Retrospective subjective evaluation of aesthetic outcome in secondary cleft lip deformities operated with Abbe’s flap

Background:The Abbe’s flap is most commonly used to repair the full thickness defects of the lip that do not involve the commissure. The Abbe flap was first introduced to correct the secondary deformity of bilateral cleft lip. By this pedicled flap, we are able to equalize the disparity which existed between the tight upper lip and excessive lower lip. Aims to study retrospective subjective evaluation of aesthetic outcome in secondary cleft lip deformities operated with Abbe’s flap.Methods:29 patients operated during the period of January 2007 - December 2011 for correction of secondary cleft lip and nasal deformity with Abbe’s flap with or without rhinoplasty were included in our retrospective study. The secondary corrective surgeries were performed by a single surgeon. The photographs of the patients were retrospectively assessed by two plastic surgeons and one oral and maxillofacial surgeon, other than the one who performed the surgery. 29 patients operated during the period of January 2007 - December 2011 for correction of secondary cleft lip and nasal deformity with Abbe’s flap with or without rhinoplasty were included in our retrospective study. The secondary corrective surgeries were performed by a single surgeon. The photographs of the patients were retrospectively assessed by two plastic surgeons and one oral and maxillofacial surgeon, other than the one who performed the surgery.Results:Out of 29 patients with secondary cleft deformities 12 were male and 17 were female. Average follow up period was 3 years. Multiple variables of the nose and the lips were used to assess the aesthetic outcome of Abbe’s flap.Conclusion:As per the subjective retrospective analysis of our study we have come to the conclusion that Abbe’s flap is a work horse for correction of shortage of tissue for the secondary cleft lip deformities. Uniform satisfactory outcome was obtained with a more natural contour and more satisfactory proportion of both lips.

Significant association of MTHFD1 1958G>A single nucleotide polymorphism with nonsyndromic cleft lip and palate in Indian population

Objectives: Nonsyndromic cleft lip and palate (NSCLP) is genetically distinct from those with syndromic clefts, and accounts for ~70% of cases with Oral clefts. Folate, or vitamin B9, is an essential nutrient in our diet. Allelic variants in genes involved in the folate pathway might be expected to have an impact on risk of oral clefts. Given the key role of methylenetetrahydrofolate dehydrogenase 1 (MTHFD1) in folate metabolism, it would be of significant interest to assess its role in NSCLP etiology. Study Design: The present study aims at examining the association between MTHFD1 1958G>A polymorphism and NSCLP risk by conducting a case-control study in south Indian population. Our sample comprised of 142 cases with nonsyndromic clefts and 141 controls without clefts or family history of clefting. The MTHFD1 1958G>A polymorphism was genotyped using PCR-RFLP. Results: An increased risk was found for the heterozygous 1958GA (OR=2.44; P =0.020) and homozygous 1958AA (OR=2.45; P =0.012) genotypes in the children. When the dominant model (AG+AA vs GG) was applied the risk remained the same as co-dominant model, but the level of significance increased (OR=2.44; P =0.002). Conclusions: The results indicated the MTHFD1 1958G>A polymorphism to be one of the important genetic determinants of NSCLP risk in South Indian subjects

Aerosol optical properties and composition over a table top complex mining area in the Monsoon trough region

Aerosol physiochemical properties over a varied mining plateau region at the eastern end of a monsoon trough are reported for the first time and analyzed at different time scales. Aerosol optical depth (single scattering albedo, SSA) is found to be 0.49 (0.9) in pre-monsoon, 0.4 (0.94) in monsoon, 0.46 (0.92) in post-monsoon, and 0.36 (0.89) in winter, with an annual mean of 0.43 (0.91). The volume-size distribution is tri-modal, with 0.02 (ultra-fine), 0.2 (accumulation) and 7 (coarse) µm, but with seasonal signatures. The angstrom exponent (AE) varies along with the AOD, especially in winter, although they are inversely related to each other during monsoons; the increase in size may be due to the effect of humidity. AODbc varies between 13.4%–4.7% of the total aerosols, with the highest contribution in March, when forest burning in the north east is at its peak. BC is the lowest in July, the mid monsoon month with the minimum biomass burning and brick-kiln activities. It is likely that the interactions of various minerals and intermittent rains help keep the aerosol size in a mixed state with regard to the relation between AE and AOD, although more work is needed to confirm this. The chemical composition of aerosols is derived from an aerosol chemical model based on the measured amount of black carbon and the assumed components. These components are selected based on back trajectories and earlier reports from the region. Their concentrations are adjusted by constraining the model output AOD and SSA to match (±2% @ 500 nm) that observed by a sun-sky radiometer. The chemical compositions of the winter and post-monsoon months are similar, while pre-monsoon period has more coarse mode minerals, and the monsoon period has more sea-salt (accu.). The component mass concentrations were grouped into various size bins based on their modal radii, and the results indicate that PM1 is at its maximum in winter whereas PM2.5 is highest in the post-monsoon period. Monsoons leads to the effective washout of 2.5–10 µm sized particles

