Unique case of inverted papilloma of septum with nasopharyngeal carcinoma:Is it a metachronous tumour?

Inverted papilloma is a rare and benign tumour. It affects the nasal cavity and paranasal sinuses, has a high rate of recurrence and is associated with malignant transformation. Only few cases of a poorly differentiated carcinoma arising from inverted papilloma have been reported, none of which in the nasopharynx. We report a case of a 37-year-old female, who presented originally in 2012 with inverted papilloma of the nasal septum which was surgically resected. Nasopharyngeal biopsy from 2014 was reported as carcinoma in situ and treated with local endoscopic resection. Three years later she presented with a solitary lesion of the right Eustachian tube opening, confirmed as invasive poorly differentiated carcinoma. Imaging revealed T4 N2b M0 malignancy with skull base and prevertebral space invasion, likely extension into right temporal lobe and malignant adenopathy. Although rare, malignant transformation of inverted papilloma in unusual places should be considered during workup and monitoring of patients

COGNITIVE, AFFECTIVE AND CONATIVE MODEL FOR ANALYSING HIGHER EDUCATION STUDENTSq

Many models are used in recent years to analyze behavior of the students in the higher education. Analyzing the learning style and student performance in academic studies are very essential to enhance their performance. This research work is focused on analyzing the learners behavior using three dimensions, i.e., cognitive, affective, and conative model. In this paper, we used Moodle learning management system which is a learning platform to create a personalized learning environment and to track learning abilities using activities. This model will be helpful to study the cognitive, conative, and emotions of students.Â

Burns Wound Sepsis in Adults: A Prospective Study

INTRODUCTION: Although burn injuries are frequent in our society, many of these patients need hospitalization, and more than 40% die due to infections. Mortality is highest among the very young and the very old Two-thirds of all burn accidents occur at home and most commonly involve young adult females and children. Young adults are most commonly burned by flammable liquids, while toddlers are most often scalded by hot liquids while playing in the kitchen. Structural fires cause about 5% of burn accident. Inhalation injury has the biggest impact on both early and late mortality. Advances in trauma and burn management has resulted in improved survival and reduced morbidity from major burns. 50 years ago, the mortality rate of a 50% body surface area (BSA) burn in a young adult was about 50% despite treatment. Today, over 50% of these patients are surviving. Improved results are due to advancements in resuscitation, surgical techniques, infection control, nutritional and metabolic support. AIMS AND OBJECTIVES: 1. To find out the prevalence of infection in adult burn patients. 2. To find out the causative organisms and their antibiotic sensitivity. 3. To find out the most common type of infection. 4. Role of age, sex, buns percentage and general condition of the patient on the recovery. 5. To find out prevalence of drug resistant and changing pattern of microbes in burn patient. This was a prospective study which was conducted in the Departement of Burns, Plastic& Reconstructive Surgery, Kilpauk Medical College, Chennai. Two hundred and eight (208) patients with acute burns were included in this study which was conducted from January 2006 to December 2007. INCLUSION CRITERIA: 1. All patients with acute burns admitted within 12 hours of the incident, 2. Chemical , Electrical , Flame Burns, 3. Patients aged between 12 to 70 years, 4. Patients with 20-60% burns. EXCLUSION CRITERIA: 1. Patients admitted after 12 hours from the incident. 2. Admitted and treated at other hospitals and subsequently referred patient. 3. Patients aged less than 13 years and over 70 years. 4. Patients with associated systemic diseases like diabetes, Systemic hypertension, renal, hepatic disorders etc. 5. Burns more than 60%. METHOD: All patients having burns admitted via casualty to the burns department were meticulously followed up from admission to till discharge. The clinical course during the treatment was studied. DISCUSSION: This study was conducted in the Departement of Burns, Plastic & Reconstructive Surgery, Kilpauk Medical College, Chennai-10, between January 2006 & December2007. Prevalence of Infection: The prevalence of burn wound infection was found to be 59.61%. Incidence of burn wound infection on admission was 8.65%,after 48 hours it became to 43.26%,4th day it increased to 96.15% and 7th day it stabilized at 90.38%.Though burn wounds were initially sterile ,they rapidly became colonized by pathological microbes(TABLE-III). Age and Sex Distribution: In our study females in the age group of 20yrs to 40 yrs were more (66.34%) when compared to males. Changing Pattern of Microbial Organism: For all patients in the study group, after taking swabs, prophylactic antibiotic was started. Because many of the patients have dirty clothing, poor personal hygiene, they may roll on floor, and applied mud, dosa batter, ink etc.. So we decided to take culture& sensitivity on admission which is supposed to be sterile44 and we started prophylactic antibiotic. Wanted to check how each organism behaved & how early wound infection occurs so we take culture& sensitivity after 48 hours, the results of which were ready on 4th PBD, so for 4 days, the day one antibiotic had been continued. The pattern of change of flora 40 & their sensitivity were noted. If the flora changed, on 4th PBD (after 48 hours culture& sensitivity results) the antibiotic also was changed. We wanted to check if such early changes in antibiotic helped in eradication of infection or only resulted in further change in flora. Hence on 4th day, we again checked for the same. The results being received on 6th PBD, since the changed antibiotic had been on only for 3 days, we waited for one more day to have uniformity of them. On 7th PBD again swab culture and sensitivity was taken and the (4th PBD culture and sensitivity report) antibiotic change required was instituted. In the control group after starting prophylactic antibiotic, swab was taken only on the 7th post burn day. Up to 7 days the same antibiotic was continued. Swab C&S on admission found to be, sterile or showed only commensals in both groups. CONCLUSION: According to this study * More number of female patients in 20-40 years age group were admitted with burns than compared to male. * Initially all burn wounds are sterile or only has commensals * Frequent change of antibiotics results in changing pattern of infective organism. * Klebsiella is the most common infecting organism seen in our department. * MRSA infection is insignificant in our unit * Amikacin was the effective antibiotic in comparison to ampicilln,ceftriaxone,cloxacillin,ciprofloxacin, cefotaxim. But it is preferred as second line antibiotic, since the raw area was still be there (potentially infected). If amikacin is started as first line of defense, chances of developing resistant is high. * Personal hygiene of both patients & care givers, aseptic precaution during dressing, separate dressing trolley for each patients, periodical bacterial survivallence and fumigation of burns ward can significantly reduce the mortality among adult burn patients

