 weeks.

Background and Aims: Hydrodistension (HD) and suprascapular nerve block (SSNB) have been shown to reduce pain and improve shoulder function in frozen shoulder (FS). The aim of this study was to compare the efficacy of HD and SSNB in the treatment of idiopathic FS. Material and Methods: This was a prospective observational study. A total of 65 patients with FS were treated with SSNB or HD. The functional outcome was evaluated by Shoulder Pain and Disability Index (SPADI) score and active shoulder range of motion (ROM) measured at 2 weeks, 6 weeks, 12 weeks, and 24 weeks. Parametric data were analyzed using an independent sample T-test. Nonparametric data were analyzed using the Mann-Whitney test and Wilcoxon test. A P value less than 0.05 was considered significant. Result: At the end of 24 weeks, the two-group improved significantly from the baseline and the improvement was comparable between the two groups. ROM also improved significantly in both groups. At 2nd week, SPADI score was significantly less in SSNB group (P < 0.05). About 43% of patients considered HD extremely painful. Conclusion: Both HD and SSNB are almost equally effective in reducing pain and improving shoulder function. However, SSNB leads to a faster improvement.

Cu(II)-Based Coordination Polymer as a Pristine Form Usable Electrocatalyst for Oxygen Reduction Reaction: Experimental Evaluation and Theoretical Insights into Biomimetic Mechanistic Aspects.

As the postsynthesis-processed metal-organic material-based catalysts for energy applications add additional cost to the whole process, the importance of developing synthesized usable pristine catalysts is quite evident. The present work reports a new Cu-based coordination polymer (Cu-CP) catalyst to be used in its pristine form for oxygen reduction reaction (ORR) application. The catalyst was characterized using single-crystal X-ray diffraction, field emission scanning electron microscopy, and X-ray photoemission spectroscopy. The Cu-CP exhibits admirable electrocatalytic ORR activity with an onset potential of 0.84 V versus RHE and a half wave potential of 0.69 V versus RHE. As revealed by the density functional theory-based computational mechanistic investigation of the electrocatalytic ORR process, the electrochemically reduced Cu(I) center binds to the molecular O2 through an exergonic process (ΔG = -6.8 kcal/mol) and generates the Cu(II)-O2•- superoxo intermediate. Such superoxo intermediates are frequently encountered in the catalytic cycle of the Cu-containing metalloenzymes in their O2 reduction reaction. This intermediate undergoes coupled proton and electron transfer processes to give OH- in an alkaline medium involving H2O2 as the intermediate. The electrocatalytic performance of Cu-CP remained stable even up to 3000 cycles. Overall, the newly developed Cu-CP-based electrocatalyst holds promising potential for efficient biomimetic ORR reactivity, which opens new possibilities toward the development of robust coordination polymer-based electrocatalysts.

Incidence and effectiveness of manipulation under anaesthesia for stiffness following primary total knee arthroplasty.

Background: There are various modalities of cor- rection of stiffness following total knee arthro-plasty. Manipulation under anaesthesia (MUA) is generally indicated for people who fail to achieve their pre operative range of motion at 12 weeks. The purpose of this study was to determine: (1) the effect of MUA on Flexion arc (2) the influence of timing of MUA from index procedure and of diabetes mellitus on final flexion achieved. Methods: We retrospectively evaluated patients who underwent manipulation following total knee arthroplasty at our institution between January 2016 to December 2018. For the purpose of analysis, we have divided the patients into two groups. Those who underwent manipulation within 12 weeks and later than 12 weeks. We have also compared the effect of MUA between diabetic and non-diabetic patients. All were operated with posterior stabilised (PS) prosthesis by a single senior arthroplasty surgeon. The final flexion achieved during their last clinical follow-up were recorded and compared with the pre MUA flexion. Results: The incidence of MUA after TKA at our institute during this period is about 1.14 %. There was a significant statistical difference between the pre and post manipulation flexion, with p value <0.01. There was no significant statistical difference between those who were manipulated before 12 weeks and after 12 weeks in improving the Flexion of the operated knees. We have found that both the diabetic and non diabetic group had comparable flexion after the manipulation in our study. Conclusion: Manipulation after anaesthesia is a safe first intervention to improve post operative stiffness and gain additional range of motion following TKA in patients who develop stiffness. It can be done even after 12 weeks of surgery with reasonably good gain in range of motion.