Aerosol optical properties and composition over a table top complex mining area in a monsoon trough region

Aerosol physiochemical properties over a varied mining plateau region at the eastern end of a monsoon trough are reported for the first time and analyzed at different time scales. Aerosol optical depth (single scattering albedo, SSA) is found to be 0.49 (0.9) in pre-monsoon, 0.4 (0.94) in monsoon, 0.46 (0.92) in post-monsoon, and 0.36 (0.89) in winter, with an annual mean of 0.43 (0.91). The volume-size distribution is tri-modal, with 0.02 (ultra-fine), 0.2 (accumulation) and 7 (coarse) µm, but with seasonal signatures. The angstrom exponent (AE) varies along with the AOD, especially in winter, although they are inversely related to each other during monsoons; the increase in size may be due to the effect of humidity. AODbc varies between 13.4%–4.7% of the total aerosols, with the highest contribution in March, when forest burning in the north east is at its peak. BC is the lowest in July, the mid monsoon month with the minimum biomass burning and brick-kiln activities. It is likely that the interactions of various minerals and intermittent rains help keep the aerosol size in a mixed state with regard to the relation between AE and AOD, although more work is needed to confirm this. The chemical composition of aerosols is derived from an aerosol chemical model based on the measured amount of black carbon and the assumed components

Best practices for the diagnosis and evaluation of infants with robin sequence:a clinical consensus report

Importance: Robin sequence (RS) is a congenital condition characterized by micrognathia, glossoptosis, and upper airway obstruction. Currently, no consensus exists regarding the diagnosis and evaluation of children with RS. An international, multidisciplinary consensus group was formed to begin to overcome this limitation. Objective: To report a consensus-derived set of best practices for the diagnosis and evaluation of infants with RS as a starting point for defining standards and management. Evidence Review: Based on a literature review and expert opinion, a clinical consensus report was generated. Findings: Because RS can occur as an isolated condition or as part of a syndrome or multiple-anomaly disorder, the diagnostic process for each newborn may differ. Micrognathia is hypothesized as the initiating event, but the diagnosis of micrognathia is subjective. Glossoptosis and upper airway compromise complete the primary characteristics of RS. It can be difficult to judge the severity of tongue base airway obstruction, and the possibility of multilevel obstruction exists. The initial assessment of the clinical features and severity of respiratory distress is important and has practical implications. Signs of upper airway obstruction can be intermittent and are more likely to be present when the infant is asleep. Therefore, sleep studies are recommended. Feeding problems are common and may be exacerbated by the presence of a cleft palate. The clinical features and their severity can vary widely and ultimately dictate the required investigations and treatments. Conclusions and Relevance: Agreed-on recommendations for the initial evaluation of RS and clinical descriptors are provided in this consensus report. Researchers and clinicians will ideally use uniform definitions and comparable assessments. Prospective studies and the standard application of validated assessments are needed to build an evidence base guiding standards of care for infants and children with RS

Physics Potential of the ICAL detector at the India-based Neutrino Observatory (INO)

The upcoming 50 kt magnetized iron calorimeter (ICAL) detector at the India-based Neutrino Observatory (INO) is designed to study the atmospheric neutrinos and antineutrinos separately over a wide range of energies and path lengths. The primary focus of this experiment is to explore the Earth matter effects by observing the energy and zenith angle dependence of the atmospheric neutrinos in the multi-GeV range. This study will be crucial to address some of the outstanding issues in neutrino oscillation physics, including the fundamental issue of neutrino mass hierarchy. In this document, we present the physics potential of the detector as obtained from realistic detector simulations. We describe the simulation framework, the neutrino interactions in the detector, and the expected response of the detector to particles traversing it. The ICAL detector can determine the energy and direction of the muons to a high precision, and in addition, its sensitivity to multi-GeV hadrons increases its physics reach substantially. Its charge identification capability, and hence its ability to distinguish neutrinos from antineutrinos, makes it an efficient detector for determining the neutrino mass hierarchy. In this report, we outline the analyses carried out for the determination of neutrino mass hierarchy and precision measurements of atmospheric neutrino mixing parameters at ICAL, and give the expected physics reach of the detector with 10 years of runtime. We also explore the potential of ICAL for probing new physics scenarios like CPT violation and the presence of magnetic monopoles.Comment: 139 pages, Physics White Paper of the ICAL (INO) Collaboration, Contents identical with the version published in Pramana - J. Physic

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries