A Rare Presentation of Crohn's Disease

Free peritoneal perforation is a rare complication of Crohn's disease with a report of only 100 cases in the literature. It needs an emergency exploration and an unaware general surgeon is confounded in intraoperative decision-making. We present our experience when this rarity struck us in a district hospital and briefly review the guidelines of optimal management of this complication of Crohn's disease

Ergonomics of free fibula flap in mandible reconstruction

INTRODUCTION: Composite defects in the oro-mandibular region commonly resulting from trauma and cancer surgeries pose a great challenge for the reconstructive surgeon. It envisages the surgeon’s planning abilities and abstractive thinking about the defect that has to be reconstructed. Seeing that Mandibular defects occur more commonly secondary to wide local excision for carcinoma in the oro-mandibular region, they produce significant morbidity by affecting both the function and aesthetics of the face. Also most carcinoma patients may already have had a course of radiotherapy or might need radiotherapy post-surgically. This imposes further burden on any of the flaps designed to cover the cancer post-excisional defect. Though various local and loco-regional options, like, pectoralis major myocutaneous flap, lattismus dorsi flap, forehead flap, bilobed forehead flap (Narayanan’s flap) are available for covering the defect, they fail to produce optimal functional and aesthetic results and add to the morbidity of the patient. Hence vascualrized free fibula osteomyocutaneous flaps, with better functional and aesthetic outcome have become the mainstay of treatment for defects in the oro-mandibular region. Reconstruction of the mandible not only brings back the contour of the chin, it also acts as base for fixing prosthetic dentition and thus aids in various functions like chewing, deglutition, breathing and speech. Applying the knowledge gleaned from cadaveric dissection in our clinical scenarios had produced improved results in terms of aesthetics and function. This study of ours tries to streamline the various steps of the harvest, transfer and anastamosis of the vascularised free fibula osteomyocutaneous flaps by studying the various parameters in cadavers and applying that knowledge in clinical scenarios to measure the outcome qualitatively and quantitatively. AIMS/OBJECTIVES: Primary Objectives: To do cadaveric dissections with the objectives of, • To find the location of perforator with good size, diameter and length to serve as the single best perforator for chimeric free fibula osseocutaneous/ osseomyocutaneous flap for reconstruction of mandible • To find the safe site for ostectomy and application of contoured plates and screws Secondary Objective: Application of the cadaveric study findings in reconstructive surgeries of oromandibular defects and assessing the outcome, and • To find the best position of pedicle in the graft without any kinking • To ascertain whether the eccentric location of the perforator with respect to the skin paddle helps in positioning and three dimensional manipulation in reconstruction of composite oro-mandibular defects. MATERIALS AND METHODS: Cadaver Studies: A total of 21 legs were dissected and the peroneal perforator system studied by mercurochrome injection studies. Procedure for Cadaver Dissection: Incision was made on the medial aspect of the popliteal fossa and brought down along the anteromedial border of tibia. The soleus muscle attachement to the soleal line is exposed. The Sartorius, Semimembranosus and gracilis attachements to the upper medial aspect of tibia excised and released. Then soleus muscle was detached from the soleal line exposing the posterior tibial vessels and tibial nerve lateral to the flexor digitorum longus. The posterior tibial artery traced to its site of branching into peroneal artery. A syringe containing mercurochrome was injected pushing it distally into the peroneal artery. Simultaneously, we exposed the distal end of the peroneal artery behind the lateral malleolus, where it branches into ramus perforans and lateral calcaneal artery, lateral to flexor hallucis longus, medial and superior to tibiofibular syndesmosis. The injection continued till the dye is seen entering into the distal parts of the peroneal artery. In fair skinned cadavers, it even caused mild discolouration in perferosomes of the peroneal vessel. OBSERVATIONS AND RESULTS: Injection studies performed in the 20 peroneal artery systems with the following objectives, 1. To find out the location is the single best perforator for the skin paddle 2. To study the configuration of the single best perforator in terms of location, course, size and length. 3. To study the course of the musculoperiosteal vessels of the fibula, to find a safe window for ostectomy without injuring the vessels. In total 20 peroneal arterial systems were studied. We found that, The middle third of the leg had the largest number of perforators with an average of 5.5 perforators; the upper third of the leg had an average of 3.5 perforators while the lower third had an average of 2.5 perforators With the size measured at the origin of the perforator from the main vessel using ordinary calipers, we found that the upper third of the leg has the perforators with average external diameter of 1.3 mm, followed by the middle third of the leg with an average diameter of 1.2 mm, while the lower third had an average diameter of 1 mm. CONCLUSION Vascularized free fibula osteocutaneous flap is an established procedure for reconstruction of the oro-mandibular defects but several questions arises like; what is the location of the single best perforator for the skin paddle? What is the safe skin paddle dimension that can be harvested on a single eccentrically located pedicle? Where are the safe windows for ostectomy located on the harvested free fibula? What is the best position of the skin paddle in the recipient site which does not cause kinking of the vessel? etc., We have done cadaver studies and clinical studies to answer some of these questions. It was found from our studies that the perforators of good length and calibre are best found in the middle third of the leg, and most of the perforators were musculocutaneous travelling through the flexor hallucis longus muscle. Hence if a larger skin paddle is needed, it can reliably be harvested from the middle third of the leg with the pedicle placed eccentrically. But if the defect requires a longer bone stock and a smaller pedicle, it is better to harvest from the lower third of the leg. We also found from our clinical studies that designing the skin paddle with the pedicle eccentrically located allows for better three dimensional manipulation of the skin paddle in the recipient site, allowing it to cover wider area in the facial region like, cheeks, chin, upper neck, upper and lower lips etc., Also from our clinical studies we found that a single eccentrically located perforator of good length and calibre can support a skin paddle of 120 cm2. We also found from our studies that the safe window for ostectomies can be found in the peroneal surface of the fibula as the musculoperiosteal vessles runs in the anteromedial and posteromedial surface of fibula. Hence ostectomies can be performed with the apex of the wedge located at the peroneal surface and base at the interosseus border. We found from our studies that the posteromedial surface of the fibula which contains the peroneal vessel, when positioned inferiorly and posteriorly in mandible reconstruction site, gives better manoeuverability during anastamosis of the flap pedicle to the recipient vessels and also does not cause kinking of the vessel. From of cadaveric and clinical studies we have tried to answer some of the burning questions of the free fibula osteomyocutaneous flap procedure

