Application of Case Studies to Practice in Foundation Engineering in India

India has massive developments, urbanization, housing, communication in last decade. The optimization of cost and saving construction time to complete, are now new aspects which geotechnical engineers are facing. Till today the typical design of shallow foundations of structure-buildings, fly over and dams on non-plastic silty fine sand subsoils found in alluvial deposits of state like Uttar Pradesh, Punjab, Gujarat, Bengal and long coastal belt, were designed by age old practice based on soil mechanics of 1948. Such proven practice became BIS codes for design and construction of structural foundations in 1976-81. The common sense and observational approach of Terzaghi (1959) did not confirm such interpretation of Standard Penetration (SP) test. SP test on non – plastic silty sand at 2 to 3 m below ground surface, being loose (Rd \u3c 15%), had permissible bearing capacity for 25 mm settlement (qa25) less than 100 kPa. This required almost double concrete in footings. Vast country with fast growth had more than million structures built/year, saving of RCC would be around 900 million cubic meter/year. The time reduced will be added advantage. Even up to 10m depth, at number of sites N recorded as 5 to 10 blows/30cm, was considered as “loose” to “medium” by the code indicating prima-facie high liquefaction potential under low seismic activity. This phobia did not spare proposed, under construction over years and existing structures from a long process of reinvestigations, consultants opinions and cost. High rise housing at Chennai, Delhi, Surat, monumental structures at Delhi, Agra, Ahmedabad, Kollkata, Panipat, Rajasthan suffered setback and perpetual suspense due to lack of proper interpretation. Some dams under construction like Ukai, Tenughat, barrages in West Bengal, Delhi, unique projects like Akshardham (Delhi) had to be stopped or delayed by suspected liquefaction. Long chain of opinions and additional tests like evaluation of Rd by alternative methods, rechecking of SPT values, blasting test as well as cross bore holes shear wave velocity tests had to be planned to remove notional interpretation. Study proposes to eliminate such decays & cost escalation by providing alternatives. Typical case studies, showing methodology are also illustrated. Authors with professionals (30 numbers) in geotechnical engineering practicing in India formed a TC-16 technical group (Year 2000-2005) to prepare a report on ground characterization by in-situ testing. The final recommendations for interpretation of SP test (N) and DCP test (NC) for non-plastic alluvial deposit, investigated as per IS code are presented in the form of a chart. It gives for observed N or NC at P0’ (effective overburden pressure) the relative density (Rd), ∅’ (angle of shear resistance), E (deformation modulus) and permissible bearing capacity for 40 mm permissible settlement. The chart also indicate likely liquefaction potential at depth for a = 0.1g for preliminary analysis. Typical case studies have been illustrated. The authors advocated bore holes to be supplemented by uncased DCPT adequate in number, to provide recommendation for an area (not point). If results are not satisfying commonsense, check by in-situ tests for Rd, plate load, even prototype test shall be used before resorting to rejection of site or adopting ground improvement. Any recommendation, for probable liquefaction for existing or under construction project, must be checked by proper reinvestigations and interpretation

Clinical profile of different type of tuberculosis in hospitalized children in tertiary care center

Background: Since the implementation of directly observed treatment short (DOTS) program, the prevalence, clinical profile, and risk factors of pulmonary and non-pulmonary tuberculosis (TB) necessitating hospitalization in pediatric patients are not evaluated extensively. Materials and Methods: We designed a prospective observational study to evaluate the clinical profile of different types of TB in hospitalized children <12 years old. Different types of TB in children hospitalized from 1st January 2013 to 30th June 2014 were recorded. Detailed clinical history, clinical examination findings, diagnostic methods, and treatment of these cases were analyzed by age groups and types of TB. Results: During the study period, 150 (2.8% of total admission) patientswith TB were admitted in our institute. 87 (58%) patients were <5 years old, and 92 (61.33%) children were male. 140 (93.33%) children were malnourished. The clinical profile of TB included neuro TB in 78 (37.32%), pulmonary in 67 (32.05), abdominal in 27 (12.91%), and disseminated in 27 (12.91%) patients. Less than half of children with neuro TB and disseminated TB were immunized with Bacillus calmette-guerin (BCG). Conclusion: Despite aggressive DOTS implementation, the prevalence of TB, particularly, non-pulmonary TB in children is quite alarming. All the variants of TB are prevalent in the children. The neuro TB and the pulmonary TB dominate in the hospitalized cases. Younger age, lack of protection of BCG vaccination, and malnutrition are the main risk factors in childhood TB

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

Percutaneous closure of patent ductus arteriosus via internal jugular vein in patient with interrupted inferior vena cava

Transcatheter closure of patent ductus arteriosus (PDA) using various occluders and coils via femoral vein is a well established therapeutic option. However, in patients with interrupted inferior vena cava (IVC) it is not feasible to close the PDA percutaneously using traditional methods. We present a nine-year-old girl with IVC interruption in whom percutaneous closure of PDA was successfully accomplished via the transjugular approach

Imaging features of double aortic arch shown by multidetector computed tomography angiography

We present a three-dimensional reconstructed image of vascular ring in a 2.5-month-old patient, which was obtained using multidetector computed tomography (MDCT). MDCT angiography made an accurate diagnosis of this life-threatening, but correctable, anomaly in an infant with a stridor, repeated respiratory infections and episodes of apnea

Clinico - diagnostic and therapeutic relevance of computed tomography scan of brain in children with partial seizures

Background: Therapeutic relevance of computed tomography (CT) in children with partial seizures is reported to be remarkably low (1-2%). However, in the developing countries where infections involving the nervous system are common, routine CT scan of brain may help in finding treatable causes of seizures. Objective: Aim of this study was to evaluate the significance of CT scan of brain in the management of children with partial seizures. Materials and Methods: Children with partial epilepsy, whose predominant seizure type was focal motor seizures, were included in the study. CT scan of brain was done in all children aged between 1 month and 12 years with partial seizures of unknown etiology prospectively. The clinical findings of these children were noted along with the CT findings. Results: Between August 2001 and July 2002, of the 200 children with seizure disorder 50 children who satisfied the inclusion criteria were included in the study. CT scan of brain was normal in 16 children (32%) and was abnormal in 34 children (68%). Twenty children (~60% of abnormal scan) had potentially correctable lesions: Tuberculoma ( n = 13), neurocysticercosis ( n = 3), and brain abscess ( n = 4). Five children had changes representing static pathology that did not influence patient management. The clinical features correlated with CT findings in 78% children. Conclusion: Children with partial motor seizures have high probability of having abnormal findings on CT scan of brain, especially, neuro-infections which are potentially treatable. Therefore, CT scan brain should be carried out in all children with partial motor seizures especially, in developing countries