Experiências Dissociativas e Traumáticas em Mulheres Internadas com Perturbações de Humor

Esta investigação pretendeu averiguar se mulheres internadas com Perturbações de Humor dissociam e se o trauma se relaciona com os sintomas dissociativos. Seleccionámos consecutivamente 41 mulheres em regime de internamento, com idades compreendidas entre os 22 e 77 anos. A amostra foi dividida em subamostras: doentes com Perturbação Depressiva (n = 25), Perturbação Bipolar (n = 6), e Outras Perturbações de Humor (n = 10). Para a confirmação dos diagnósticos psicopatológicos, recorremos a uma entrevista estruturada, a Mini International Neuropsychiatric Interview (MINI). Na recolha dos dados usámos a Dissociative Experiences Scale (DES) e o Traumatic Experiencies Checklist (TEC) para avaliar as experiências dissociativas e traumáticas. Para controlar os sintomas depressivos e psicopatológicos aplicámos o Beck Depression Inventory (BDI) e o Brief Symptom Inventory (BSI) respectivamente. Os doentes com perturbações de humor, no seu todo, pontuam mais alto no factor distractibilidade do DES e tiveram experiências traumáticas particularmente elevadas dos 0 aos 6 anos e na família de origem. Não se verificaram diferenças significativas entre as subamostras, nem na dissociação, nem no trauma. Não observámos relação significativa entre as experiências dissociativas e traumáticas. Todavia, estas variáveis associaram-se com o BDI e BSI. Por fim, verificámos que o sintoma de hostilidade prediz a dissociação. O nosso estudo é o primeiro a investigar as experiências traumáticas em doentes com Perturbações de Humor e a obter estes resultados. A nossa amostra não foi equilibrada nos três tipos de patologia, pelo que os nossos resultados deveriam ser confirmados num estudo futuro

Alligatoring: An investigation into paint failure and loss of image integrity in 19th century oil paintings