Gender issues and livelihood pattern of migrant women labourers of farm families

Migration of labour is getting feminized especially in the developing countries like India in the recent past, and more so in Odisha state that face acute migration where farm women migrate for a better livelihood option. In the milieu, the present study was carried out to document the gender issues and livelihood pattern of migrant women labourers of farm families from Odisha. The study sourced data from a survey conducted in the labour congregating areas of Bhubaneswar during 2011-12. Highest percentage of women labour migrants were within the age group of 26-35 (40%) and lowest number was found within 56-65 age group (4%). Ninety two per cent of the respondents were wage labourers and among them, a majority (52%) of women performed both construction and road work, and 40% performed only construction work. A majority of the respondents (42%) earned a monthly income ranging from rs.` 2 000 to `rs. 3 000 and their total monthly family income varied from `rs. 5 000 to `rs. 8 000. However, 68% of the respondents saved their income for the future requirements and 32% of the respondents were living hand-to-mouth life due to a large family size. The income of majority of respondents ranged from rs.` 2 000 to rs.` 3 000 per month and their family income was also within the range of rs. 2 000 to rs.` 8 000. Moreover, a meager amount of money was sent to the family at origin which is not even sufficient to purchase cereals and pulses. The study concludes that, adoption of effective and efficient region specific strategies through entrepreneurial skills coupled with some profitable agricultural business ventures will curtail the rate of rural migration

Assessing resource and infrastructure disparities to strengthen Indian dairy sector

The present study reveals the resource and infrastructure disparities of dairy development in India. The relative progress of the states in dairying was measured by multitude of developmental indicators. To get a lucid picture, a composite Dairy Progressiveness Index (DPI) with 20 indicators was developed for 16 states of India. Principal Component Analysis (PCA) was employed for the construction of DPI. As per the indices score, Punjab, Kerala, Haryana, Goa and Gujarat were categorized as highly dairy progressive states. Tamil Nadu, Rajasthan, Maharashtra, Andhra Pradesh, Karnataka and Uttar Pradesh were categorized as moderate dairy progressive states while West Bengal, Himachal Pradesh, Bihar, Madhya Pradesh and Odisha states were grouped as least dairy progressive states. The study implicates the strong need to develop organized marketing network along with reforms in dairy cooperatives as well as producer companies in Punjab, Haryana, Himachal Pradesh, Bihar, Madhya Pradesh and Odisha. Since fodder, pasture and irrigation resources in Himachal Pradesh, Andhra Pradesh, Madhya Pradesh, Odisha, Kerala and Gujarat are poor, policy intervention like restriction on export of oilseed cake and ban on harvesting using combine harvester without straw ripper, establishment of fodder bank network could address the fodder scarcity. Transfer of technologies such as hydroponics, azolla, silage, urea treatment, use of mineral mixtures to field in resource poor states need attention. Poor genetic potential in the low performing states demand proper breeding strategies, conservation and spread of elite indigenous breeds such as Sahiwal, Gir and Tharparkar. Improvement in veterinary infrastructure would reduce the imbalanced progress. The policy interventions on identified gaps would pave even development of dairy farming and reduce future demand gap

