Triage and resuscitation tools for low and middle income countries: how to catch the killer?

Under-5 mortality rates in low and middle-income countries (LMIC) remain high. One major contributing factor is the failure to recognise critically unwell children when they first present to hospital. This leads to delayed or inadequate resuscitation and an increased risk of death.Triage is a key skill in this setting to sort the queue and prioritise patients, even when staff and equipment are scarce. In LMIC, children generally present late in their illness and often have progressed to some degree of multiorgan dysfunction.Following triage, a structured systematic primary survey is critical to ensure the detection of subtle signs of multiorgan dysfunction. Repeated physiological assessments of the child guide subsequent resuscitation management decisions, which depend somewhat on the resources available.It is possible to achieve significant improvements in survival of critically unwell children presenting for emergency care in the resource-limited setting. The three key steps in the patient's journey that we can influence in emergency care are triage, primary survey and initial stabilisation. Resources that address these steps have been developed for all settings. However, these resources were developed in a specific clinical context, and must therefore be adapted to local structures and processes. A systematic approach to triage and resuscitation saves lives.

On Data-Driven Sparse Sensing and Linear Estimation of Fluid Flows.

The reconstruction of fine-scale information from sparse data measured at irregular locations is often needed in many diverse applications, including numerous instances of practical fluid dynamics observed in natural environments. This need is driven by tasks such as data assimilation or the recovery of fine-scale knowledge including models from limited data. Sparse reconstruction is inherently badly represented when formulated as a linear estimation problem. Therefore, the most successful linear estimation approaches are better represented by recovering the full state on an encoded low-dimensional basis that effectively spans the data. Commonly used low-dimensional spaces include those characterized by orthogonal Fourier and data-driven proper orthogonal decomposition (POD) modes. This article deals with the use of linear estimation methods when one encounters a non-orthogonal basis. As a representative thought example, we focus on linear estimation using a basis from shallow extreme learning machine (ELM) autoencoder networks that are easy to learn but non-orthogonal and which certainly do not parsimoniously represent the data, thus requiring numerous sensors for effective reconstruction. In this paper, we present an efficient and robust framework for sparse data-driven sensor placement and the consequent recovery of the higher-resolution field of basis vectors. The performance improvements are illustrated through examples of fluid flows with varying complexity and benchmarked against well-known POD-based sparse recovery methods.

Intraosseous Neurofibroma of Mandible in a 5-Year-Old: A Rare Case Report and Review of Literature.

Neurofibromas are benign tumours originating from the peripheral nerve sheath mainly the endoneurium. The lesion can occur in a solitary form or as multiple tumours associated with neurofibromatosis (NF-1), which is also known as von Recklinghausen's disease. Intraosseous neurofibromas are exceedingly rare with only less than 50 cases reported in the literature. We report a case of paediatric neurofibroma of the mandible which is even more rare with only 9 cases reported so far. Hence, systematic and thorough investigations are mandatory to correctly diagnose and plan appropriate treatment for intraosseous neurofibroma because of the rarity of the lesion in the paediatric age group. The clinical presentations, diagnostic challenges and treatment plan with a thorough review of literature have been addressed in this case report. The purpose of this paper is to present a case of pediatric intraosseous neurofibroma and to  stress the importance of considering such a rare lesion in the differential diagnosis of jaw lesions, especially in children to reduce functional and aesthetic morbidity.

Role of Custom-Made Prosthesis for Temporomandibular Joint Replacement in Unilateral Ankylosis - An Evaluative Study.

