Combined nephrectomy and aortic valve replacement: perioperative decision-making.

Open heart surgery and urologic surgery may be required for patients with coincident diseases. We report a patient who suffered from aortic valve stenosis which was asymptomatic barring atrial fibrillation. He was prescribed warfarin and then developed a large perinephric hematoma. The perioperative considerations focused on whether to conduct aortic valve replacement for this patient and, if such surgery was indicated, the appropriate time to conduct it. Traditionally, severe cardiac disease is addressed first before conducting elective noncardiac surgery; however, this option was not available since the patient already had a perinephric hematoma which could bleed more when subjected to systemic heparinization for cardiopulmonary bypass. Here, we describe the process of perioperative decision-making involving multiple specialities and re-examine several guidelines.

Multi-modal fusion of deep transfer learning based COVID-19 diagnosis and classification using chest x-ray images.

COVID-19 pandemic has a significant impact on the global health and daily lives of people living over the globe. Several initial tests are based on the detecting of the genetic material of the coronavirus, and they have a minimum detection rate with a time-consuming process. To overcome this issue, radiological images are recommended where chest X-rays (CXRs) are employed in the diagnostic process. This article introduces a new Multi-modal fusion of deep transfer learning (MMF-DTL) technique to classify COVID-19. The proposed MMF-DTL model involves three main processes, namely pre-processing, feature extraction, and classification. The MMF-DTL model uses three DL models namely VGG16, Inception v3, and ResNet 50 for feature extraction. Since a single modality would not be adequate to attain an effective detection rate, the integration of three approaches by the use of decision-based multimodal fusion increases the detection rate. So, a fusion of three DL models takes place to further improve the detection rate. Finally, a softmax classifier is employed for test images to a set of six different. A wide range of experimental result analyses is carried out on the Chest-X-Ray dataset. The proposed fusion model is found to be an effective tool for COVID-19 diagnosis using radiological images with the average sens y of 92.96%, spec y of 98.54%, prec n of 93.60%, accu y of 98.80%, F score of 93.26% and kappa of 91.86%.

Vitamin D deficiency as an etiological factor in delayed eruption of primary teeth: A cross-sectional study.

CONTEXT: Delayed tooth eruption might be the primary or sole manifestation of local or systemic pathology. Aims: The aim of the study was to correlate Vitamin D level and eruption status of primary teeth. The objectives also included the assessment of the association between Vitamin D levels and socioeconomic status, infant's sun exposure, maternal sun exposure during pregnancy and religion. SETTINGS AND DESIGN: A cross-sectional, observational study conducted on 96 infants aged 12-15 months. MATERIALS AND METHODS: Ninety-six infants, aged 12-15 months were selected after obtaining parental consent. Blood samples were assessed for Vitamin D3 levels using the Vitamin D ELISA Kit. The eruption status of the teeth was recorded in all the 96 infants. The obtained data were subjected to the statistical analysis. STATISTICAL ANALYSIS USED: The obtained data were subjected to relevant statistical analysis such as Analysis of Variance, unpaired t-test, Kruskal-Wallis test, and Mann-Whitney U test, Chi-square Test, Tukey HSD, and Fisher's exact Test. Results: A significant correlation was found in the Vitamin D levels and the eruption timing (P < 0.001). The difference in mean Vitamin D levels among the three socio economic groups was not statistically significant (P = 0.088). A significant association was found between the infant's sun exposure and mother's sun exposure during pregnancy and religion on the Vitamin D levels (P = 0.002, P = 0.042, P = 0.002). CONCLUSIONS: Vitamin D deficiency can be considered as an etiological factor for delayed eruption. A strong association exists between the socioeconomic status, infant's sun exposure, maternal sun exposure during pregnancy, and religion with Vitamin D levels.

Comparing epidural and wound infiltration analgesia for total abdominal hysterectomy: A randomised controlled study.

BACKGROUND AND AIMS: Continuous wound infiltration (CWI) is emerging as an alternative to continuous epidural infusion (CEI). This study compared postoperative pain scores of CEI with CWI in patients undergoing total abdominal hysterectomy (TAH). METHODS: This prospective randomised controlled trial included 102 patients planned for TAH who were randomised into either Group E (CEI) or Group L (CWI). The catheter (epidural/wound infiltration) was inserted in Group E before induction) and Group L at the end of surgery. General anaesthesia was administered according to standard protocol. At the end of surgery, both groups received 10 mL bolus of 0.2% ropivacaine followed by infusion at 6 mL/h through the respective catheters. They also received intravenous patient-controlled analgesia with morphine. The primary outcome was the visual analogue score at rest (VASR) and at deep breathing (VASDB) post-operatively. Secondary outcomes were post-operative morphine consumption, side effects and patient satisfaction. RESULTS: The mean VASR between two groups were comparable up to 8 h. Group E showed significantly reduced VASR compared to Group L at 12 h (2.32 ± 0.59 vs 2.62 ± 0.67, P = 0.019) and 24 h (2.30 ± 0.58 vs 2.62 ± 0.57, P = 0.006). Group E showed significantly reduced VASDB compared to Group L at 5 min and from 4 to 24 h. Total morphine consumption, side effects and patient satisfaction were comparable. CONCLUSION: We conclude that CEI is a superior analgesic technique compared to CWI in total abdominal hysterectomy in terms of reduced pain scores.