Primary mandibular molars with supernumerary roots: a report of 2 cases.

A supernumerary root is a developmental condition occurring due to disturbances in the Hertwig epithelial root sheath. Supernumerary roots are rare in primary mandibular molars, and the etiology is uncertain. However, it is crucial for dental practitioners to be aware that extra roots may be present in primary teeth and provide accurate diagnosis when they occur. An extra root or canal that is not identified during endodontic treatment can lead to treatment failure. The present report describes 2 cases of primary mandibular second molars with supernumerary roots showing carious involvement. In one of the patients, the molar had 2 supernumerary roots and was treated successfully by pulpectomy. In the other patient, the molar had 1 supernumerary root. The tooth was extracted, and a space maintainer was placed.

Bilateral presentation of different supernumerary teeth in nonsyndromic patients: case reports.

Supernumerary teeth--teeth in excess of the normal dental complement--are usually asymptomatic, and their presence is detected incidentally on radiographs. Mesiodentes are the most common type of supernumerary teeth, followed by maxillary distomolars, maxillary lateral incisors, mandibular fourth molars, and maxillary premolars. Bilateral occurrence of supernumerary teeth is rare. When supernumerary teeth do occur bilaterally, they are most often associated with a syndrome such as Gardner syndrome or cleidocranial dysostosis. This article presents case reports of 4 nonsyndromic patients with different forms of bilateral supernumerary teeth: bilateral mesiodentes, bilateral paramolars, bilateral distomolars, and bilateral parapremolars. The supernumerary teeth were managed by extraction or clinical and radiographic monitoring.

An Anatomic Morphological Study of Occipital Spurs in Human Skulls.

Occipital spurs are quite common; however, they are also the source of frequent discomfort to the patients. Their role has been implicated in causation of pain at the base of skull, which may extend to shoulder limiting the movement of the shoulder and neck. The present was carried out to find out the prevalence of occipital spur in human skull and to find out the anatomic morphological characteristics of occipital spur. A total of 30 cadaveric skulls were examined in the Department of Anatomy, Uttar Pradesh University of Medical Sciences, for the presence of occipital spur. These skulls were the part of boneset obtained as a part of undergraduate training in the department. All the measurements were taken using a digital Vernier Caliper after taking all necessary precaution to avoid any damage to these spurs. The prevalence of occipital spur in the present study was 10%. The mean width recorded in the present study was 13.40 mm (±6.7) and the mean length recorded was 13.45 mm (±1.05). Similarly, mean thickness noted was 2.43 mm (±0.43). Thus, the present study concludes that occipital spurs are the frequent source of discomfort to patients. The knowledge of this tubercle is of paramount importance to neurosurgeons, sports physicians, and radiologists for the diagnosis of such discomfort.

Connecting science, policy, and implementation for landscape-scale habitat connectivity.

We examined the links between the science and policy of habitat corridors to better understand how corridors can be implemented effectively. As a case study, we focused on a suite of landscape-scale connectivity plans in tropical and subtropical Asia (Malaysia, Singapore, and Bhutan). The process of corridor designation may be more efficient if the scientific determination of optimal corridor locations and arrangement is synchronized in time with political buy-in and establishment of policies to create corridors. Land tenure and the intactness of existing habitat in the region are also important to consider because optimal connectivity strategies may be very different if there are few, versus many, political jurisdictions (including commercial and traditional land tenures) and intact versus degraded habitat between patches. Novel financing mechanisms for corridors include bed taxes, payments for ecosystem services, and strategic forest certifications. Gaps in knowledge of effective corridor design include an understanding of how corridors, particularly those managed by local communities, can be protected from degradation and unsustainable hunting. There is a critical need for quantitative, data-driven models that can be used to prioritize potential corridors or multicorridor networks based on their relative contributions to long-term metacommunity persistence.

MRI Based Comparison of Tibial Bone Coverage by Five Knee Prosthesis: Anthropometric Study in Indians.

