Rare branching pattern of the aortic arch in a neonate.

Here, we describe the case of a neonate who was found to have a complex pattern of branching on radiological imaging. The right common carotid artery, left common carotid artery and left subclavian artery were arising as a common single trunk from the arch of aorta with the additional presence of an aberrant right subclavian artery from the distal aortic arch on the left side and having a retroesophageal course to reach the right arm.

A Briggs-Rauscher Reaction-based Spectrometric Assay to Determine Antioxidant Content in Complex Matrices in Low Technology Environments.

The Briggs-Rauscher (BR) reaction is free radical based where the kinetics of formation of different iodide species leads to potentiometric and color oscillations. These oscillations were monitored in this study using a UV/Vis attenuated total reflection probe to develop an assay to measure the antioxidant content in complex matrices. The periodicity of the BR reaction was found to be very consistent (range 24-25 seconds, n = 16). Adding various amounts of ascorbic acid, a well-known antioxidant, led to an inhibition of the reaction with a linear calibration curve of antioxidant periodicity time (APT, r 2 > 0.99). The validity of this test in complex matrices was studied by determining the APT of nine fruits, and the resulting antioxidant capacity in ascorbic acid equivalency was calculated. The results generated by this assay were found be accurate through comparison with the well-established FRAP assay. These results show that visual or spectrometric monitoring of BR reaction can be used as a reliable, quick, and inexpensive alternative to more established assays with the added advantage that values generated from this assay is at pH 2 which is similar to that in the human stomach.

Congenital superior vena cava (SVC) stenosis and obstructed supracardiac total anomalous pulmonary venous connection (TAPVC)-A surgical perspective.

Congenital superior vena cava (SVC) stenosis is a very rare anomaly, especially in pediatric population. Coexistence with obstructed supracardiac total anomalous pulmonary venous connection (TAPVC) has never been reported. Clinical examination should prompt detailed and focused evaluation for this treatable etiology. Pericardial patch augmentation can cure SVC stenosis, and may allow for growth potential as well. We describe a case of congenital SVC stenosis in a case of obstructed supracardiac TAPVC in a 3-month-old infant, managed successfully.

Localized Hyperlucency in an Acutely Dyspneic Patient: Always a Pneumothorax?

BACKGROUND: Every emergency physician encounters acutely dyspneic patients with localized hyperlucency on chest x-ray study. Although most commonly due to pneumothorax, alternative diagnosis in selected cases with atypical features includes bullae and cystic lesions, especially in childhood. Presence of atypical radiology shouId alert an emergency physician to rule out any alternative diagnosis. Computed tomography is usually diagnostic in such cases and a double-wall sign on computed tomography aids to distinguish between pneumothorax and bullous disease. CASE REPORT: A 60-year-old male presented with sudden increase in dyspnea and a localized hyperlucency on chest x-ray study. A review of his medical records and evaluation of atypical radiology by computed tomography revealed increase in size of bulla to be the cause for distress rather than a pneumothorax. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Every emergency physician encountering acutely dyspneic patients should be aware of these potential mimickers of pneumothorax and ways to distinguish them to avoid inadvertent tube thoracostomy and possible complications.

Comparison of longitudinal changes in clinical periodontal parameters of canines and first molars treated with fixed orthodontic appliances.

INTRODUCTION: Our objective was to learn the possible effects of fixed orthodontic therapy on the periodontium of the extraction sites adjacent to canines and first molars. This was a prospective cohort study. METHODS: Sixty-two systemically healthy subjects were selected. The study was divided into the period of oral hygiene instructions and the period of active orthodontic treatment. Plaque index, gingival index, probing pocket depth, and clinical attachment loss were recorded for the canines and first molars at baseline, after 1 month of orthodontic therapy, and every 3 months until the completion of the orthodontic treatment. RESULTS: There was a statistically significant increase in all clinical parameters (plaque index, gingival index, probing pocket depth, and attachment loss; P <0.05) on the first molars compared with the canines. Significant increases in attachment loss were noted in both the canines (baseline, 0.06 ± 0.01 mm; end of treatment, 0.17 ± 0.02 mm) and the molars (baseline, 0.07 ± 0.01 mm; end of treatment, 0.20 ± 0.02 mm). CONCLUSIONS: Attachment loss cannot be explained solely by the effect of plaque or the banding of teeth. Other factors such as tooth extractions adjacent to the canines, tooth movement, and occlusal trauma may have contributing roles in the loss of periodontal support in adolescent patients.

Anxiety, depression, professional fulfilment and burnout: Public and private doctors' differential response to CoVID-19 pandemic.

Introduction: Covid-19 pandemic has been a challenge for healthcare system; the doctors in public and private setups are at the center of this challenge. Public and private doctors differ in personality and some occupational aspects. Do these differences reflect in their response to Covid? Aim: To study the difference in anxiety, depression, burnout, and professional fulfillment between doctors in public and private setup during Covid-19 second wave and to assess their coping strategies. Methods: A cross-sectional Internet-based observational study was conducted using Stanford PFI, GAD-7, PHQ-2, BFI-10, and brief COPE questionnaires. Results: A total of 114 public and 37 private doctors participated in the study. Doctors in private were older in age and deferred in personality profile. Significantly, more private doctors screened for anxiety disorder. 62.2% of private and 41.2% public doctors felt professionally fulfilled. Burnout and depression were not significantly different between groups. Active coping, acceptance, and planning coping were significantly more used by private doctors. Conclusion: There are differences how doctors in different setups respond to Covid-19, and there is need to understand these factors.