A high pressure XRD setup at ADXRD beamline (BL-12) on Indus-2

A high pressure XRD measurement setup in the angle dispersive geometry has been setup in the Angle Dispersive X-ray diffraction beamline (BL-12) in Indus-2 synchrotron facility. The X-ray beam is collimated inside the Diamond Anvil Cell (DAC) using a pair of cross-slit collimators and 100 micron orifice in a 400 micron thick Ta sheet. With the use of an adaptive optics to ensure a converging beam at the sample position, the need of an X-ray beam collimator is eliminated making the alignment of the DAC quite easy. The alignment of the DAC with respect to the incident X-ray beam is made by placing it on a computer controlled sample mounting and alignment stage developed specifically for this setup. Interactive software has been developed to make the alignment of the X-ray through the DAC very easy and accurate. NIST standard LaB6 powder was used for test runs, and a few fine pieces of gold served as pressure calibrator. The data was recorded on a MAR345 Image plate detector

Econometric modeling of tobacco exports in the milieu of changing global and national policy regimes: repercussions on the Indian tobacco sector

IntroductionTobacco, an important commercial crop, plays a crucial role in farmers' incomes and livelihoods to a sizable population and contributes significant exchange earnings to the Indian economy. Currently, India is the second-largest tobacco producer after China, with a production of 758 million kg (13% of global production) and exports of ~190 million kg of tobacco (9% of global tobacco export volume). However, there are uncertainties surrounding the tobacco sector, such as growing public health and environmental issues associated with tobacco production and consumption and changing national and international tobacco-related policy regimes. In this context, the current study investigates the determinants of tobacco exports and geographical shifts in export destinations over the years.MethodsThe statistical models employed are co-integration, and vector error-correlation models to test the short-run and long-run dynamics relationship between tobacco exports and the explanatory variables, and the Markov chain approach to find out geographical shifts in export destinations.Results and discussionThe econometric model estimated the relationship between the tobacco export volume with domestic production, export price, and global demand for Indian tobacco, and investigated the geographical shift in export destinations of tobacco in the context of changing global and national policy regimes on the sector. The econometric modeling framework confirms that there exists a statistically significant relationship between Indian tobacco export demand, domestic production, export price, and world demand for Indian tobacco. The geographical shift was evident in major export destinations during the post-WHO-FCTC (Framework Convention on Tobacco Control) regime. The model findings direct that India should take advantage of the export price, and global demand for tobacco as India ratified WHO-FCTC; there is no scope for horizontal expansion of the area under tobacco. This modeling framework aids as a tool to direct and explore the possible options with a greater emphasis on export-centric farming system in tobacco production by augmenting crop compliance and quality to meet the standards of international markets

A Catering Theory of Analyst Bias

We posit a theory that runs counter to how conventional wisdom thinks about analyst bias, that it is the result of distorted incentives by "the system" - especially upstream factors like the analysts' employers. We suggest that analysts are also heavily influenced by what investors believe, the purported victims of analyst bias. We adapt Mullainathan-Shleifer's theory of media bias to build a theory of how analysts cater to what investors believe. The theory also predicts that competition among analysts does not reduce their bias. We provide empirical support for this theory, using an enormous dataset built from over 6.5 million analyst estimates and 42.8 million observations on investor holdings, which we argue is a proxy for what they believe. We use a simultaneous-equations model for estimation, with instruments to rule out alternative interpretations of the direction of causality. For additional robustness, we investigate the time series of analyst bias and heterogeneity in investor beliefs from 1987 through 2003. Dickey-Fuller tests show that both have unit roots, but we establish that cointegration hold. Further, we employ a vector-autoregressive model to show Granger - causality between the two

New Measure of Insulin Sensitivity Predicts Cardiovascular Disease Better than HOMA Estimated Insulin Resistance

10.1371/journal.pone.0074410PLoS ONE89-POLN