Comparison of various Head Injury Prognostic Scales

INTRODUCTION: Traumatic Brain injury (TBI) is a considerable health care problem1-3 and is one of the most common causes of death. Its incidence is rising at large proportions in regions with rapidly increasing motorization because of industrialized development. The incidence varies from 67 to 317 per 100000 individuals and mortality rates range from around 4-8% for moderate injury to approximately 50% with severe head injury. The symptoms of TBI can be various depending on the extent of damage to the brain. The outlook for patients with mild TBI is generally a good recovery, while patients with a severe TBI have a substantial risk to die. Predicting outcome for very good or very severe patients is therefore rather easy. However, for severe and moderate TBI patients the outcome is not so easy to predict, while such predictions would be helpful in supporting clinical decision making, providing realistic and evidence based expectations to relatives and care givers, as well as in clinical research. Any ideal prediction score or model should be easy to apply, with high sensitivity and specificity rates irrespective of the management protocol, its time and place of application. Several prospective and retrospective studies have been done to derive a baseline predictive model for patients in the intensive care unit in general or specific to traumatic brain injury. AIM OF THE STUDY: 1. The application of various prognostic scales on outcome of moderate and severe traumatic brain injury patients. 2. To compare the sensitivity, specificity and efficacy of the various prognostic scales. MATERIALS AND METHODS: This study was conducted at Madras Medical College and Rajiv Gandhi Government. General Hospital, Institute of Neurology which included 300 patients with moderate and severe traumatic brain injury. It was a prospective study from 2010 to 2013. A thorough Clinical and detailed neurological examination was done and the patient details were recorded in a Proforma and the following Prognostic Scores were calculated for every patient: - Madras Head Injury Prognostic Scale (MHIPS). - NIMHANS Model (NM). - Edinburgh Prognostic Scale. The efficacy, sensitivity and specificity was noted for every score and compared for the outcome of these patients. All Patients presenting to the trauma ward of our hospital with moderate and severe head injury along with other systemic injuries were included in our study population. All patients presenting with mild head injury were excluded from our study population. The primary reason for choosing to compare these three scores in this study is: 1. All the three scores have taken into account almost similar variables. 2. All these scores are objective and measurable on a numerical scale. 3. All the three scores are simple enough to be used during a routine bed side clinical assessment. 4. Also these scores are easy to apply even for a junior member of the team. CONCLUSION: In patients with moderate and severe head injury age of the patient plays a significant role in deciding the outcome. Older the patient poorer the prognosis. • In Glasgow Coma Scale, the best motor response is the most accurate predictor of outcome in moderate and severe head injury patients. • Both Occulocephalic and pupillary reflexes should be noted on admission in patients with moderate and severe TBI. Their response holds a significant correlation to the final outcome. • Single variable is not enough to prognosticate the outcome in traumatic brain injury patients. The scoring should always be a multivariate analysis • In this study Madras Head Injury prognostic Scale (MHIPS) was the most significant scoring system in accurate prediction of outcome in moderate and severe head injury patients as compared to Edinburgh and NIMHANS models

DESIGN & FPGA IMPLEMENTATION OF EFFICIENT MULTIBAND OFDM USING DWT/DUC/DDC

To increase data rate of wireless medium with higher performance, OFDM (orthogonal frequency division multiplexing) is used. Here DWT (Discrete wavelet transforms) is adopted in place of FFT (Fast Fourier transform) for frequency translation. Modulation schemes such as 16-QAM (Quadrature amplitude modulation) have been used in the development of OFDM system using DWT. In this paper, I propose a DWT-IDWT based OFDM transmitter and receiver .It has been proven that all the wavelet families better over the IFFT-FFT implementation.. The wavelet filter used in the project is Bi-orthoganal (9,7) with N=2. The Project also include implementation of Digital Up Converter and Digital Down Converter at the transmitter and receiver part respectively. The project is implemented on FPGA by designing using Verilog HDL and System Generator

Crouzon’s syndrome with adenotonsillitis: conventional surgery in altered anatomy.

Background/Objectives: Crouzon’s syndrome is characterized by premature closure of the cranial sutures, midface hypoplasia, orbital deformities & other associated abnormalities.Children with Crouzon syndrome frequently have obstructive sleep apnea due to the underdevelopment of the midface.Case report: A 12 year old boy of Crouzon’s syndrome with chronic adeno-tonsillitis was managed by adeno-tonsillectomy under general anaesthesia by scalpel cautery method. The boyresponded well to surgery & the mild sleep disorder disappeared within a week uveventfully.Conclusion: Sleep disorders in this condition can be treated by improving the airway by selective procedures like midface advancement, mandibular expansion , adeno-tonsillectomy,uvulo-palatopharyngoplasty, anterior tongue reduction & endoscopic tracheal granuloma excision.