This MRI based study evaluates morphological differences of proximal tibia (total cross-sectional area, mediolateral and anteroposterior distance) 8-10 mm distal to the lateral tibial plateau. We evaluated the difference in the coverage of the tibial surface between symmetric and asymmetric tibial trays and difference in coverage between males and females. 150 patients who underwent MRI scans for sports related soft tissue injury without osteoarthritis were studied. The tibial trays of the 5 total knee arthroplasty designs (4 symmetric and 1 asymmetric) were scanned. Mean total tibial coverage of all designs was more than 80%. Asymmetric baseplate had maximum total tibial coverage and maximum rate of optimal fit, with only 2% absolute overhang posterolaterally. Females had better tibial coverage as compared to males.

Malunion in displaced intracapsular fracture of femoral neck: A rare case.

Intracapsular fracture of femoral neck is treated by anatomical reduction (preferably closed) and cannulated cancellous lag screw fixation. Malunion of these fractures have been described in the coronal plane (coxa valga or coxa vara). We reported a case of young adult patient with displaced intracapsular fracture of femoral neck that had malunited in sagittal plane with callus formation with excellent functional outcome. The radiographs revealed intracapsular fracture of femoral neck right side (Garden type 4 and Pauwel type 3). The patient was operated and closed reduction and internal fixation with three cannulated cancellous screws was performed. The postoperative radiograph revealed a loss of reduction in the lateral view. Due to this technical error, the patient was counselled for revision fixation for which he refused. At 9 months we observed union of the fracture in the displaced position by callus formation. Harris hip score at 2 years was 96 that indicate excellent functional outcome and the radiographs did not reveal any evidence of avascular necrosis of femoral head. We advised revision surgery to our patient as he had increased chances of implant failure and nonunion. However he refused the revision surgery and was continued with the suboptimal reduction. However, the fracture united and that too with callus formation, which is not a described phenomenon in neck of femur fracture.

Inguinoscrotal pain resistant to conventional treatment.

Inguinoscrotal pain (ISP) is a common complaint that affects almost all age groups. The etiology may be vascular, neurogenic, visceral, muscular or psychological. Most causes of ISP are benign, but Pott's spine as a cause of ISP, when missed, may lead to serious outcomes.

Multiple bilateral lower limb fractures in a 2-year-old child: previously unreported injury with a unique mechanism.

Fall from height is a common cause of unintentional injuries in children and accounts for 6% of all trauma-related childhood deaths, usually from head injury. We report a case of a 2-year-old child with multiple fractures of the bilateral lower limbs due to this reason. A child fell from a height of around 15 feet after toppling from a balcony. He developed multiple fractures involving the right femoral shaft, right distal femoral epiphysis (Salter Harris type 2), right distal metaphysis of the tibia and fibula, and undisplaced Salter Harris type 2 epiphyseal injury of the left distal tibia. There were no head, abdominal or spinal injuries. The patient was taken into emergency operation theatre after initial management which consisted of intravenous fluids, blood transfusion, and splintage of both lower limbs. Fracture of the femoral shaft was treated by closed reduction and fixation using two titanium elastic nails. Distal femoral physeal injury required open reduction and fixation with K wires. Distal tibia fractures were closely reduced and managed nonoperatively in both the lower limbs. All the fractures united in four weeks. At the last follow-up, the child had no disability and was able to perform daily activities comfortably. We also proposed the unique mechanism of injury in this report.

Randomized controlled trial comparing stabilization of fresh close femoral shaft fractures in children with titanium elastic nail system versus stainless steel elastic nail system.

In vitro mechanical studies have demonstrated equal or superior fixation of pediatric femoral fractures with use of titanium elastic nails (TENS) as compared with stainless steel elastic nails (SSEN). SSEN are less expensive as compared to TENS. However, there are only two studies in the English literature which have compared the results of TENS and SSEN in paediatric femoral shaft fracture. The present study compares the clinical and radiological outcomes of femoral shaft fracture in patients 6-12 years of age, operatively stabilised either by TENS or SSEN. 35 children (6-12 years) with closed, post traumatic femoral shaft fractures were randomized into two treatment groups. Both groups underwent closed reduction internal fixation (CRIF) by either of the implants (TENS OR SSENS) as per randomization protocol and followed up for six months. Comparison of clinical and radiological outcomes in both the groups was done in terms of time to union of fracture and radiological angulations in coronal and sagittal plane. There was no significant difference in both groups with respect to fracture site tenderness and presence of bridging callus at fracture site at 3 weeks, 6 weeks and 6 months follow up (p-value = 1.000). There was no significant difference in radiological angulation rate in both groups in the sagittal (p-value = 0.661) as well as in the coronal plane (p-value = 0.219) at six month follow up. Both groups showed a similar rate of complication, most common being prominent hardware. TENS and SSENS are equally effective treatment modalities for paediatric femoral shaft fracture with similar rate of complications. However, SSENS is less costly as compared to TENS and can be considered as an alternative in a resource constrained setup.

