Exploitation of mica deposits at Nellore mica belt, Andhra Pradesh, India

India is the leading producer of sheet mica and a major part of this is exported. Nellore mica belt is the largest mica-producing area covering part of Nellore district in Andhra Pradesh, India. As most of the mines are old and privately operated, they are developed and operated purely based on local experiences. In this article, we highlight the problems associated with the present mica-mining practices in the Nellore mica belt, and scientific approaches that have been adopted for fixing different parameters associated with mica extraction. Based on detailed field study, geo-mechanical data and tested rock properties, extensive numerical modelling is done to suggest the best possible method of mining for safe and sustainable mica extraction from the area

Interdisciplinary sequential management of combination traumatic dental injuries

Combination dental trauma or combination traumatic dental injuries (C-TDIs) are often seen with unique presentations. Although most guidelines address the evidence-based management of such injuries in detail, a sequential protocol and classifications for C-TDI are lacking. In these scenarios, clinical details with imaging tools play an essential role by helping the clinician apply the elements of the TDI protocol in the correct sequence. However, most cases of C-TDI are attended by a general dentist, who often finds it difficult to make such clinical decisions, adversely affecting the prognosis. This article reports a case of a 14-year-old male patient with avulsion of 12, intrusion of 11, 21, and 13, and uncomplicated crown fracture of 11, 21, and 14, with a sequential interdisciplinary approach for the management and long-term follow-up of 10 years

Management of difficult airway in intratracheal tumor surgery

BACKGROUND: Tracheal malignancies are usual victim of delay in diagnosis by virtue of their symptoms resembling asthma. Sometimes delayed diagnosis may lead to almost total airway obstruction. For difficult airways, not leaving any possibility of manipulation into neck region or endoscopic intervention, femorofemoral cardiopulmonary bypass can be a promising approach. CASE PRESENTATION: We are presenting a case of tracheal adenoid cystic carcinoma (cylindroma) occupying about 90% of the tracheal lumen. It was successfully managed by surgical excision of mass by sternotomy and tracheotomy under femorofemoral cardiopulmonary bypass (CPB). CONCLUSION: Any patient with recurrent respiratory symptoms should be evaluated by radiological and endoscopic means earlier to avoid delay in diagnosis of such conditions. Femorofemoral cardiopulmonary bypass is a relatively safe way of managing certain airway obstructions

Association of homocysteine and methylene tetrahydrofolate reductase (MTHFR C677T) gene polymorphism with coronary artery disease (CAD) in the population of North India

The implications of the methylene tetrahydrofolate reductase (MTHFR) gene and the level of homocysteine in the pathogenesis of coronary artery disease (CAD) have been extensively studied in various ethnic groups. Our aim was to discover the association of MTHFR (C677T) polymorphism and homocysteine level with CAD in north Indian subjects. The study group consisted of 329 angiographically proven CAD patients, and 331 age and sex matched healthy individuals as controls. MTHFR (C677T) gene polymorphism was detected based on the polymerase chain reaction and restriction digestion with HinfI. Total homocysteine plasma concentration was measured using immunoassay. T allele frequency was found to be significantly higher in patients than in the control group. We found significantly elevated levels of mean homocysteine in the patient group when compared to the control group (p = 0.00). Traditional risk factors such as diabetes, hypertension, smoking habits, a positive family history and lipid profiles (triglyceride, total cholesterol, HDL-cholesterol, LDL-cholesterol, VLDL-cholesterol), were found significantly associated through univariate analysis. Furthermore, multivariable logistics regression analysis revealed that CAD is significantly and variably associated with diabetes, hypertension, smoking, triglycerides and HDL-cholesterol. Our findings showed that MTHFR C677T polymorphism and homocysteine levels were associated with coronary artery disease in the selected population

Mitral regurgitation jet around neoannulus: Mitral valve replacement in erysipelothrix rhusiopathiae endocarditis

A 50-year-old male presented with erysipelothrix rhusiopathiae (ER) endocarditis of the mitral valve, severe mitral regurgitation, and heart failure. The ER endocarditis destroyed the native mitral annulus therefore a new annulus was created for the suspension of the mitral bioprosthesis. Postoperative neoannulus dehiscence and leak prompted to redo surgery where transesophageal echocardiography (TEE) played an important role in pointing out the exact location of perineoannular leaks for repair

Major vessel venous thrombosis in patients of posttubercular chronic constrictive pericarditis undergoing pericardectomy: A rare scenario

We are reporting two cases of neck and arm major venous thrombosis in patients of posttubercular chronic constrictive pericarditis posted for pericardectomy. There was unanticipated difficulty in placement of Internal Jugular vein catheter and subsequent ultrasound revealed thrombosis in the major veins. It was not diagnosed in the preoperative period. This report raises this major complication and highlights the use of ultrasound in such scenarios

Unknown left atrial appendage mass! real-time three-dimensional transesophageal echocardiography helps in identification

Left Atrial Appendage (LAA) is the most contractile part of Left atrium. It is also the most frequent place for thrombus formation that may lead to disastrous consequences. Complete trasoesophageal echocardiography examination always includes assessing LAA but sometimes unusually placed pectinate muscle, which is a normal structure may give baffling shadow that can only be interpreted correctly by Real time 3D echocardiography