Human otoacariasis: a common outbreak in rubber growing belt of Karnataka.

Background/Objective: Soft tick in the ear is a very common acute painful and distressing condition in the flowering months of October to March. It’s a common condition in the rubber growing belt of Sullia.The mouthparts of the tick grips firmly the skin of the external auditory canal or the tympanic membrane and sucks blood and swells up. Otoscopy and removal of the tick from the ear can be done in outpatients in adults and difficult in a frightened irritable child.Materials and methods: 312 cases of intra-aural ticks presenting to the opd and casualty which included 131 males and 181 females were included in the study.Results: Out of the 312 cases of intra-aural ticks, 170 cases were treated in the outpatient and 140 cases under short general anesthesia with oto-microscopy.Conclusion: Intra-aural tick infestation is an acute painful condition which needs prompt management by an experienced otolaryngologist. Proper visualization and instrumentation is necessary to avoid complications.

Boosting the MHC class II-restricted tumor antigen presentation to CD4+ T helper cells: A critical issue for triggering protective immunity and re-orienting the tumor microenvironment toward an anti-tumor state

6noopenAlthough the existence of an immune response against tumor cells is well documented, the fact that tumors take off in cancer patients indicates that neoplastic cells can circumvent this response. Over the years many investigators have described strategies to rescue the anti-tumor immune response with the aim of creating specific and long-lasting protection against the disease. When exported to human clinical settings, these strategies have revealed in most cases a very limited, if any, positive outcome. We believe that the failure is mostly due to the inadequate triggering of the CD4+ T helper (TH) cell arm of the adaptive immunity, as TH cells are necessary to trigger all the immune effector mechanisms required to eliminate tumor cells. In this review, we focus on novel strategies that by stimulating MHC class II-restricted activation of TH cells generate a specific and persistent adaptive immunity against the tumor. This point is of critical importance for both preventive and therapeutic anti-tumor vaccination protocols, because adaptive immunity with its capacity to produce specific, long-lasting protection and memory responses is indeed the final goal of vaccination. We will discuss data from our as well as other laboratories which strongly suggest that triggering a specific and persistent anti-tumor CD4+ TH cell response stably modify not only the tumor microenvironment but also tumor-dependent extratumor microenvironments by eliminating and/or reducing the blood-derived tumor infiltrating cells that may have a pro-tumor growth function such as regulatory CD4+/CD25+ T cells and myeloid-derived-suppressor cells. Within this frame, therefore, we believe that the establishment of a pro-tumor environment is not the cause but simply the consequence of the tumor strategy to primarily counteract components of the adaptive cellular immunity, particularly TH lymphocytes.openAccolla, R.S.; Lombardo, L.; Abdallah, R.; Raval, G.; Forlani, G.; Tosi, G.Accolla, Roberto; Lombardo, L.; Abdallah, R.; Raval, G.; Forlani, Greta; Tosi, Giovann

Budesonide/formoterol combination in COPD: a US perspective

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease of the lung caused primarily by exposure to cigarette smoke. Clinically, it presents with progressive cough, sputum production, dyspnea, reduced exercise capacity, and diminished quality of life. Physiologically, it is characterized by the presence of partially reversible expiratory airflow limitation and hyperinflation. Pathologically, COPD is a multicomponent disease characterized by bronchial submucosal mucous gland hypertrophy, bronchiolar mucosal hyperplasia, increased luminal inflammatory mucus, airway wall inflammation and scarring, and alveolar wall damage and destruction. Management of COPD involves both pharmacological and nonpharmacological approaches. Bronchodilators and inhaled corticosteroids are recommended medications for management of COPD especially in more severe disease. Combination therapies containing these medications are now available for the chronic management of stable COPD. The US Food and Drug Administration, recently, approved the combination of budesonide/formoterol (160/4.5 μg; Symbicort™, AstraZeneca, Sweden) delivered via a pressurized meter dose inhaler for maintenance management of stable COPD. The combination also is delivered via dry powder inhaler (Symbicort™ and Turbuhaler™, AstraZeneca, Sweden) but is not approved for use in the United States. In this review, we evaluate available data of the efficacy and safety of this combination in patients with COPD