Fate of kyphosis in tuberculosis of subaxial cervical spine treated non-operatively.

OBJECTIVE: Observation of post treatment kyphotic angle in patient of cervical spine tuberculosis managed non operatively. BACKGROUND: The incidence of tuberculosis of cervical spine is about 6-9%. The most dreaded complications of spinal tuberculosis are neural involvement and spinal deformity. Due to destruction of the vertebra tuberculosis of spine usually leads to variable amount of kyphotic deformity. METHODS: We retrospectively reviewed 13 patients with clinico-radiological diagnosis of cervical spine tuberculosis managed in our centre between 2004 to 2011. The patients were started on antitubercular therapy. Crutchfield tongs traction was applied 8 to 12 weeks followed by mobilization with four post collar. The kyphotic angles were measured by radiograph at presentation and last available follow up radiograph. OBSERVATIONS: The mean age of the patients was 20 years. C3-C4 vertebra was the most commonly involved area. One patient had single vertebra involvement, five patients had two vertebrae involvement, five patients had three vertebrae involvement and two patients had four vertebrae involvement. The average number of vertebrae involved was 2.6 vertebrae. 9 out of 13 patients had neural deficit at the time of initial presentation. The mean follow up was 21.23 months (12 to 42 months). All patients responded favorably and had neural recovery. At final follow up, 10 out of 13 patients had improvement in kyphotic angle, two patients had deterioration of kyphotic angle and one patient had no change in kyphotic angle. Only one patient had significant deterioration in kyphotic angle. CONCLUSIONS: Non operative treatment of cervical spine tuberculosis by initial traction and antitubercular therapy improves the pretreatment deformity irrespective of the number of vertebra involved.

Displacement of Zygomatic Implant in Infratemporal Region in a Case of COVID-19-Associated Mucormycosis.

Reconstruction of maxillary defects can be carried out using a variety of treatment modalities. The choice of modality depends on numerous factors, including the size and extent of the defect, patient characteristics, and existing comorbidities. One of the various options is reconstruction and rehabilitation using a fixed prosthesis supported over a zygomatic implant. In maxillectomy cases, a zygomatic implant can be used to improve the retention of the obturator prosthesis, as the loss of alveolar bone makes it impossible to use conventional endosseous implants. Although zygomatic implants are reported to have high success rates, they are not free of complication. We hereby present a rare complication associated with the placement of a zygomatic implant in a patient with COVID-19-associated mucormycosis who underwent operation. This rare complication has never been reported before. This case report also highlights on the management of complications involving displacement of a zygomatic implant in the infratemporal region.

Clinical Significance of Hepatobiliary Localization of Tc-99m EC in Diuretic Renography.

Objective Technetium-99m ethylene dicysteine (Tc-99m EC) is a well-established, tubular tracer for diuretic renography. Few occasional cases have been reported in literature regarding visualization of liver, gallbladder (GB), or bowel due to increased hepatobiliary route of excretion of Tc-99m EC on diuretic renography. This study aimed to retrospectively review the incidence of visualization of liver, GB, or bowel and its clinical significance in Tc-99m EC diuretic renography. Materials and Methods Data of all patients who underwent diuretic renography in the department from January 24, 2022 to March 31, 2023 was included in the study. The data was analyzed to assess the incidence of visualization of GB or bowel loops, correlation of the hepatobiliary localization with factors like age of the patient, concentration of 99m TcO4 solution, quality control parameters, presence of renal stone disease, serum creatinine, relative renal function, and effective renal plasma flow. Effect of hepatobiliary localization on scan interpretation and reporting was assessed. Results The retrospective analysis of 437 diuretic renograms revealed the hepatobiliary localization of tracer in 34 patients. Out of these 34 patients, 14 patients had only faint visualization of tracer at 4 hours delayed image. Twenty scans had visualization of both GB and bowel. Out of these 20 scans, GB and bowel were visualized during dynamic imaging in one scan, after initial 20 minutes in two scans and in 2 to 4 hours delayed images in rest of the 17 scans. Two out of 20 patients had increased serum creatinine, 16 patients had either single kidney or relative renal function less than 26%, and 12 patients had renal stone disease. Out of the four patients in whom relative renal function was more than 25%, one patient had raised serum creatinine and three patients had renal stone disease. Interpretation of images was affected only in three patients, in which reporting of the scans required single-photon emission computed tomography imaging and correlation with other imaging modalities. Conclusion Hepatobiliary excretion of Tc-99m EC usually does not usually affect the scan interpretation and quantitative renogram analysis, but reader should be cognizant of the potential pitfalls during scan interpretation. In this study, we reviewed the possible causes of this hepatobiliary clearance and importance of additional views and correlation with other imaging modalities to clarify the suspicion arises for accurate reporting.

