Effect of middle ear and mastoid air space volume on acoustic transmission of sound in tympanic membrane perforation

Background: Loss of hearing is a national health problem with significant social and psychosocial implications. Worldwide there are about 65-330 million people affected with hearing impairment, of which 60% suffers from significant hearing loss. Role of tympanic membrane and ossicular chain in the physiology of hearing is well documented. The emergence of the role played by mastoid air space volume in sound transmission is being critically evaluated these days. The present study is designed to analyze the effect of mastoid air space volume in tympanic membrane perforation with conductive hearing loss.Methods: 32 subjects both male and female with medium sized tympanic membrane perforation were included in the study. They were grouped into two (those with sclerotic and cellular mastoid). Hearing threshold assessed using pure tone audiometer. Mastoid air space volume evaluated using digital X-ray mastoid schuller’s view. Tympanic membrane perforation size assessed using otoscope.Results: The hearing loss in first group having cellular mastoid and second group with sclerotic mastoid were 22.82±6.28 and 27.82±5.66 respectively. Their p value was 0.026 which was statistically significant.Conclusions: Mastoid air space volume is inversely proportional to conductive hearing loss. Therefore mastoid air space volume also plays a key role in the sound transmission. The awareness of the pneumatisation status of the mastoid helps clinicians to choose appropriate line of management.

Reconstructing the Earthquake Recurrence Pattern in the Central Himalaya: Evidence from the Himalayan Frontal Thrust

Abstract HKT-ISTP 2013 A

Role of nebivolol in anthracycline-induced cardiotoxicity

Background: Anthracyclines are extensively used in the treatment of breast cancer. However, these therapeutic agents are responsible for chemotherapy-induced cardiotoxicity. Aim of this study was to assess the effect of use of prophylactic nebivolol for the prevention of anthracycline-induced cardiotoxicity in breast cancer patients.Methods: This was a prospective, randomized, single-blind, and placebo-controlled trial involving 80 participants with breast cancer, scheduled to undergo chemotherapy with doxorubicin. Patients were randomly divided into two groups: the nebivolol group (n=40) to receive nebivolol 5 mg daily and the placebo group (n=40) to receive placebo. All patients were evaluated with baseline Electrocardiogram (ECG) and echocardiography prior to treatment, and at the 6-month follow-up. Echocardiography included 2D echocardiography, colour doppler and tissue doppler imaging.Results: The study groups had comparable baseline echocardiographic variables. At the 6-month echocardiographic follow-up, there were no changes of statistical significance in any 2D echocardiographic variables in either group. However, there were minimal reductions of 0.4% in left ventricular ejection fraction in the nebivolol group (62.2±4.4% to 61.9±4.2%, p=0.75) and 1.6% in the placebo group (62.8±3.6% to 61.8±3.2%, p=0.18). Doppler examinations also did not reveal any statistically significant changes in variables such as peak A velocity, peak E velocity, E/A ratio, isovolumic relaxation time, and isovolemic contraction time in either group.Conclusions: Prophylactic use of nebivolol treatment may possess cardioprotective properties against anthracycline-induced cardiotoxicity in breast cancer patients although not statistically significant in this study

A rare case of acute lymphoblastic leukaemia with hemophilia A

A rare case of Acute lymphoblastic leukemia with hemophillia in a 12 year old boy is presented in the article. Patient was known case of hemophillia (factor VIII deficiency). He was diagnosed as a case of ALL based on bone marrow examination and immunophenotypic study. Patient was treated as per Children Cancer group guidelines. The main aim of reporting this rare association lies in developing treatment strategies in preventing life threatening bleeding due to this rare association which though may be accidental but need further research

Age and sex variation in the distribution of visceral fat among healthy doctors

Background: Non Communicable Diseases (NCDs) are a mushrooming problem and accounts for majority of deaths. Paradoxically the population of Kerala is increasingly susceptible to NCDs despite having good access to health care. Doctors work in highly stressful conditions and often adopt sedentary lifestyles thereby forming a subset of the NCD prone population. The objective of this study was to assess the health status of the doctors which would provide an insight into their health and level of awareness regarding the role of lifestyle in prevention of NCDs.Methods: Sixty five doctors participated in this Cross-Sectional Observational study conducted at a CME in Kerala. After obtaining Institutional Ethical clearance, demographic profile was collected, and fat levels were estimated using body composition analyzer (OMRON-HBF375). The results were tabulated using Microsoft Office Excel, analyzed using SPSS version 20.Results: On classifying the study group based on BMI, only 34 were normal, 26 were Overweight, and 4 were Obese. Gender wise distribution of body fat revealed only 4 had normal body fat composition. The study also showed that as age advances the amount of total and visceral fat shows a significant upward trend in males.Conclusions: BMI alone cannot be used as a predictor of health status. Body Fat percentage analysis should be included in routine screening programs. Men have a tendency to develop visceral adiposity with age. Females depend more on fat as primary source and hence females will respond better to a properly programmed exercise regime and men to a well guided diet program with exercise