Optimal packet routing for wireless body area network using software defined network to handle medical emergency

The packet forwarding node selection is one of the main constraints in the Software Defined Network (SDN). To improve the network performance, the SDN controller has to choose the shortest and optimised path between source and destination in routine and emergency packet transmission. In e-health service, information of the emergency patient has to be transferred immediately to remote hospitals or doctors by using efficient packet routing approach in Wireless Body Area Network (WBAN). In WBAN, to improve the packet transmission, the optimal packet routing policy developed based on packets priority with the support of a greedy algorithm for SDN. The SDN Controller selects the forwarding node based on node propagation delay and available bandwidth between two forwarding nodes. The mesh network topology network created for implementation, implementation results are compared with existing research works. Finally, this algorithm implemented in our institution, Software defined communication testbed laboratory (SDCTestbed Lab) with the support of 13 Zodiac-Fx (Forwarding device), 2 Raspberry-Pi3 B+ Model (host) and Arduino kit (sensor node)

A study on prevalence and co-morbidity of bipolar and anxiety disorders in chronic headache patients

Background: Co morbidity between headache and psychiatric disorders is more prevalent in chronic headache patients. The bipolar disorders and anxiety disorders are predominant in migraine and TTH respectively. This co morbidities have a poor reflection and impact on quality and outcome of chronic headache patients and results in worst prognosis and poor response to medical treatment.Methods: The chronic headache patients especially migraine and tension type of headache were analyzed with following materials such as the structured psychiatric clinical interview with ICD-10 mental and behavioural disorder, DSM-5 criteria. HAM-A, HAM-D, BDI-2, BPRS, young mania rating scale, Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and panic disorder scale.Results: Various subsets of bipolar disorder and anxiety disorder were found as follows: 74% of migraineurs are associated with psychiatric disorders in which bipolar affective disorder 6%, depressive episode 48%, dysthymia 30%, GAD 10% and Panic disorder 6%. 52% of TTH are associated with psychiatric disorders as follows: major depressive episode 52%, GAD 30%, separation anxiety disorder 6%, PTSD 7%, OCD 3% and panic disorder 2%.Conclusions: From previous and future studies the headache can be identified according to subsets of headache with psychiatric disorders make easier to provide appropriate pharmacological and psychological treatment which may reduce the chronicity and intractability of headache

Knowledge, attitude and practice of insulin use and its adverse effects in adult diabetic population

Background: Diabetes is a disease when left untreated, leads to many complications. India is emerging as a diabetic capital of the world. Insulin is widely used as a therapeutic option, and hence this study was conducted to assess the awareness of Insulin use and its adverse effects in diabetic population.Methods: The study was a questionnaire survey conducted in adult patients with diabetes who are on Insulin therapy. The participants’ knowledge, attitude and practice were assessed by using a questionnaire consisting of 32 questions. Scores were allotted to each question, and evaluated after applying appropriate statistical tests.Results: The mean age of the participants was 57.26±11.24 years. About 54% were males. 46% belonged to rural areas. The mean knowledge score was 17.53±4.40, mean attitude score 7.42±4.85 and the mean practice score was 6.56±1.91. 40% responded that they will return the expired insulin vials to the pharmacy. The most common reason for non adherence was economical constraints (60%). The females had better knowledge (17.60±4.43 vs. 17.45±4.40, p>0.88), attitude (8.21±3.84 vs. 6.58±5.56, p>0.09) and practice (6.97±1.84 vs. 6.13±1.92, p0.297), attitude (8.70±3.95 vs. 6.06±5.37, p 1.395) than the rural counterparts.Conclusions: There exists a gap between knowledge attitude and practice of insulin use. This can be overcome by conducting awareness programmes by health care providers, to sensitise people about the proper use, side effects and the methods of disposal of insulin vials