Unusual presentation of inverted impacted premolars as a result of dentigerous cyst: a case report.

A case of dentigerous cyst associated with upper right lateral incisor that had resulted in displacement of the canine, inverted impaction of both the premolars and dilaceration of apical 1/3 of central incisor is reported here.

Fluoride uptake by enamel and dentin from bonding agents and composite resins: a comparative study.

The present study was performed to compare the amount of in vitro fluoride uptake by enamel and dentin from fluoridated bonding agent with non-fluoridated composite (Group I), non-fluoridated bonding agent with fluoridated composite (Group II) and fluoridated bonding agent with fluoridated composite resin (Group III). Sixty extracted premolars were selected and divided into three groups of 20 teeth each. Restorative materials were applied according to manufacturer's instructions into standard windows created in the teeth, cured and placed in de-ionised water for three months. The fluoride content of successive acid etch biopsy was determined by specific ion-electrode analysis. Although significant amount of fluoride uptake occurred in all the test groups, fluoride uptake was found to be highly significant in dentin when compared to enamel in Group, I, II and III (P<0.001). The fluoride uptake was greater by both enamel and dentin in Group III ie fluoridated bonding agent with fluoridated composite resin.

Nasopalatine duct cyst--a case report.

A nasopalatine duct cyst is that which occurs in or near the incisive canal. A case of nasopalatine duct cyst in a 14-year-old male is reported here.

Dermatoglyphics: a genetic marker of early childhood caries.

BACKGROUND: It is an accepted fact that genetics plays an important role in determination of palmar dermatoglyphic patterns. Since caries is a multifactorial disease with the influence of genetic pattern, this study was undertaken to explore the possibility of dermatoglyphics as a noninvasive and early predictor of dental caries in children, so as to initiate preventive oral health measures at an early age. MATERIALS AND METHODS: The study group comprised of 200 children aged between 4 and 5 years. The dmfs score was evaluated. The experimental group (Group 1), comprised of 100 children with early childhood caries (ECC) with dmfs >5. The control group (Group 2) comprised of 100 children with dmfs score of 0. RESULTS: An increased frequency of ulnar loops in caries-free children and whorls in children with ECC was observed. Low mean atd angle and low mean. Total ridge count was observed in the ECC group. CONCLUSION: There is definite variation in dermatoglyphics between the ECC and caries-free group, indicating that dermatoglyphic patterns can be used as a predictive tool for children with ECC.

Estimation and comparison of dental, skeletal and chronologic age in Bangalore south school going children.

OBJECTIVE: Precise evaluation of the developmental stages of a child is an integral part of both diagnosis and treatment planning of pediatric patients and also essential in forensic medicine and dentistry. As human growth shows considerable variation in chronological age, physiological maturity is preferred over chronological age in the estimation of person's exact age. MATERIALS AND METHODS: Two hundred and fifty children consisting of 124 girls and 126 boys were selected randomly from the age group of 6-15 years. They were divided into 10 groups based on their age. The chronological age was determined by their date of birth as per the school records. An orthopantomogram and left hand-wrist radiographs was taken for each child to assess the dental age through Demirjian's method and skeletal age through the atlas of Greulich and Pyle's method respectively. RESULT: The dental age showed a significant correlation (P<0.05) with chronological age in group 1 and 5 in males and group 3 and 7 females, whereas skeletal age showed a significant correlation with chronological age in group 3, 5, 9, and 10 in males and 1, 2, 5, 9, and 10 years in females. CONCLUSION: Demirjian's method of dental age estimation and Greulich and Pyle's method of skeletal age estimation showed accuracy only in certain age groups in the school children of Bangalore.

Monitoring of heavy metal partitioning in reef corals of Lakshadweep Archipelago, Indian Ocean.

This paper focuses on the partitioning of trace metals in five selected coral species from Lakshadweep Archipelago, which remains as one of the least studied areas in the Indian Ocean. Based on the morphological features, selected coral species are classified as massive (Porites andrewsi), ramose or branching (Lobophyllia corymbosa, Acropora formosa and Psammocora contigua) and foliaceous (Montipora digitata). Relating trace metal concentrations with morphological features in skeleton, highest concentrations of all the trace metals (except Zn) were reported for the ramose type corals. In tissue, all the metals (essential as well as non essential) showed highest concentrations within the branching type corals. Irrespective of their growth characteristics/pattern, all species except P. contigua displayed higher concentrations of Pb, Ni, Mn and Cd within their skeleton compared to tissue which may exemplify a regulatory mechanism to avoid the build up of the concentrations of these metals in their bio-part, strikingly toxic metals like Cd and Pb. The concentrations of trace metals in the skeleton and tissues of these coral species were subjected to 3 way ANOVA based on non standardized original data and the results showed significant differences between metals and between species leading to high skeleton/ tissue - species interaction as well as skeleton/tissue - metal interaction. The significant values of student's t calculated are depicted in the form of Trellis diagrams.