A Parallel Monte-Carlo Tree Search-Based Metaheuristic For Optimal Fleet Composition Considering Vehicle Routing Using Branch & Bound

In this paper, a Monte-Carlo Tree Search (MCTS)-based metaheuristic is developed that guides a Branch & Bound (B&B) algorithm to find the globally optimal solution to the heterogeneous fleet composition problem while considering vehicle routing. Fleet Size and Mix Vehicle Routing Problem with Time Windows (FSMVRPTW). The metaheuristic and exact algorithms are implemented in a parallel hybrid optimization algorithm where the metaheuristic rapidly finds feasible solutions that provide candidate upper bounds for the B&B algorithm which runs simultaneously. The MCTS additionally provides a candidate fleet composition to initiate the B&B search. Experiments show that the proposed approach results in significant improvements in computation time and convergence to the optimal solution.Comment: Submitted to the IEEE Intelligent Vehicles Symposium 202

Sonneratia ovata (Sonneratiaceae)－A New Distributional Record for India from Andaman and Nicobar Islands

Sonneratia ovata Backer was found from Havelock, Andaman and Nicobar Islands, representing a new addition to the mangrove flora of India. This species lacks petals and is characterized by the finely warty calyx, the lobes of which are red on the inner side and by the adpressed calyx lobes in fruit. Since S. ovata is considered rare as a whole, conservation measures are imperative for managing the mangrove diversity of the Islands with special reference to this species

Fishery and Exploitation of Malabar Grouper, Epinephelus malabaricus (Bloch & Schneider 1801) from Andaman Islands

The fishery and population dynamics of groupers from Andaman Islands were studied from Jan 2010 to Dec 2011 with a special emphasis on Malabar grouper, Epinephelus malabaricus (Bloch & Schneider 1801). The average annual catch of Malabar grouper was 1,296 tonnes contributing to 21.6% of annual grouper landings. Length-weight relationship of Malabar grouper showed that growth was allometric (b=2.96) and relative condition factor (Kn) was 1 and the growth parameters viz., L∞, K and t0 were 124.60 cm, 0.80 and -0.05 respectively. The recruitment pattern was unimodal with one major peak during April to July throughout the study period. The natural mortality (M), fishing mortality (F) and total mortality (Z) were 1.05, 1.48 and 2.53 respectively and exploitation rate (E) was 0.58. The M/K ratio (1.31) was found to be well within the normal range of 1to 2.5. Catch per unit effort varied from 4 to16.5 kg.h-1. The maximum sustainable yield (MSY) was 1,107 tonnes which was lower than the average annual catch (1,296 tonnes), indicating over exploitation. The current study calls for further research in identifying the grouper fishing and spawning aggregation grounds and introduce measures for reducing fishing efforts with input and output controls to sustain the Malabar grouper fishery in Andaman waters

PRESURGICAL NASOALVEOLAR MOLDING ASSISTED PRIMARY RECONSTRUCTION IN 5-DAY OLD INFANT WITH UNILATERAL CLEFT LIP, ALVEOLUS AND PALATE USING PSIO-J HOOK APPLIANCE A CASE REPORT.

Introduction: Management of cleft patients is quite challenging and controversial. Advances in reconstructive surgery have significantly improved the quality of repair for cleft of the lip, alveolus and palate. This case report describes a new approach of presurgical nasoalveolar molding (PNAM) therapy in a 5 day old infant using PSIO-J hook appliance. Methods: Lip taping was started on the initial visit using 3M Steri- Strip. Initial impressions were made to fabricate the PSIO appliance. On second visit appliance was delivered to approximate the cleft alveolus. Once the cleft gap has been reduced to approximately 5 mm a J- hook modification was given to avoid bulkiness and thereby enhancing retention. Conventional nasal stent exerts a reciprocal intraoral molding force against the alveolar segments hence this drawback was eliminated by using J-hook modification appliance. Following surgical repair of lip, the lip was taped for several weeks and the use of PSIO-J hook appliance was discontinued. Results: There was significant improvement in nasal tip projection, columella size on cleft side and position of lower lateral cartilages as well as approximation of the lip segments. Additionally the alveolar defect reduced from 14mm to 3mm from pre NAM to post NAM. Conclusion: The pre-surgical nasoalveolar molding assisted primary reconstruction using PSIO-J hook appliance results is an overall improvement in the esthetics of the nasolabial complex in cleft conditions while minimizing the extent of surgery and the overall number of surgical procedures