Anticoagulant induced spontaneous spinal epidural hematoma, conservative management or surgical intervention—A dilemma?

AbstractSpontaneous spinal epidural hematoma (SSEH) is a rare cause of cord compression. SSEH with neurological deficit is an emergency situation that is commonly considered an indication for emergency surgical decompression. We describe a patient with SSEH who recovered clinically and radiologically with conservative treatment. A 25-year-old hypertensive male presented with acute onset back pain followed by asymmetrical paraparesis. He had sensory level at D9 dermatome with preserved bladder and bowel functions. He was taking anticoagulants for deep venous thrombosis of the left lower limb. Surgery was deferred because of the deranged coagulation profile. He was managed conservatively with correction of coagulopathy. After 3 days, he recovered significantly. Repeat neuroimaging revealed significant resolution of epidural hematoma. The conservative approach can be considered for selected patients who are unsuitable for early surgical intervention, those with stable neurological status [American Spinal Injury Association (ASIA) Scale E], or those in whom early recovery of function has been initiated with ASIA Scale C or D. Neurological status at presentation and suitability for surgical intervention seem to be important determinants of the type of therapeutic intervention

Barriers to the adoption of industry 4.0 technologies in the manufacturing sector: An inter-country comparative perspective

This paper examines barriers to the implementation of Industry 4.0 technologies in the manufacturing sector in the context of both developed and developing economies. A comprehensive literature review, followed by discussions with industry experts, identifies 15 barriers, which are analyzed by means of a Grey Decision-Making Trial and Evaluation Laboratory (DEMATEL) approach. The ‘lack of a digital strategy alongside resource scarcity’ emerges as the most prominent barrier in both developed and developing economies. The influencing barriers identified suggest that improvements in standards and government regulation could facilitate the adoption of Industry 4.0 technologies in developing country case, whereas technological infrastructure is needed to promote the adoption of these technologies in developed country case. This study is one of the first to examine the implementation of Industry 4.0 in both developing and developed economies. This article highlights the difficulties in the diffusion of technological innovation resulting from a lack of coordinated national policies on Industry 4.0 in developing countries, which may prevent firms from fully experiencing the Industry 4.0 revolution. The results of this study may help decision makers and practitioners to address the barriers highlighted, paving the way for successful implementation of Industry 4.0 across the manufacturing sector

Assessment of Oral Health Status among Orphanage Children (Underprivileged Population): A Descriptive Cross-Sectional Study

INTRODUCTION: An orphan is a child under 18 year who has lost both parents or has been abandoned by them. Such children are deprived of the parental love and care and get little health care as well as their oral cavity is  generally neglected. AIM: To assess the dental caries experience, oral hygiene status and periodontal status among the orphanage children in Prakasam District, Andhra Pradesh, India. MATERIALS AND METHOD: A cross sectional study among 485 orphan children of various institutes ranged from 12 to 16 years where WHO oral health assessment form 2013 was used and chi- square test and descriptive statistics test  were used for statistical analysis by using SPSS 22.0 software. RESULTS: It was seen that 73.4% were having dental caries and  the mean DI-S scores, CI-S scores and OHI-S scores were 1.41 ±0.47,  1.07 ±0.47 and 2.48 ±0.92 respectively. The prevalence and severity of gingival bleeding was found to be more  i.e.64.7% among them. CONCLUSION: Majority of orphan children were suffering from oral problems. Oral health fraternity should actively involve with other parts of the community in order  to maintain oral care of this group