"Alligatoring" or "Bitumen cracking" are terms used to describe extreme paint defects found in 19th century oil paintings. This paint failure in the form of severely disfiguring cracking and surface distor- tions often results in a loss of image integrity. This problem has been associated with the use of as- phalt/bitumen paint, with no clear understanding of the materials and mechanisms which contribute to the phenomenon. This thesis investigates this phenomenon from a multi-disciplinary approach that aims to con- tribute knowledge to the study of oil painting suffering from alligatoring. Part 1 focuses on the perception of the problem through a literature survey, and introduces the 19th century painting used in the case study. A thorough review of the literature showed the existing bias created by the perceived connection between appearance and cause, resulting in an association of paint film defects in brown paint with the use of asphalt/bitumen. Because of this, the overall focus of previous research has been the detection of asphalt, considering it in isolation and as the primary factor in the paint defect. This singular view has had significant implications in the study and analyses of paintings with alligatoring. It inhibited wider investigations and overlooked other materials present in the paintings that may be acting in combination or be more predominant in the deterioration mech- anism. The visual and chemical study of the oil painting O Cardeal D. Henrique recebendo a notícia da morte de D. Sebastião, by Marciano Henriques da Silva (1831-1873), painted in Rome in 1861, which exibits extreme alligatoring, offered specific challenges due to its complex and highly disrupted paint layer stratigraphy coupled with the uncertainty introduced by analytical detection limits. For that rea- son, a multi-analytical approach was carried out using Optical Microscopy, micro Raman Spectroscopy, Scanning Electron Microscopy with Energy Dispersive X-ray Spectrometry, X-ray Fluorescence, micro Fourier Transform Infrared Spectroscopy, Fourier Transform Raman Spectroscopy, Attenuated Total Reflection Fourier Transform Infrared Spectroscopy Microscopy, Pyrolysis-Tetramethylammonium Hy- droxide-Gas Chromatography/Mass Spectrometry and Time-of-Flight Secondary Ion Mass Spectrome- try. This research indicates that the deterioration of the painting might be related to the oil binder which has a high degree of oxidation, rich in polar fatty acids and diacids, combined with a lack of the xiv pigments that are capable of stabilizing the paint. The presence of the translucent lead azelate layer above the ground underlines the complexity of the paint layering, materials present, and possible mechanisms for degradation. Part 2 reports on new research carried out using the British colourman Winsor & Newton's 19th- century Archive Database to analyse their production records for “Bitumen” brown for oil tube paints. While there are a substantial number of published recipes in 19th century artist’s manuals for the use of asphalt/bitumen brown, for the first time W&N’s records offer a unique source of detailed infor- mation on the commercially prepared product which differs substantially in ingredients used and method of preparation. The critical analysis of W&N's production records for "Bitumen" revealed that their formulation became standardised in the 1850s and that their product was prepared in two sep- arate steps at two separate locations. Despite standarisation of the ingredients this research revealed that the company still found it necessary to make adjustments for each production run in order to achieve a uniform product. A production record from 1858 was selected and reconstructed, using where possible, histori- cally appropriate materials. W&N’s formulation for bitumen brown oil paint involved a complex mix- ture of ingredients, some of which were other proprietary products sold by the company (these were reconstructed individually using their production records and included drying oil, double mastic var- nish, lead acetate, purple lake and the gelled painter's Medium, megilp). The reconstructions were analysed using thermally assisted methylation with tetrame- thylammonium hydroxide, and pyrolysis comprehensive two-dimensional gas chromatography and compared with the starting material, Trinidad Lake asphalt, to determine how detectable this asphalt is after heat processing in lead treated linseed oil. Results show that asphalt markers identified in the Trinidad Lake asphalt disappear in the first stage of reconstructing W&N's "Bitumen" oil paint. This important finding offers an explanation for the paucity of analytical evidence in previous attempts to identify asphalt/bitumen in paintings where this material was believed to have been used. In addition to clarifying the analytical results obtained from the investigation of the painting, O Cardeal D. Henrique…, the reference samples produced from the W&N reconstruction illustrate the strengths and weaknesses of organic analysis of highly processed complex mixtures."Alligatoring" ou "Bitumen cracking" são termos utilizados para descrever defeitos extremos encon- trados em pinturas a óleo do século XIX. Esta patologia sob a forma de fissuras e distorções severas da superfície pictórica resulta frequentemente numa perda de integridade da imagem. Este problema tem sido associado à utilização de tintas de asfalto/betume, sem no entanto existir uma compreensão clara dos materiais e mecanismos que contribuem para este fenómeno. Esta tese investiga este fenómeno a partir de uma abordagem multidisciplinar que visa contri- buir para o conhecimento de pinturas a óleo afetadas por este defeito extremo. A parte 1 centra-se na perceção que existe sobre este problema através de uma pesquisa bibli- ográfica, e introduz a pintura do século XIX utilizada como caso de estudo. A revisão rigorosa da lite- ratura revelou o preconceito existente criado pela perceção da ligação entre a aparência e a causa, resultando numa associação de defeitos em filmes de tinta castanha com a utilização de tintas de as- falto/betume. Devido a isto, o foco geral de estudos anteriores foi a deteção do asfalto, considerando- o isoladamente e como a principal causa nos defeitos de tinta. Esta visão simplista tem tido implicações significativas no estudo e análise de pinturas com “alligatoring” (efeito de pele de crocodilo), inibindo investigações mais abrangentes e subvalorizando outros materiais presentes nas pinturas que podem estar a atuar em combinação ou ser mais predominantes no mecanismo de deterioração. O estudo visual e químico da pintura a óleo O Cardeal D. Henrique recebendo a notícia da morte de D. Sebastião, de Marciano Henriques da Silva (1831-1873), pintado em Roma em 1861, que exibe “alligatoring” extremo, ofereceu desafios específicos devido à sua estratigrafia complexa e muito alte- rada, aliada à incerteza introduzida pelos limites de deteção analítica. Por essa razão, foi realizada uma abordagem multi-analítica utilizando Microscopia Óptica, Micro-espectroscopia de Raman, Microsco- pia Electrónica de Varrimento com Espectrometria Dispersiva de Raios-X, Micro-espectrometria por Fluorescência de Raios X Dispersiva de Energias, Micro-espectroscopia de Infravermelho com Trans- formada de Fourier, Espectroscopia Raman com Transformada de Fourier, Espectroscopia de Infraver- melho com Transformada de Fourier por Reflexão Total Atenuada acoplada a Microscopia Óptica, Pi- rólise-Cromatografia Gasosa acoplada à Espectrometria de Massa com derivatização usando Hidróxido de Tetrametilamónio e Espectrometria de Massa de iões secundários. Esta investigação indica que a deterioração da pintura pode estar relacionada com o aglutinante de óleo altamente hidrolisado, rico em ácidos gordos polares e diácidos, combinado com a falta de pigmentos capazes de estabilizar a tinta. A presença da camada translúcida de azelato de chumbo sobre a camada de preparação sublinha a complexidade da estratigrafia, dos materiais presentes, e dos possíveis mecanismos de degradação. A Parte 2 descreve a analise dos registos de produção de "Betume" castanho para tintas em tubos de óleo do arquivo e base de dados do século XIX da Winsor & Newton (fabricante de materiais para artistas britânico). Embora exista um número substancial de receitas de tintas castanhas de as- falto/betume publicadas em manuais para artistas do século XIX, os registos da W&N são uma fonte de informação detalhada e única sobre o produto preparado comercialmente que difere substancial- mente nos ingredientes utilizados e no método de preparação. A análise crítica dos registos de produ- ção da W&N para "Betume" revelou que a sua formulação foi normalizada na década de 1850 e que era preparado em duas etapas distintas e em dois locais distintos. Apesar da padronização dos ingre- dientes, esta investigação revelou que a empresa comsiderava necessário fazer ajustes em cada etapa de produção, a fim de obter um produto uniforme. Um registo de produção de 1858 foi selecionado e reconstruído, utilizando, sempre que possí- vel, materiais historicamente apropriados. A formulação da W&N para a tinta castanha de betume a óleo envolveu uma mistura complexa de ingredientes, alguns dos quais eram produtos produzidos e vendidos pela W&N. Estes foram reconstruídos individualmente, utilizando os seus próprios registos de produção, e incluíram óleo de secagem, verniz mástique duplo, acetato de chumbo, pigmento laca roxo, e o gel tixotrópico Megilp). As reconstruções foram analisadas utilizando Pirólise-Cromatografia Gasosa acoplada à Espec- trometria de Massa com derivatização usando Hidróxido de Tetrametilamónio, e Pirólise por Croma- tografia Gasosa Bidimensional acoplada à Espectrometria de Massa. As reconstruções foram compa- radas com a materia prima utilizada, o asfalto do Lago Trinidad, para determinar o grau de deteção deste asfalto após o processamento térmico em óleo de linhaça tratado com chumbo. Os resultados mostram que os marcadores asfálticos identificados no asfalto do Lago de Trinidad desaparecem na primeira fase da reconstrução da tinta a óleo "Betume" da W&N. Esta descoberta importante oferece uma explicação para a escassez de provas analíticas em tentativas anteriores de identificação do asfalto/betume em pinturas em que se acreditava ter sido utilizado este material. Para além de clarificar os resultados analíticos obtidos a partir da investigação da pintura O Cardeal D. Henrique..., as amostras de referência produzidas a partir da reconstrução da W&N ilustram os pontos fortes e fracos da análise orgânica de misturas complexas altamente proces- sadas

Distinct factors are related to lower limbs atherosclerosis in smokers and nonsmokers

Orientador: Wilson Nadruz JuniorDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: O tabagismo aumenta o risco de doença arterial periférica, entretanto os mecanismos envolvidos neste processo ainda não estão bem estabelecidos. Este estudo comparou a associação da tensão circunferencial local (TC), marcadores de remodelamento e rigidez vascular e fatores de risco tradicionais com placas poplíteas e carotídeas entre tabagistas e não tabagistas. Duzentos e cinquenta e dois indivíduos (126 tabagistas e 126 não tabagistas) foram submetidos a análises clínicas, laboratoriais e ultrassonografia de artéria poplítea e carotídea. Medidas de tensão circunferencial local foram calculadas em posição supina e ortostática nas artérias poplíteas e em posição supina nas carótidas. Placas poplíteas foram mais comuns em pacientes tabagistas do que em não tabagistas (39 vs. 19%; P < 0,001). Em tabagistas, placas poplíteas não se relacionaram a diferenças entre fatores de risco vasculares tradicionais. Em modelos ajustados de propensão, medidas de tensão circunferencial local foram associadas com placas locais em tabagistas, mas não entre não tabagistas. A tensão circunferencial sistólica ortostática foi à medida que mostrou maior associação com placas poplíteas (beta ± dp = 0,91 ± 0,28; P = 0,001). Medidas locais de tensão circunferencial de parede também demostraram uma forte associação com espessamento de intima média em tabagistas quando comparadas com não tabagistas. Em não tabagistas, as placas poplíteas foram mais associadas com idade avançada, hipertensão, diabetes e dislipidemia e menor nível de complacência arterial. Placas carotídeas não foram independentemente relacionadas à tensão circunferencial da parede poplítea ou carotídea em tabagistas. Esses achados indicam que fatores de risco para doença arterial periférica podem diferir entre tabagistas e não tabagistas e sugerem que a aterosclerose em artérias de membros inferiores é diretamente relacionada a forças hemodinâmicas em tabagistasAbstract: Smoking increases the risk of peripheral artery disease (PAD), but the mechanisms are not well established. This study evaluated the association of local circumferential wall tension (CWT), markers of vascular remodeling and stiffness, and traditional risk factors with popliteal and carotid plaques among smokers and non-smokers. Two hundred fifty-two subjects (126 smokers and 126 non-smokers) underwent clinical, laboratory, and popliteal and carotid ultrasound analysis. Popliteal and carotid CWT measures were calculated in supine and orthostatic positions, and supine position, respectively. Popliteal plaques were more common in smokers than non-smokers (39% vs. 19%; p<0.001). Among smokers, popliteal plaques were not related to differences in traditional vascular risk factors. In propensity score-adjusted models, popliteal CWT measures were associated with local plaques in smokers, but not in non-smokers. Peak orthostatic CWT was the measure showing the most significant association with popliteal plaques (Beta±standard error=0.91±0.28; p=0.001). Local CWT measures also showed a stronger association with popliteal intima-media thickness among smokers as compared with non-smokers. By contrast, non-smokers with popliteal plaques were more likely to have older age, hypertension, diabetes and dyslipidemia, and lower arterial compliance among non-smokers. Lastly, carotid plaques were not independently related to local CWT among smokers. These findings indicate that risk factors for PAD may differ between smokers and non-smokers and further suggest that atherosclerosis in lower limb arteries is directly related to local hemodynamic forces among smokersMestradoClinica MedicaMestre em Ciência

Efeito da administração intermitente de PTH na periodontite induzida em ratas com deficiencia de estrogeno

Orientadores: Silvana Pereira Barros, Sergio Roberto Peres LineDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaMestrad

Are in person and telephone interviews equivalent modes of administrating the CAT, the FACIT-FS and the SGRQ in people with COPD?

Background: The COVID-19 pandemic brought numerous challenges, namely in routine assessment of people with chronic obstructive pulmonary disease (COPD). The COPD Assessment Test (CAT), the Functional Assessment of Chronic Illness-Fatigue-Subscale (FACIT-FS) and the St. George's respiratory questionnaire (SGRQ) are important patient-reported outcome measures used to assess people with COPD, but its face-to-face application has been compromised. The telephone interview offers a simple and effective alternative, yet uncertainty regarding its equivalence remains. This study aimed to establish the reliability and validity of the CAT, the FACIT-FS and the SGRQ administered by telephone interview in people with COPD. Methods: Data from an observational prospective study including people with COPD were analyzed. Participants answered to the CAT, FACIT-FS and SGRQ questionnaires in person and by telephone, with a maximum interval of 48-h. Participants were randomly selected to answer first to the in-person questionnaire followed by telephone or vice versa. Reliability measures included internal consistency with Cronbach's alpha, test-retest reliability with the intraclass correlation coefficient (ICC2,1), test-retest measurement error with the standard error of measurement (SEM) and agreement with the Bland and Altman 95% limits of agreement. Validity was assessed with the Spearman correlation (rho). Results: Fifty-five people with COPD (44 men; 68.1 ± 7.9 years; FEV1: 59.1 ± 20.3% predicted) were included. Similar internal consistency was observed between in person vs. telephone interview for the CAT (0.82 vs. 0.84), the FACIT-FS (0.83 vs. 0.84) and the SGRQ (0.92 vs. 0.93). Test-retest reliability was excellent, with an ICC2,1 of 0.77 (95% CI: 0.65; 0.86), 0.86 (95% CI: 0.77; 0.92) and 0.94 (95% CI: 0.90; 0.96) for the CAT, FACIT-FS and SGRQ total scores, respectively. The SEM showed a low level of associated measurement error and the Bland and Altman plots illustrated a good level of agreement between both modes of administration, with no evidence of systematic bias. Robust positive correlations (rho 0.87–0.94, p < 0.001) were found for the CAT, FACIT-FS and SGRQ total scores applied by both methods. Conclusion: The telephonic administration of the CAT, the FACIT-FS and the SGRQ are a valid and reliable alternative approach to in person interviews for monitoring symptoms and health-related quality of life in people with COPD. The telephone might be an important add-on for personalized assessment and management of COPD thru remote monitoring.publishe