Surgical Challenges in a Case of a Recurrent Giant Pleomorphic Liposarcoma of Neck And Mediastinum in a Child: A Rare Occurrence.

Liposarcomas are rare in childhood, representing < 1% of all childhood soft tissue sarcomas. The most frequent site of involvement are the extremities with the involvement of head and neck being an absolute rarity. Pleomorphic subtype of liposarcoma is pretty aggressive and hence portends a poor prognosis. Here, we present the case of a child who presented with a recurrence of liposarcoma in the neck and mediastinum within 3 months of the index surgery. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-021-02837-w.

Hierarchical, Grid-Aware, and Economically Optimal Coordination of Distributed Energy Resources in Realistic Distribution Systems.

Renewable portfolio standards are targeting high levels of variable solar photovoltaics (PV) in electric distribution systems, which makes reliability more challenging to maintain for distribution system operators (DSOs). Distributed energy resources (DERs), including smart, connected appliances and PV inverters, represent responsive grid resources that can provide flexibility to support the DSO in actively managing their networks to facilitate reliability under extreme levels of solar PV. This flexibility can also be used to optimize system operations with respect to economic signals from wholesale energy and ancillary service markets. Here, we present a novel hierarchical scheme that actively controls behind-the-meter DERs to reliably manage each unbalanced distribution feeder and exploits the available flexibility to ensure reliable operation and economically optimizes the entire distribution network. Each layer of the scheme employs advanced optimization methods at different timescales to ensure that the system operates within both grid and device limits. The hierarchy is validated in a large-scale realistic simulation based on data from the industry. Simulation results show that coordination of flexibility improves both system reliability and economics, and enables greater penetration of solar PV. Discussion is also provided on the practical viability of the required communications and controls to implement the presented scheme within a large DSO.

Multiple sclerosis in India: An institutional study.

BACKGROUND: Few population based studies on multiple sclerosis have been published from India. There is an increasing demand to establish a nationwide MS registry in India especially in view of the percieved increased incidence and prevalence. OBJECTIVES: To create a registry data base for all MS patients presenting at our institute and understand the disease characteristics in our population and compare them with the published reports from the west. METHODS: MS was diagnosed on the basis of clinical and imaging features (Revised McDonald׳s criteria 2010). Demographics, clinical data, treatment details and disease behavior were recorded over a follow up of one year. Descriptive analyses was performed. RESULTS: 101 patients (61 females) were recruited in the study period from June 2011 to December 2012. Mean age of the patients at the time of presentation was 33.3±9.2 years and mean duration of illness was 5.98±4.95. 68.4% patients had RRMS, 16.8% had SPMS whereas 14.8% patients had PPMS. Site(s) involved in first relapse was spinal cord in 43.7% patients followed by brainstem 25.3% and optic nerve in 24.1% patients. Mean number of relapses were 3.26±2.026. Mean EDSS at the time of presentation was 3.20±2.11. Overall, 55.44% patients took DMT at some point during their course of disease. No significant differences were observed between our patient characteristics when compared to publications from west. CONCLUSION: Demographic data in the present study are comparable to those reported in population-based epidemiological studies from west. A nationwide registry network will help establish stronger data on incidence, prevalence and disease profile of MS in India.

Managing endodontic patients with severe gag reflex by glossopharyngeal nerve block technique.

INTRODUCTION: Gagging is a protective reflex, but when the gag reflex becomes abnormally active, it poses a difficulty for the dentist because it hinders all aspects of dental procedures including diagnosis, radiography, and any form of active procedure. METHODS: In this case report, to overcome this difficulty the authors used a glossopharyngeal nerve block technique that is used by anesthetists and otolaryngologists, but its endodontic use has gone previously unreported. RESULTS: Response to gag reflex decreases after successful glossopharyngeal nerve block. CONCLUSIONS: The glossopharyngeal nerve block technique is a relatively safe, simple, and easy to master technique as compared with general anesthesia for treating a patient with an exaggerated gag reflex. The glossopharyngeal nerve block technique may be used in dental procedures in patients with an exaggerated gag reflex or when performing procedures in the posterior aspect of the mouth. Due caution should be exercised to prevent inadvertent intravascular administration of local anesthetic when using this procedure.

Congenital granular cell lesion: A rare tumor of new born.

Congenital granular cell tumor (CGCT), or congenital epulis, is an uncommon benign soft tissue lesion that usually arises from the alveolar mucosa of neonates and may cause respiratory and feeding problems. The histogenesis and clinical history of the lesion remains obscure. Treatment involves surgical excision and recurrences are rare. The present report describes a case of congenital granular cell lesion (CGCL) in the anterior segment of maxillary alveolar ridge of a 2-month-old female. This lesion was causing feeding problem and was excised under local anesthesia, with no recurrence even after 3 years.