INTRODUCTION: Ankylosis is a physically and psychologically distressing condition to a patient. The aim of this study was to evaluate the efficiency of custom-made temporomandibular joint (TMJ) prosthesis (fossa-condyle component) in patients with unilateral ankylosis in restoring the form and functions of the TMJ. MATERIALS AND METHODS: This retrospective study was conducted in ten patients with unilateral TMJ ankylosis who had undergone TMJ reconstruction with custom-made TMJ prosthesis. Clinical parameters assessed were maximal mouth opening, lateral movements, improvement of the pain levels, and dietary efficiency of the patient. The data were analyzed using SPSS version 20 (IBM Corporation, SPSS Inc.; Chicago, IL, USA). RESULTS: The mean preoperative mouth opening was 5.70 ± 3.62 mm. After gap arthroplasty, it was 32.50 ± 3.31 mm. The postoperative mouth opening after the reconstruction of TMJ using alloplastic joint prosthesis was 34.90 ± 2.69 mm, and after a mean follow-up period of 4 years, the mean postoperative mouth opening was 34.60 ± 2.50 mm. The mean preoperative movement toward the right and left side was 0.9 ± 1.2 mm and 1.3 ± 1.25 mm, respectively. The mean right and left lateral movements of the TMJ after reconstruction were 3.5 ± 0.97 mm and 3.70 ± 1.06 mm, respectively. There was decrease in deviation of the unaffected jaw during mouth opening and closure. Functional occlusion was maintained postoperatively. There was no appreciable change in the visual analog pain scales. The dietary efficiency improved from a scale of 10 (liquids) to a scale of 0 (no restriction to diet) in eight patients and 1 in two patients. The dietary score improved significantly after alloplastic reconstruction (P = 0.000). No evidence of facial nerve paralysis or foreign body reactions was noted in the patients during the follow-up period. Radiographic assessment revealed good positioning and adaptation of the fossa component and the condylar ramal component both postoperatively and after a mean 4-year follow-up period. There was no evidence of screw loosening or prosthesis breakage during the follow-up period. DISCUSSION AND CONCLUSION: The custom-made TMJ-total joint replacement (TJR) devices provide stable, improved long-term results, thereby increasing the quality of life of the patient. The custom-made alloplastic TMJ-TJR prosthesis proves to be the optimal surgical procedure to reconstruct the TMJ in comparison to the autogenous grafts (to avoid complications) in severe degenerated and ankylosed joints. However, long-term clinical and radiological studies on a larger sample size are imperative to establish the versatility of this procedure.

Recurrent ameloblastoma 24 years after hemimandibulectomy: A case report and review of literature.

Ameloblastoma is a benign, locally aggressive epithelial odontogenic tumor with a high recurrence rate. The management of ameloblastoma has always been controversial and an enigma to the surgeons. Literature suggests that 50% of the recurrences occur during first 5 years after the primary surgery, and the recurrence rate following a radical approach such as a segmental resection is 4.6%. The reasons for recurrence after a radical approach can be multifactorial such as remaining stumps, soft tissues, or intraoperative contamination. The purpose of this case report is to emphasize the fact that a recurrence even after 24 years is possible in spite of a radical segmental resection, and hence, a continuous follow-up of the patient is needed and to highlight the fact that the possibility of malignant ameloblastoma or ameloblastic carcinoma should be ruled out when dealing with such ameloblastomas recurring after a long period after a radical primary surgery.

Plunging Ranula in a 78- year- old Male - a Rare Case Report.

The term Ranula is a Latin word meaning frog. It refers to a bluish translucent cystic lesion in the floor of the mouth resembling the underbelly of a frog. Ranulas can be true cysts occurring due to ductal obstruction of the sublingual gland or a minor salivary gland or a pseudocyst as a result of ductal injury leading to extravasation and accumulation of saliva in the surrounding tissues. Clinically ranulas present as intraoral or plunging ranulas. The prevalence of ranula is 0.2% per 1000 patients Ranulas account for 6% of all salivary gland cysts. Ranulas are more common in children and young adults. However the plunging type occurs most commonly in the later third decade. The diagnosis of plunging ranula is based on a combined clinical,radiographic imaging and histologic findings. The treatment of ranulas have always been controversial.The treatment modalities range from simple marsupialisation to excision of the pseudocyst along with sublingual or submandibular gland excision.The purpose of this paper is to present a rare case of plunging ranula and to highlight the importance of considering plunging ranula in the differential diagnosis of lesions of the neck. Key words:Plunging Ranula,mucus, submandibular gland, transcervical approach.