Minas Mundi maior programa de mobilidade internacional entre as universidades brasileiras

O CONGRESSO DE INTERNACIONALIZAÇÃO DA EDUCAÇÃO SUPERIOR – CIES 2019 é um evento in- ternacional, que reúne professores, pesquisadores e estudantes de graduação e pós-graduação para divulgar a produção científica no campo da Internacionalização do Ensino Superior e fortalecer a cooperação internacional entre diferentes instituições de ensino e grupos de pesquisa no âmbito do MERCOSUL. A iniciativa é fruto de uma parceria entre pesquisadores da Universidade Federal da Integra- ção Latino-Americana (UNILA - Brasil), a Universidad Nacional del Litoral (UNL - Argentina), a Uni- versidad Nacional de Asunción (UNA - Paraguay) e a Universidad de la República (UDeLaR - Uru- guay), que atuam em projetos vinculados ao Setor Educacional do MERCOSUL, no Núcleo de Estudos e Investigações em Educação Superior. O evento será realizado nos dias 4, 5 e 6 de Setembro de 2019 no campus PTI da UNILA, dentro do Parque Tecnológico da Usina Hidrelétrica de Itaipu, na cidade de Foz do Iguaçu, Paraná, Brasil. A UNILA, sede do evento, é uma universidade temática criada em 2010 pelo governo federal do Brasil com a missão institucional de formar recursos humanos aptos a contribuir com a integra- ção latino-americana, com o desenvolvimento regional e com o intercâmbio cultural, científico e educacional da América Latina, especialmente no MERCOSUL. Sua finalidade, portanto, é conver- ter-se em um espaço de encontros, de trocas e de aprendizagem mútua, que reforçam o compro- misso em prol da pertinência, da excelência e da construção sustentável de um mundo melhor.Este artigo apresenta as características do Programa de Mobilidade Internacional de graduação da Universidade Federal de Minas Gerais denominado Minas Mundi. O referido programa propicia aos discentes experiências internacionais ao longo do ano letivo. Ele promove o intercâmbio científico e cultural entre a UFMG e mais de 100 (cem) instituições estrangeiras parceiras, localizadas em mais 30 (trinta) países proporcionando aos alunos de graduação da UFMG uma experiência acadêmica internacional, que integrará seu currículo e histórico escolar.Núcleo de Estudios e Investigaciones en Educación Superior del Mercosur - NUCLEO Grupo Interdisciplinar de Pesquisa em Educação na América Latina – EducAL/UNILA Instituto Mercosul de Estudos Avançados – IMEA/UNILA Pró-Reitoria de Relações Institucionais e Internacionais – PROINT/UNIL

Media mix modeling: a case study on optimizing television and digital media spend for a retailer

Project Work presented as the partial requirement for obtaining a Master's degree in Information Management, specialization in Marketing IntelligenceRetailers invest most of their advertising budget in traditional channels, namely Television, even though the percentage of budget allocated towards digital media has been increasing. Since the largest part of sales still happen in physical stores, marketers face the challenge of optimizing their media mix to maximize revenue. To address this challenge, media mix models were developed using the traditional modeling approach, based on linear regressions, with data from a retailer’s advertising campaign, specifically the online and offline investments per channel and online conversion metrics. The models were influenced by the selection bias regarding funnel effects, which was exacerbated by the use of the last-touch attribution model that tends to disproportionately skew marketer investment away from higher funnel channels to lower-funnel. Nonetheless, results from the models suggest that online channels were more effective in explaining the variance of the number of participations, which were a proxy to sales. To managers, this thesis highlights that there are factors specific to their own campaigns that influence the media mix models, which they must consider and, if possible, control for. One factor is the selection biases, such as ad targeting that may arise from using the paid search channel or remarketing tactics, seasonality or the purchase funnel effects bias that undermines the contribution of higher-funnel channels like TV, which generates awareness in the target audience. Therefore, companies should assess which of these biases might have a bigger influence on their results and design their models accordingly. Data limitations are the most common constraint for marketing mix modeling. In this case, we did not have access to sales and media spend historical data. Therefore, it was not possible to understand what the uplift in sales caused by the promotion was, as well as to verify the impact of the promotion on items that were eligible to participate in the promotion, versus the items that were not. Also, we were not able to reduce the bias from the paid search channel because we lacked the search query data necessary to control for it and improve the accuracy of the models. Moreover, this project is not the ultimate solution for the “company’s” marketing measurement challenges but rather informs its next initiatives. It describes the state of the art in marketing mix modeling, reveals the limitations of the models developed and suggests ways to improve future models. In turn, this is expected to provide more accurate marketing measurement, and as a result, a media budget allocation that improves business performance