Clinical outcome of perioperative airway and ventilatory management in patients undergoing surgery for oral cavity cancer: a prospective observational study.

Objectives: This prospective observational study aimed to assess the clinical outcomes of perioperative airway and ventilatory management in patients undergoing surgery for oral cavity cancer. The study described the frequencies and types of procedures for securing the airway and the duration and types of postoperative ventilatory support. We compared the findings with those of the TRACHY study. Patients and Methods: One hundred patients undergoing oral cavity oncological surgeries were included. Airway assessment included inter-incisor gap, Mallampati class, neck movements, and radiological features. Surgical parameters, postoperative ventilatory support, and complications were documented. Results: The buccal mucosa was the most common cancer site (48.0%), and direct laryngoscopy was deemed difficult in 58.0% of patients. Awake fibreoptic intubation or elective tracheostomy was required in 43.0% of cases. Thirty-three patients were extubated on the table, and 34 patients were successfully managed with a delayed extubation strategy. In comparison with the TRACHY study, variations were observed in demographic parameters, tumour characteristics, and surgical interventions. Our mean TRACHY score was 1.38, and only five patients had a score ≥4. Prophylactic tracheostomy was performed in 2.0% of cases, in contrast to the TRACHY study in which 42.0% of patients underwent the procedure. Conclusion: The study emphasizes the challenges in airway management for oral cavity cancer surgery. While prophylactic tracheostomy may be necessary in specific cases, individualized approaches, including delayed extubation, are preferrable to maximize safety. Our findings contribute to better understanding and managing perioperative challenges in oral cancer patients and highlight the need for personalized strategies. Scoring systems like TRACHY should not be accepted as universally applicable.

Leprosy in Post-elimination Era: A Study Conducted in Rural Tertiary Settings in North India.

Background Leprosy is an age-old disease caused by Mycobacterium leprae. The disease was declared eradicated in India in 2005. Many new cases are still being identified in the outdoor patient department. This study was undertaken to understand the epidemiological, clinical, and social aspects of leprosy among new patients, and assess the current situation regarding caseload and presentation. Material and methods This study was designed as an observational study. It was carried out in people newly diagnosed with leprosy attending the outpatient department of Dermatology, Venereology, and Leprology in the tertiary care hospital in Uttar Pradesh University of Medical Sciences from July 2022 to January 2024. A total of 231 people afflicted with leprosy were included in the study. The data collected was statistically analyzed to identify demographic and social patterns, clinical presentations, and features associated with leprosy. Result Out of these 231 patients, 139 (60.17%) were male and 92 (39.83%) were female. Most cases belonged to the age group 40-59 years 87 (37.66%). History of close contact with an afflicted person was present in 34 (14.71%). Clinically, most patients belong to the borderline tuberculoid (BT) type. Only 24 (10.4%) patients were found positive for M. leprae by slit-skin smear examination. The ulnar nerve was the most common nerve involved in 63 (27.27%) cases. Trophic ulcers were the predominant deformity in 34 (14.7%), followed by foot drop in 13 (5.62 %). Conclusion The present study provides an overview of the prevailing trends of Leprosy within a specific region in the post-elimination era. The findings underscore the significance of the ongoing National Leprosy Eradication Program (NLEP) program and stress the importance of aligning them with the common goal of eliminating the burden and stigma of Leprosy from society.