Byzantine Resilient Computing with the Cloud

We study a framework for modeling distributed network systems assisted by a reliable and powerful cloud service. Our framework aims at capturing hybrid systems based on a point to point message passing network of machines, with the additional capability of being able to access the services of a trusted high-performance external entity (the cloud). We focus on one concrete aspect that was not studied before, namely, ways of utilizing the cloud assistance in order to attain increased resilience against Byzantine behavior of machines in the network. Our network is modeled as a congested clique comprising $k$ machines that are completely connected to form a clique and can communicate with each other by passing small messages. In every execution, up to $\beta k$ machines (for suitable values of $\beta \in [0, 1)$) are allowed to be Byzantine, i.e., behave maliciously including colluding with each other, with the remaining $\gamma k$ or more machines being \emph{honest} (for $\gamma=1-\beta$). Additionally, the machines in our congested clique can access data through a trusted cloud via queries. This externality of the data captures many real-world distributed computing scenarios and provides a natural context for exploring Byzantine resilience for essentially all conceivable problems. Moreover, we are no longer bound by the usual limits of $\beta < 1/3$ or even $\beta < 1/2$ that are typically seen in Byzantine Agreement. We focus on a few fundamental problems. We start with the ${\textsf{Download}}$ problem, wherein the cloud stores $n$ bits and these $n$ bits must be downloaded to all of the $k$ machines. In addition to ${\textsf{Download}}$, we also consider the problem of computing the ${\textsf{Disjunction}}$ and ${\textsf{Parity}}$ of the bits in the cloud. We study these problems under several settings comprising various $\beta$ values and adversarial capabilities.Comment: 54 page

Pericardial tamponade masking associated pulmonary thrombo embolism in a case of adeno carcinoma of lung

This case report describes a patient admitted with shortness of breath of 15 days duration and found to have cardiac tamponade, which masked concomitant pulmonary embolism that was diagnosed by echocardiographic signs of dilate RA/RV with PAH only after successful pericardiocentesis. Subsequently patient was found to have widely metastatic adenocarcinoma of lungs. This case emphasizes the diagnostic challengewhen cardiac tamponade is associated with pulmonary thromboembolism and requires high index of clinical suspicion in patients with underlying malignancy

Comparing Outcomes with Bone Marrow or Peripheral Blood Stem Cells as Graft Source for Matched Sibling Transplants in Severe Aplastic Anemia across Different Economic Regions

Bone marrow (BM) is the preferred graft source for hematopoietic stem cell transplantation (HSCT) in severe aplastic anemia (SAA) compared to mobilized peripheral blood stem cells (PBSC). We hypothesized that this recommendation may not apply to those regions where patients present later in their disease course, with heavier transfusion load and with higher graft failure rates. Patients with SAA who received HSCT from an HLA-matched sibling donor from 1995 to 2009 and reported to the Center for International Blood and Marrow Transplant Research or the Japan Society for Hematopoietic Cell Transplantation were analyzed. The study population was categorized by gross national income per capita (GNI) and region/countries into four groups. Groups analyzed were high income countries (HIC), which were further divided into US-Canada (N=486) and other HIC (N=1264), upper middle-income (UMIC) (N=482), and combined lower middle, low income countries (LM-LIC) (N=142). In multivariate analysis, overall survival (OS) was highest with BM as graft source in HIC compared to PBSC in all countries or BM in UMIC or LM-LIC (p<0.001). There was no significant difference in OS between BM and PBSC in UMIC (p=0.32) or LM-LIC (p=0.23). In LM-LIC the 28-day neutrophil engraftment was higher with PBSC compared to BM (97% vs. 77%, p<0.001). Chronic GVHD was significantly higher with PBSC in all groups. Whereas BM should definitely be the preferred graft source for HLA-matched sibling HSCT in SAA, PBSC may be an acceptable alternative in countries with limited resources when treating patients at high risk of graft failure and infective complications

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Applications of Partial Depth Precast Concrete Deck Panels on Horizontally Curved Steel and Concrete Bridges

0-6816Horizontally curved bridges are commonly used for direct connectors at highway intersections as well as other applications. The majority of curved bridges utilize continuous steel curved I-girder or tub girder systems. In recent years, isolated applications of spliced prestressed concrete U-beams have been successfully used for curved bridge applications in Colorado and are currently being considered for use in Texas bridges. One of the most critical construction stages from a stability perspective is placement of the wet concrete deck at which point the girders must support the full construction load of the system until the deck stiffens and acts compositely. Bridges with a curved geometry experience significant torsional forces and require a substantial amount of bracing to control deformation during construction. Bracing in the form of cross frames for steel I-girder systems, top lateral trusses for steel tub girder systems, and lid slabs for concrete U-beams are provided to improve the girder behavior. While partial depth precast concrete panels (PCPs) are commonly used as stay-in-place formwork for straight bridges, the panels are not currently permitted on horizontally curved girder systems in Texas. TxDOT would like to extend the use of PCPs to bridges with curved girders. This report focuses on the stability of PCPs that rest on polystyrene bedding strips. The project studied the behavior for PCPs with and without a positive connection to steel girders and also considered the behavior of the current TxDOT reinforcing details for PCPs with concrete U-beam systems. The experimental portion of this study consists of large-scale PCP shear tests and large-scale combined bending and torsion tests on both a twin steel I-girder system and on a single steel tub girder. The PCP shear tests were used to develop a simple and effective connection between the PCPs and the girder, as well as to empirically determine the in-plane stiffness and strength of the PCP/connection system. The large-scale girder tests were used to investigate the performance of PCPs and their connection to a system that simulates the load experienced in a realistic construction situation. Also, parametric finite element modeling of the PCPs and the curved girder systems were performed and validated with the results from the experimental tests. The finite element models were used to develop an understanding of the fundamental behavior of the steel girder systems in combination with the PCP systems. In addition to focusing on connection methods to the PCPs, guidelines were also developed for cases where the panels can be used on horizontally curved girder systems without a positive connection to the girders