Canalization and control in automata networks: body segmentation in Drosophila melanogaster

We present schema redescription as a methodology to characterize canalization in automata networks used to model biochemical regulation and signalling. In our formulation, canalization becomes synonymous with redundancy present in the logic of automata. This results in straightforward measures to quantify canalization in an automaton (micro-level), which is in turn integrated into a highly scalable framework to characterize the collective dynamics of large-scale automata networks (macro-level). This way, our approach provides a method to link micro- to macro-level dynamics -- a crux of complexity. Several new results ensue from this methodology: uncovering of dynamical modularity (modules in the dynamics rather than in the structure of networks), identification of minimal conditions and critical nodes to control the convergence to attractors, simulation of dynamical behaviour from incomplete information about initial conditions, and measures of macro-level canalization and robustness to perturbations. We exemplify our methodology with a well-known model of the intra- and inter cellular genetic regulation of body segmentation in Drosophila melanogaster. We use this model to show that our analysis does not contradict any previous findings. But we also obtain new knowledge about its behaviour: a better understanding of the size of its wild-type attractor basin (larger than previously thought), the identification of novel minimal conditions and critical nodes that control wild-type behaviour, and the resilience of these to stochastic interventions. Our methodology is applicable to any complex network that can be modelled using automata, but we focus on biochemical regulation and signalling, towards a better understanding of the (decentralized) control that orchestrates cellular activity -- with the ultimate goal of explaining how do cells and tissues 'compute'

Temporomandibular Joint Ankylosis in an Infant: A Rare Cause of Difficult Airway

1.Pre-assessment data of the patient A 2-year-old boy, weighing 15 kg was admitted with a history of limited mouth opening(inter-incisor distance of 6 mm), hypoplastic and retrognathic mandible (bird face deformity) and facial asymmetry from left temporomandibular joint ankylosis (TMJA). He was born at term, after an uneventful pregnancy, and there was no report of trauma during caesarean section. No other possible aetiologies were identified. He was scheduled for mandibular osteotomy. Preoperative ENT examination revealed adenotonsillar hypertrophy. 2. Anaesthetic Plan A fiberoptic nasal intubation was performed under deep inhalation anaesthesia with sevoflurane, with the patient breathing spontaneously. Midazolam (0.05 mg.kg-1) and alfentanil (0.03 mg.kg-1) were given and anaesthesia was maintained with O2/air and sevoflurane. No neuromuscular blocking agent was administered since the surgical team needed facial nerve monitoring. 3. Description of incident During surgery an accidental extubation occurred and an attempt was made to reintubate the trachea by direct laryngoscopy. Although the osteotomy was nearly completed, the vocal cords could not be visualized (Cormack-Lehane grade IV laryngoscopic view). 4. Solving the problem Re-intubation was finally accomplished with the flexible fiberscope and the procedure was concluded without any more incidents. Extubation was performed 24 hours postoperatively with the patient fully awake. After surgery mouth opening improved to inter-incisor gap of 15 mm. 5. Lessons learned and take home message Two airways issues present in this case can lead to difficultventilation and intubation: TMJA and adenotonsillar hypertrophy. These difficulties were anticipated and managed accordingly. The accidental extubation brought to our attention the fact that, even after surgical correction, this airway remains challenging. Even with intensive jaw stretchingexercises there is a high incidence of re-ankylosis, especially in younger patients. One should bear that in mind when anaesthetizing patients with TMJA