Insights from within activity based learning (ABL) classrooms in Tamil Nadu, India: Teachers perspectives and practices

Quality has been an Education for All (EFA) goal since the 2000 Dakar framework positioned it ‘at the heart of education’ as a fundamental determinant of student enrolment, retention and achievement. Over the years, classroom pedagogy has been consistently regarded as ‘the crucial variable for improving learning outcomes’ (e.g., Hattie, 2009) and is thus seen as critical to reforms aimed at improving educational quality (UNESCO, 2005 p.152). The quality of teacher–pupil classroom interaction remains of central importance, rather research evidence (e.g., Borich, 1996) suggests that it is the single most important factor accounting for wide variation in the learning attainments of students who have used the same curriculum materials and purportedly experienced similar teaching methods. Other more recent studies (e.g., Aslam and Kingdon, 2011) have also reported that teacher ‘process’ variables have a more significant impact on student achievement than standard background characteristics. In the current era of the ‘global learning crisis’ (UNESCO, 2014) many developing economies have embarked on major pedagogical reforms. In India, the notion of energising schools and transforming classrooms has received unprecedented attention in the last 15 years. A number of programmes have been introduced in various states to provide meaningful access (Jandhyala and Ramachandran, 2007). The Activity Based Learning (ABL) Programme is one such effort to change the nature of teaching and learning in mainstream classrooms. In a national context, where there are innumerable on-going efforts aimed at pedagogical reform, ABL is hailed as a success story in terms of replication of a small model to a grand scale. From modest beginnings in 2003 in 13 Chennai (the capital city of Tamil Nadu) schools, ABL was rolled out in a phased manner across the entire state of Tamil Nadu for all children in classes 1–4, in all government and aided schools. The last few years have witnessed its adaptation under various guises in several other Indian states, such as Ekalavya in Madhya Pradesh, Digantar in Rajasthan and Nali Kali in Karnataka. Efforts to promote it internationally in other parts of the developing world, such as Ghana, Bangladesh, Ethiopia and Mozambique (Fennell and Shanmugam, 2016)have also been made. Though as Nudzor et al., 2015 note it has been met with mixed success in the case of Ghana. Nonetheless, ABL is an interesting programme to examine given its rapid growth and international outreach.The project was funded by Department for International Development (DFID, India)

A study on Electron Beam Welding of Stainless steel (03X12H10MTPY) with Russian copper alloy

Modern age demand for flexible design and high quality structures. Different properties are essential for different parts and use of dissimilar metals joints gives possibilities of flexible design and products by using each material efficiently. EBW is one of the most widely used application in industries for joining dissimilar materials .The advantages of EBW welding is its high energy density, high depth to width ratio, low HAZ and result in very strong weld and low residual stress .The quality of weld depend upon the parameter accelerating voltage, beam current, focus current, welding speed, beam shifts and vacuum levels. The beam shift, focus current and vacuum level are fixed parameters .The primary objective of the project is to optimizing the parameter to obtain best quality weld based on Taguchi L9 array. Micro-indentation hardness and Electron spectroscopy is also carried out in selected welding sets to study the joint characteristics. It is observed that the optimum parameter levels for 3mm penetration in both parent metal are Accelerating voltage 50KV, beam current 38mA, welding speed 1 m/min

Positional identification of variants of Adamts16 linked to inherited hypertension

A previously reported blood pressure (BP) quantitative trait locus on rat Chromosome 1 was isolated in a short congenic segment spanning 804.6 kb. The 804.6 kb region contained only two genes, LOC306664 and LOC306665. LOC306664 is predicted to translate into A Disintegrin-like and Metalloproteinase with Thrombospondin Motifs-16 (Adamts16). LOC306665 is a novel gene. All predicted exons of both LOC306664 and LOC306665 were sequenced. Non-synonymous variants were identified in only one of these genes, LOC306664. These variants were naturally existing polymorphisms among inbred, outbred and wild rats. The full-length rat transcript of Adamts16 was detected in multiple tissues. Similar to ADAMTS16 in humans, expression of Adamts16 was prominent in the kidney. Renal transcriptome analysis suggested that a network of genes related to BP was differential between congenic and S rats. These genes were also differentially expressed between kidney cell lines with or without knock-down of Adamts16. Adamts16 is conserved between rats and humans. It is a candidate gene within the homologous region on human Chromosome 5, which is linked to systolic and diastolic BP in the Quebec Family Study. Multiple variants, including an Ala to Pro variant in codon 90 (rs2086310) of human ADAMTS16, were associated with human resting systolic BP (SBP). Replication study in GenNet confirmed the association of two variants of ADAMTS16 with SBP, including rs2086310. Overall, our report represents a high resolution positional cloning and translational study for Adamts16 as a candidate gene controlling B